Background Mental Health Problems Research Articles

Evidence for implementation of interventions to promote mental health in the workplace: a systematic scoping review protocol

BackgroundMental health problems are common in the working population and represent a growing concern internationally, with potential impacts on workers, organisations, workplace health and compensation authorities, labour markets and social policies. Workplace interventions that create workplaces supportive of mental health, promote mental health awareness, destigmatise mental illness and support those with mental disorders are likely to improve health and economical outcomes for employees and organisations. Identifying factors associated with successful implementation of these interventions can improve intervention quality and evaluation, and facilitate the uptake and expansion. Therefore, we aim to review research reporting on the implementation of mental health promotion interventions delivered in workplace settings, in order to increase understanding of factors influencing successful delivery.Methods and analysisA scoping review will be conducted incorporating a stepwise methodology to identify relevant literature reviews, primary research and grey literature. This review is registered with Research Registry (reviewregistry897). One reviewer will conduct the search to identify English language studies in the following electronic databases from 2008 through to July 1, 2020: Scopus, PROSPERO, Health Technology Assessments, PubMed, Campbell Collaboration, Joanna Briggs Library, PsycINFO, Web of Science Core Collection, CINAHL and Institute of Occupational Safety and Health (IOSH). Reference searching, Google Scholar, Grey Matters, IOSH and expert contacts will be used to identify grey literature. Two reviewers will screen title and abstracts, aiming for 95% agreement, and then independently screen full texts for inclusion. Two reviewers will assess methodological quality of included studies using the Mixed Methods Appraisal Tool and extract and synthesize data in line with the RE-AIM framework, Nielson and Randall’s model of organisational-level interventions and Moore’s sustainability criteria, if the data allows. We will recruit and consult with international experts in the field to ensure engagement, reach and relevance of the main findings.DiscussionThis will be the first systematic scoping review to identify and synthesise evidence of barriers and facilitators to implementing mental health promotion interventions in workplace settings. Our results will inform future evaluation studies and randomised controlled trials and highlight gaps in the evidence base.Systematic review registrationResearch Registry (reviewregistry897)

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BackgroundMental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question.MethodsThe study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents.ResultsImprovements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents.ConclusionsFindings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults

BackgroundMental health problems are common amongst adults with an Autism Spectrum Disorder (ASD). Stressful and traumatic life events can trigger or exacerbate symptoms of anxiety, depression and PTSD. In the general population, transdiagnostic processes such as suppression and perseverative thinking are associated with responses to trauma and mental health symptoms. AimsThis study explored the relationships between thought suppression, perseverative thinking and symptoms of depression, anxiety and PTSD in ASD adults who reported exposure to a range of DSM-5 and non-DSM-5 traumatic events. Methods59 ASD adults completed a series of online self-report questionnaires measuring trauma, transdiagnostic cognitive processes, and mental health symptoms. ResultsProbable PTSD rarely occurred in isolation and was associated with depression and anxiety symptoms in trauma-exposed ASD adults. All cognitive processes and mental health symptoms were positively associated with one another, regardless of whether the trauma met DSM-5 PTSD Criterion A. When accounting for both cognitive processes, only thought suppression significantly predicted PTSD and anxiety symptoms, while only perseverative thinking significantly predicted depression symptoms. Conclusions and implicationsThese preliminary results suggest that different cognitive processes more strongly affect anxiety/PTSD versus depression symptom severity in trauma-exposed ASD adults, although co-occurring symptoms are common. Implications for assessment, treatment and future research are discussed.

Mental health among university students: The associations of effort-reward imbalance and overcommitment with psychological distress

BackgroundMental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between “effort-reward imbalance” (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health. MethodsCross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI – Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses. Results78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2–32.5) and 22.2 (95% CI: 16.1–30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9–2.7) to 1.4 (95% CI: 1.2–1.7). LimitationsThis cross-sectional study was performed on a large, but convenient sample. DiscussionMore than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.

Lost in space - an exploration of help-seeking among young people with mental health problems: a constructivist grounded theory study

BackgroundMental health problems among young people is a worldwide public health concern. There has been an increase in mental health problems among young people in the Nordic countries in the last 25 years, particularly in Sweden. Despite this increase, international research has repeatedly shown that young people do not access or receive support when encountering mental health problems. The purpose of this study was to explore the process of help-seeking for professional support among young people with mental health problems.MethodsThe study used qualitative constructivist Grounded Theory and open-ended interviews. Thirteen young people between 15 and 23, recruited from two local support clinics, were interviewed.ResultsLost in space emerged as the core category, capturing aspects of both the experience of self and mental health problems as well as the process of seeking and acquiring help from professional support systems. The study identified several prominent barriers for seeking and acquiring professional help for mental health problems. The young people expressed a lack of knowledge on mental health issues and support services and substantial efforts were made to try to cope with problems on one’s own. Lost in space involved Drifting - trying to make sense of own experiences and struggling to cope with problems, Navigating - searching for help through multiple attempts and contacts and Docking - finding support with something/somebody that feels right.ConclusionsThe theoretical model sheds light on how young people with mental health problems were met with fragmented support services. Society needs to provide encompassing, youth-friendly and flexible support services, so that attempts at help-seeking are not missed.

Maternal psychological distress & mental health service use during the COVID-19 pandemic

BackgroundMental health problems are increasingly recognized as a significant and concerning secondary effect of the COVID-19 pandemic. Research on previous epidemics/pandemics suggest that families, particularly mothers, may be at increased risk, but this population has yet to be examined. The current study (1) described prevalence rates of maternal depressive and anxiety symptoms from an online convenience sample during the COVID-19 pandemic, (2) identified risk and protective factors for elevated symptoms, and (3) described current mental health service use and barriers. MethodsParticipants (N = 641) were mothers of children age 0–8 years, including expectant mothers. Mothers completed an online survey assessing mental health, sociodemographic information, and COVID-19-related variables. ResultsClinically-relevant depression was indicated in 33.16%, 42.55%, and 43.37% of mothers of children age 0–18 months, 18 months to 4 years, and 5 to 8 years, respectively. Prevalence of anxiety was 36.27%, 32.62%, and 29.59% for mothers across age groups, respectively. Binary logistic regressions indicated significant associations between risk factors and depression/anxiety across child age groups. LimitationsCross-sectional data was used to describe maternal mental health problems during COVID-19 limiting the ability to make inferences about the long-term impact of maternal depression and anxiety on family well-being. ConclusionsMaternal depression and anxiety appear to be elevated in the context of COVID-19 compared to previously reported population norms. Identified risk factors for depression and anxiety across different child age ranges can inform targeted early intervention strategies to prevent long-term impacts of the COVID-19 pandemic on family well-being and child development.

Assessing quality of life in psychosocial and mental health disorders in children: a comprehensive overview and appraisal of generic health related quality of life measures

BackgroundMental health problems often arise in childhood and adolescence and can have detrimental effects on people’s quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems.MethodsFirst, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree.ResultsThis review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health.ConclusionsWe found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).

The Strengths and Difficulties Questionnaire is a usable way to address mental health at well-child visits in general practice - a qualitative study of feasibility

BackgroundMental health problems is frequent among children and psychopathology in early childhood seems to predict mental disorders in adulthood. All Danish children are offered seven free well-child visits at their General Practitioner (GP) during their first 5 years of life. GPs have a unique position to address mental health problems at the well-child visits, but they lack a systematic approach when assessing children’s mental health. The purpose of this study was to investigate if the Strengths and Difficulties Questionnaire (SDQ) is a usable way to address preschool children’s mental health in general practice.MethodsA qualitative study of feasibility. Parents completed an online version of the SDQ at home. At the well-child visit, the GP used the SDQ results as a basis for a talk about the child’s mental health. Afterwards the author JS conducted semistructured interviews with both the parent and the GP over the phone. The interviews were descriptively analyzed using the Framework Approach.ResultsFive primary care centres with 22 general practitioners in both Copenhagen and Region Zealand participated. Twenty four parents completed the SDQ and were interviewed. Participating parents and GPs agreed, that the SDQ introduced mental health as a natural and important part of the well-child visit. Online access had clear advantages: time for reflection at home and preparation, plus a clear result summary for the GP. Some of the GPs were worried that the questionnaire would be too time consuming, and might compromise the individualistic style of general practice. Some parents were worried if children with minor problems would be diagnosed.ConclusionsThe online SDQ was well-accepted and feasible in daily practice. Implementing the SDQ into the well-child visit could strengthen the focus on the child’s mental health. However, before the SDQ can be generally implemented a guideline on how to utilize it in the well-child visit is needed, as well as studies of efficacy in this setting.Trial registrationNot relevant.

Leisure time physical activity and depressive symptoms among adolescents in Sweden

BackgroundMental health problems have increased noticeably among adolescents. Physical activity has been identified as an important factor in the promotion of mental health. The purpose of this study was to explore how leisure time physical activity was associated with depressive symptoms among adolescents in Sweden.MethodsUsing binary logistic regression we analyzed Swedish data collected as part of the Children of Immigrants: Longitudinal Survey in Four European Countries. The complete sample used for analysis consisted of 3787 adolescents (including 1855 boys and 1932 girls).ResultsAdolescents who participated in physical activity during their leisure time on a daily, weekly, or monthly basis had substantially lower odds of often feeling depressed than those who were physically inactive. This pattern applied to both boys and girls. Relative to boys, girls had significantly higher odds of often feeling depressed.ConclusionsThe findings of this study suggested that participation in physical activity regularly during leisure time was associated with a lower level of depressive symptoms among adolescents in Sweden. Because of the cross-sectional study design conclusions about causality cannot be drawn. Future research based on longitudinal data is needed to further explore the mechanisms behind the association. This study calls for recognition of the value of physical activity in promoting mental health among adolescents.

Exploring the identification, validation, and categorization of costs and benefits of education in mental health: The PECUNIA project

BackgroundMental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.ObjectivesThe aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.MethodsPreviously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.ResultsAdditional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.ConclusionBy providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.

Association between social capital and mental health among older people living with HIV: the Sichuan Older HIV-Infected Cohort Study (SOHICS)

BackgroundMental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China.MethodsThe study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥ 10) and probable anxiety (GAD-7 score ≥ 5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety.ResultsThe prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529), respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95% CI: 0.84–0.93, p < 0.001) and probable anxiety (OR: 0.90, 95% CI: 0.86–0.95, p < 0.001). The community/society level social capital was associated with probable depression (OR: 0.91, 95% CI: 0.84–0.99, p < 0.001) but not probable anxiety (p > 0.05).ConclusionsInterventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.

Associations between screen time, negative life events, and emotional and behavioral problems among Chinese children and adolescents

BackgroundMental health problems among children and adolescents are a pressing public health issue. This study aimed to investigate the associations between screen time (ST), negative life events (NLEs), and emotional and behavioral problems (EBPs) among Chinese children and adolescents. MethodsA total of 5959 boys and girls from 14 elementary and junior high schools of four cities in China were included in this study. EBPs were assessed by the Strengths and Difficulties Questionnaire (SDQ), NLEs were evaluated by the Adolescent Self-Rating Life Events Checklist (ASLEC), and ST data were obtained through self-reporting. Descriptive analyses, chi-squared tests, and logistic regression were performed using SPSS 23.0. ResultsThere were significant associations between ST/NLEs and EBPs. Participants with high exposure to ST or NLEs were more likely to have EBPs than those with low exposure to ST or NLEs. The simultaneous associations of ST and NLEs on EBPs were stronger than those of ST or NLEs, individually. LimitationsThis was a cross-sectional research study; therefore, it could not judge causality or direction. ST and NLEs were retrospective and might have recall biases. ConclusionsOur results showed positive associations between ST, NLEs, and EBPs. The results indicate that interventions should be considered to decrease ST and NLEs for children and adolescents.

The effects of martial arts participation on mental and psychosocial health outcomes: a randomised controlled trial of a secondary school-based mental health promotion program

BackgroundMental health problems are a significant social issue that have multiple consequences, including broad social and economic impacts. However, many individuals do not seek assistance for mental health problems. Limited research suggests martial arts training may be an efficacious sports-based mental health intervention that potentially provides an inexpensive alternative to psychological therapy. Unfortunately, the small number of relevant studies and other methodological problems lead to uncertainty regarding the validity and reliability of existing research. This study aims to examine the efficacy of a martial arts based therapeutic intervention to improve mental health outcomes.Methods/designThe study is a 10-week secondary school-based intervention and will be evaluated using a randomised controlled trial. Data will be collected at baseline, post-intervention, and 12-week follow-up. Power calculations indicate a maximum sample size of n = 293 is required. The target age range of participants is 11–14 years, who will be recruited from government and catholic secondary schools in New South Wales, Australia. The intervention will be delivered in a face-to-face group format onsite at participating schools and consists of 10 × 50–60 min sessions, once per week for 10 weeks. Quantitative outcomes will be measured using standardised psychometric instruments.DiscussionThe current study utilises a robust design and rigorous evaluation process to explore the intervention’s potential efficacy. As previous research examining the training effects of martial arts participation on mental health outcomes has not exhibited comparable scale or rigour, the findings of the study will provide valuable evidence regarding the efficacy of martial arts training to improve mental health outcomes.Trial registrationAustralian New Zealand Clinical Trials Register ACTRN12618001405202. Registered 21st August 2018.

The prevalence and impact of psychiatric comorbidity in inpatients admitted to a district general hospital in England: a 1-week cross-sectional study.

Mental health problems are amongst the most frequent health problems throughout life and they interfere deeply with physical wellbeing. This study investigated the prevalence and impact of psychiatric comorbidities in a general hospital in the National Health Service. A single-centre cross-sectional study of all inpatients during a 1-week period. The prevalence of psychiatric comorbidity was 11.8% in 2,444 inpatients. These patients had higher inpatient mortality (8.7 vs 3.3%; p < 0.001), 30-day readmission rates (24.7 vs 9.7%; p < 0.001), length of stay (mean 16.7 vs 5 days; p < 0.001), admission numbers (mean 1.3 vs 0.6; p < 0.001) and emergency department presentations in the year prior to their index admission (mean 2.3 vs 1.1; p < 0.001). A total of 86.2% were admitted via emergency medicine, with peaks on Saturdays and Tuesdays, in the afternoon and around midnight. This detailed account of psychiatric comorbidity in a general hospital shows a significant prevalence of mental health problems and its effect in a large general hospital serving a mixed urban and rural population in the UK.

The relationship between depression symptoms, absenteeism and presenteeism

BackgroundMental health problems are common within the working population. Depression is both highly prevalent and debilitating and is linked to increases in absenteeism and presenteeism. The use of summed depression scale scores may conceal differential impacts of depressive symptoms on absenteeism and presenteeism. We aimed to explore both the relationship between absenteeism and presenteeism and both depression severity, along with the independent contributions of different symptoms. MethodsParticipants (N = 4953) were employees recruited as part of a larger study to evaluate a mental health smartphone app and were recruited via industry partner organisations and social media. Participants completed in-app assessment which included demographic information, the Patient Health Questionnaire-9 depression tool, and items of the World Health Organization Health and Work Performance Questionnaire. The relationship between depressive symptoms, absenteeism and presenteeism was estimated using both total summed scores and individual symptoms of depression. ResultsUnivariate linear regression confirmed a negative linear relationship between depression severity and presenteeism, which remained significant after controlling for age, gender, industry, and work position. Similarly, there was a statistically significant relationship between depression severity and the amount of mental health related sickness absence taken over the preceding 28 days. Johnson's relative weights analysis showed contributory differences amongst depression symptoms in relation to presenteeism and absenteeism. DiscussionSignificant relationships between depression severity and both absenteeism and presenteeism were present indicating increases in absence and decreases in performance with increasing severity. There existed differences amongst the contribution of specific symptoms of depression to both outcomes of interest. The symptoms that contribute most to absence were more behavioural in nature, whilst those contributing most to presenteeism were more cognitive. These findings have practical implications for clinicians and employers in making treatment and return-to-work decisions.

Mental health in medical students: time to act.

Mental health problems are prevalent amongst medical students. However, many students delay seeking medical help or support from the medical school for a variety of reasons, including a fear of facing fitness to practice proceedings. Tackling this problem of awareness and delayed presentation will need a strong and dedicated focus at all stages, with prevention being of great importance. A conference dedicated to mental health and well-being was organised for students of all years. The first part of the conference centred on well-being dilemmas and the second part focused on discussing important issues in small group sessions. Students were divided into eight groups and each group suggested improvements to the course that they felt would improve mental health and well-being. The main suggestions raised were: reassurance that the disclosure of mental health problems would not automatically result in fitness to practice proceedings; separate academic and pastoral roles of tutors; open up the topic of mental health and well-being more frequently during the programme; improve knowledge about the availability of support services; and have mentors who are at an earlier stage in postgraduate training (e.g. junior doctors). It is necessary to tackle the prevalent myths about this topic. Many students are unaware of the support services available. This conference has therefore sought to increase awareness of the topic. An approach is also now needed to identify those who need extra help. The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference, for example. Many students are unaware of the support services available The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference ….

The appropriateness of psychotropic medicines: an interview study of service users attending a substance misuse service in England

Background Mental health problems are common in people with substance misuse problems. However, there is a paucity of evidence regarding prescribing of psychotropic medications for people with comorbid mental health and substance misuse problems. Objective To explore the views of service users attending an addiction service on the appropriateness of psychotropic medications prescribed for their co-existing mental health problems. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with twelve service users. Data were analysed using thematic framework analysis. Main outcome measure Service users’ views concerning the appropriateness of their prescribed psychotropic medications. Results The following themes captured service users’ views on the appropriateness of their medications: benefits from medicines, entitlement to medicines, and assessment and review. Service users mostly described benefits from their medications (including those prescribed outside guideline recommendations) and there was also an awareness of the adverse effects they experienced from them. It appears that people with substance misuse problems have a particularly strong sense of their own needs and seek to influence prescribing decisions. Service users further described varied practices regarding assessment and review of their medications with evidence of regular reviews while others identified suboptimal or inadequate practices. Conclusion Most service users described improved functioning as a result of their prescribed psychotropic medications. Prescriptions that are inappropriate in terms of their usual indications may well be justified if they assist in stabilising service users and moving them on to recovery.

\u201cIt is like a mind attack\u201d: stress and coping among urban school-going adolescents in India

BackgroundMental health problems are leading contributors to the global disease burden in adolescents. This study aims to highlight (1) salient context-specific factors that influence stress and coping among school-going adolescents across two urban sites in India; and (2) potential targets for preventing mental health difficulties.MethodsFocus group discussions were undertaken with a large sample of 191 school-going adolescent boys and girls aged 11–17 years (mean = 14 years), recruited from low- and middle-income communities in the predominantly urban states of Goa and Delhi. Framework analysis was used to identify themes related to causes of stress, stress reactions, impacts and coping strategies.ResultsProximal social environments (home, school, peers and neighborhood) played a major role in causing stress in adolescents’ daily lives. Salient social stressors included academic pressure, difficulties in romantic relationships, negotiating parental and peer influences, and exposure to violence and other threats to personal safety. Additionally, girls highlighted stress from having to conform to normative gender roles and in managing the risk of sexual harassment, especially in Delhi. Anger, rumination and loss of concentration were commonly experienced stress reactions. Adolescents primarily used emotion-focused coping strategies (e.g., distraction, escape-avoidance, emotional support seeking). Problem-focused coping (e.g., instrumental support seeking) was less common. Examples of harmful coping (e.g., substance use) were also reported.ConclusionsThe development of culturally sensitive and age-appropriate psychosocial interventions for distressed adolescents should attend to the challenges posed by home, school, peer and neighborhood environments. Enhancements to problem- and emotion-focused strategies are needed in order to bolster adolescents’ repertoire of adaptive coping skills in stressful social environments.

Association between parental visitation and depressive symptoms among institutionalized children in Japan: a cross-sectional study

BackgroundMental health problems are an important issue among institutionalized children. Although positive communication with parents is essential for children’s well-being, it has not been sufficiently verified how interactions with parents affect mental health among institutionalized children, who have experienced childhood adversity and likely lack secure attachment formation with their parents. The objectives of this study were to investigate the association between parental visitation and depressive symptoms among institutionalized children in Japan, and to explore whether the established security of attachment interacts with that association.MethodsA cross-sectional data from 399 institutionalized children aged 9 to 18 in Japan was used for the analysis. A mixed effects regression analysis was conducted to investigate the associations.ResultsInstitutionalized children who had parental visitation showed higher depressive symptoms than those who did not. In particular, father’s visitations were significantly associated with higher depressive symptoms. There was a significant interaction with score of secure attachment; children with low scores on secure attachment showed higher levels of depression with their father’s visitation, whereas children with high scores on secure attachment did not.ConclusionsFindings suggested that parental visitation and the frequency of visitation were not actually associated with better psychological status, but that instead, father’s visitations were associated with higher depressive symptoms among institutionalized children. It should be noted that our cross-sectional results cannot infer any causal relationship and do not emphasize that parental visitation should be avoided. However, it may be important to conduct careful assessment before starting parental visitation, especially when children seem to have problems with attachment formation.

The Prevalence of Mental Health Problems and the Associated Familial Factors in Adolescents in the South of Iran

Background Mental health problems are common among adolescents. Proper screening and rehabilitation could improve adolescents’ function at the present time and in the future. This study aimed to assess the prevalence of psychiatric disorders and the associated familial factors among high school students. Materials and Methods The present cross-sectional study was conducted on 630 high school students (315 boys and 315 girls) aged 13-17 years in Jahrom, Iran. The participants were selected using random cluster sampling. The data were collected using the self-report version of strength and difficulties questionnaire (SDQ), and were analyzed using the SPSS statistical software, version 16.0. Results: The results showed that 22.38% of the students had total difficulty (14.9% of boys, and 29.8% of girls). The highest prevalence was related to peer relationship problems (23%) followed by conduct problems (18.1%), hyperactivity (11.1%), pro-social behaviors (6.3%), and emotional problems (5.7%). The results of multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.68-3.66) increased the odds; while grade 9 (OR=0.52, 95% CI: 0.32-0.83), and number of siblings (OR: 0.88, 95% CI: 0.78-0.99) decreased the odds of mental health problems (p<0.05). Conclusion According to the results, the prevalence of behavioral disorders was relatively high among the students. The number of sibling, being girl and being in nine grade significantly contributed to the prevalence of behavioral disorders. In order to reduce these disorders, familial intervention and educational programs are recommended to be designed and implemented to prevent and treat behavioral disorders among students.