Interventions For Young People Research Articles

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial.

Although clinical guidelines prioritize the treatment of depression and anxiety in young persons, there is accumulating evidence that the presence of symptoms of borderline personality disorder (BPD) is associated with the limited effectiveness of these standard treatments. These findings stress the need for interventions addressing early-stage BPD in young people with presenting symptoms of anxiety and depressive disorders. The aim of this study is to investigate the (cost-)effectiveness of an early intervention programme for BPD (MBT-early) compared to first-choice psychological treatment for depression and anxiety according to Dutch treatment guidelines (CBT), in adolescents with either depression, anxiety, or both, in combination with early-stage BPD. This study is a multi-centre randomized controlled trial. A total of 132 adolescents, presenting with either depression, anxiety, or both and significant BPD features will be randomized to either MBT-early or CBT. The severity of BPD, symptoms of depression and anxiety, personality, social and academic functioning, and quality of life will be assessed at baseline, end of treatment, and at 12-, 18-, and 24-month follow-up, along with medical costs and costs of productivity losses for cost-effectiveness analyses. This study will provide an empirical evaluation of the potential surplus value of early intervention in young people for whom treatment oriented at common mental disorders like anxiety and depression may be insufficient given their underlying personality problems. Netherlands Trial Register, NL9569. Registered on June 15, 2021.

Systematic review of tobacco smoking prevalence among young people in treatment for first-episode psychosis.

To determine whether smoking prevalence in first-episode psychosis (FEP) is different than in people with established psychosis in long-term treatment. A systematic review of cross-sectional, case-control and cohort studies identified from searches of PubMed, Embase, CINAHL and PsycINFO up to 12 August 2023. 20 studies out of 2773 screened titles were included. There was no clear pattern of smoking by diagnosis as smoking rates in people with FEP ranged from 43% to 78%, while in those with established psychosis, it ranged from 19% to 76%. The wide range of smoking levels in both populations precluded conclusions as to whether smoking rates are different between people with FEP and established psychosis suggesting that factors other than the time course of the illness influence smoking levels.

Evaluation of a psychoeducation group for children presenting with functional tic-like behaviours.

We describe the implementation and evaluation of an online psychoeducation group for young people experiencing functional tic-like behaviours (FTLBs) - a type of functional neurological disorder (FND). Across six groups, 50 participants completed pre- and post-group goal-based outcomes (GBOs) and 36 participants completed service-user feedback, which gathered qualitative and quantitative data about participants experiences of the group. Young people and their parents reported significant improvement in their GBOs following the group and increased knowledge and confidence in managing FTLBs. The findings highlight that virtual psychoeducation group intervention is an acceptable and effective first step in treatment of young people with FTLBs. We discuss implications for future intervention development.

Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people.

People of all ages are subject to involuntary psychiatric detention and treatment worldwide but there is current discussion about whether this complies with modern human rights law. The use of involuntary psychiatric hospitalisation among children and young people has largely eschewed research and policy interest to date. In this debate section, we hear from people with experience of child mental health services in the UK, USA and low- and middle-income countries about their views on the use of involuntary treatment in young people.

Challenging Notions of Children’s “Participation” in the Youth Justice System

Abstract A child’s right to participate in decision making is seminally proclaimed in Article 12, uncrc. Yet, it is often the case that the rhetoric associated with children’s “participation rights” does not reflect practice. Especially in the case of the youth justice system, significant challenges exist concerning both notions of the right to participate and how it translates into and influences what should be appropriate interventions for young people. This article draws upon three studies which critically examined the concept of participation and children’s decision making in pre-court and custody and resettlement settings. Listening to what young people said through these studies, reflections are offered concerning prevailing understandings and the operationalisation of “participation” within existing youth justice approaches. Additionally, consideration is afforded to barriers to effective participation in youth justice and the transformative potential that the right to participate in decision making offers those who come into conflict with the law.

Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review.

Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.

Digital adaptation of the Standing up for Myself intervention in young people and adults with intellectual disabilities: the STORM feasibility study.

Stigma contributes to the negative social conditions persons with intellectual disabilities are exposed to, and it needs tackling at multiple levels. Standing Up for Myself is a psychosocial group intervention designed to enable individuals with intellectual disabilities to discuss stigmatising encounters in a safe and supportive setting and to increase their self-efficacy in managing and resisting stigma. To adapt Standing Up for Myself to make it suitable as a digital intervention; to evaluate the feasibility and acceptability of Digital Standing Up for Myself and online administration of outcome measures in a pilot; to describe usual practice in the context of the coronavirus disease 2019 pandemic to inform future evaluation. Adaptation work followed by a single-arm pilot of intervention delivery. Four third and education sector organisations. Individuals with mild-to-moderate intellectual disabilities, aged 16+, members of existing groups, with access to digital platforms. Digital Standing Up for Myself intervention. Adapted from face-to-face Standing Up for Myself intervention, delivered over four weekly sessions, plus a 1-month follow-up session. Acceptability and feasibility of delivering Digital Standing Up for Myself and of collecting outcome and health economic measures at baseline and 3 months post baseline. Outcomes are mental well-being, self-esteem, self-efficacy in rejecting prejudice, reactions to discrimination and sense of social power. Adaptation to the intervention required changes to session duration, group size and number of videos; otherwise, the content remained largely the same. Guidance was aligned with digital delivery methods and a new group member booklet was produced. Twenty-two participants provided baseline data. The intervention was started by 21 participants (four groups), all of whom were retained at 3 months. Group facilitators reported delivering the intervention as feasible and suggested some refinements. Fidelity of the intervention was good, with over 90% of key components observed as implemented by facilitators. Both facilitators and group members reported the intervention to be acceptable. Group members reported subjective benefits, including increased confidence, pride and knowing how to deal with difficult situations. Digital collection of all outcome measures was feasible and acceptable, with data completeness ≥ 95% for all measures at both time points. Finally, a picture of usual practice has been developed as an intervention comparator for a future trial. The pilot sample was small. It remains unclear whether participants would be willing to be randomised to a treatment as usual arm or whether they could be retained for 12 months follow-up. The target number of groups and participants were recruited, and retention was good. It is feasible and acceptable for group facilitators with some training and supervision to deliver Digital Standing Up for Myself. Further optimisation of the intervention is warranted. To maximise the acceptability and reach of the intervention, a future trial could offer the adapted Digital Standing Up for Myself, potentially alongside the original face-to-face version of the intervention. This study was registered as ISRCTN16056848. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/149/03) and is published in full in Public Health Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

Ethical aspects of fertility-preserving treatment in young people with cancer

ZusammenfassungEigene Kinder zu bekommen und eine Familie zu gründen ist für viele Menschen ein wichtiger Aspekt eines guten Lebens. Die Einschränkung der Fertilität durch Krebstherapien kann für Patient*innen eine lebensgeschichtlich bedeutsame Belastung darstellen. Deshalb muss über die Möglichkeiten von fertilitätserhaltenden Maßnahmen (FEM) aufgeklärt werden. Die Entscheidung, ob diese durchgeführt werden sollen, findet in einer ohnehin belastenden Situation statt. Die Entscheidung über FEM wirft eine Reihe ethischer Fragen auf, derer sich Ärzt*innen bei der Aufklärung und Beratung bewusst sein müssen. In der Aufklärungs- und Entscheidungssituation werden Themen der Patient*innenautonomie, des Nicht-Schadens und der Gerechtigkeit verhandelt. Auch können Einstellungen zu Partnerschaft, Fragen des Kindeswohls und Alternativen zu FEM für die Entscheidung von Betroffenen wichtig sein. Der Artikel gibt einen Überblick über relevante ethische Fragen rund um fertilitätserhaltende Maßnahmen und wie damit umgegangen werden sollte.

A new way of Presbyopia Treatment in Young People (20-40) years by Physical Exercises of the Eye Muscles.

Examination of degree of vision for patient to determine presbyopia in young people before and after therapeutic exercises and to know the amount of improvement in each session after taking a history of the patient and identification of treatment methods according the prescription with the eye moving to all directions and push it forward to reduce pressure on the eye muscle about 20 mints during the exercises (1-6) session in order to stimulate the weak eye.
 The appearance of presbyopia among young people from new cases because concentration for long periods and for more than 4 hours using the modern devices, which caused the occurrence phenomenon among young people and need for reading glasses. All patients were treated of and improved in the degree of consideration each session with therapeutic exercises after identifying and moving the weak eye muscle and found the examination and do not need to use any glasses to read during the examination and get visual acuity (VA=6/6 or 6/9).

The effectiveness of mental health literacy interventions in young people: a meta-analysis

PurposeAdolescence and young adulthood are recognised as critical time for developing mental health literacy (MHL). The purpose of this study is to analyse the effectiveness of current MHL interventions to guide the future development of MHL intervention strategies.Design/methodology/approachA meta-analysis adopting the PRISMA framework for systematically reviewing the literature was adopted. Three authors independently reviewed studies and extrapolated key data for analysis. A robust random-effects model with adjustments for small study biases was conducted to establish the effect sizes of all included MHL interventions. Moderator analysis was conducted to examine the effects of intervention length in MHL.FindingsA total of 11 intervention studies were identified and analysed, resulting in a medium to large pooled effect size of 0.62 (95% CI: 0.28; 0.96). Moderator analysis found that short interventions had an estimated standard mean difference (SMD) effect size of 0.9220 (95% CI: −1.1555; 2.9995). This was greater than the medium length interventions, with an estimated SMD effect size of 0.4967 (95% CI: 0.0452; 0.9483), and long interventions, with an estimated SMD effect size of 0.5628 (95% CI: −0.2726; 1.3983). As a result, MHL interventions are proficient in improving young adults’ MHL, with shorter interventions (45–50 min) having the largest effect size. This study highlights several inconsistencies in methodological rigour and reporting from studies in this area, which future research should look to address.Originality/valueTo date, MHL review studies have often focused their attention on a specific domain, most notably education and school-based setting. To the best of the authors’ knowledge, no reviews have conducted a meta-analysis across contexts and domains with a specific focus on MHL intervention strategies for young adults.

The development and preliminary evaluation of Cognitive Behavioural Therapy (CBT) for Chronic Loneliness in Young People.

Approximately 10% of young people 'often' feel lonely, with loneliness being predictive of multiple physical and mental health problems. Research has found CBT to be effective for reducing loneliness in adults, but interventions for young people who report loneliness as their primary difficulty are lacking. CBT for Chronic Loneliness in Young People was developed as a modular intervention. This was evaluated in a single-case experimental design (SCED) with seven participants aged 11-18 years. The primary outcome was self-reported loneliness on the Three-Item Loneliness Scale. Secondary outcomes were self-reported loneliness on the UCLA-LS-3, and self- and parent-reported RCADS and SDQ impact scores. Feasibility and participant satisfaction were also assessed. At post-intervention, there was a 66.41% reduction in loneliness, with all seven participants reporting a significant reduction on the primary outcome measure (p < .001). There was also a reduction on the UCLA-LS-3 of a large effect (d = 1.53). Reductions of a large effect size were also found for parent-reported total RCADS (d = 2.19) and SDQ impact scores (d = 2.15) and self-reported total RCADS scores (d = 1.81), with a small reduction in self-reported SDQ impact scores (d = 0.41). Participants reported high levels of satisfaction, with the protocol being feasible and acceptable. We conclude that CBT for Chronic Loneliness in Young People may be an effective intervention for reducing loneliness and co-occurring mental health difficulties in young people. The intervention should now be evaluated further through a randomised controlled trial (RCT).

Adherence to treatment in young people with perinatal HIV infection in the first years after transition from pediatric to the adult medical service

Adherence to treatment in young people with perinatal HIV infection in the first years after transition from pediatric to the adult medical service

Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences.

There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.

Effect of Shi-Zhen-An-Shen herbal formula granule in the treatment of young people at ultra-high risk for psychosis: a pilot study.

To date, there is no conclusive evidence for early interventions on ultra-high risk (UHR) for psychosis. The Chinese herbal medicine is confirmed to be beneficial in improving psychiatric symptoms and cognitive impairments for schizophrenia patients. However, the effect of Chinese herbal medicine on treating UHR patients remains unknown. Eighty UHR patients were recruited from the outpatient department. They were randomly assigned to receive either Shi-Zhen-An-Shen herbal formula granule (SZAS-HFG) combined with aripiprazole placebo or aripiprazole combined with SZAS-HFG placebo for a 12-week treatment. The psychiatric symptoms were assessed using the Structured Interview for Prodromal Syndromes (SIPS). The Trail Making Test part A (TMT-A), Brief Visuospatial Memory Test (BVMT), Hopkins Verbal Learning Test (HVLT), and Continuous Performance Test (CPT) were used to assess cognitive functions. we also employed the Global Assessment of Functioning (GAF) to evaluate social functioning. The linear mixed-effects models were performed to detect the difference in effectiveness between the two groups. After 12-week treatment, both groups showed significant effects of time on SIPS, TMT-A, HVLT, BVMT, and GAF. There was a significant effect of group only on CPT. Moreover, we also found a significant interaction effect on GAF. SZAS-HFG can effectively alleviate psychosis symptoms, and improve cognitive impairments and overall functioning as well as aripiprazole.Clinical trial registration: Chinese Clinical Trial Registry, ChiCTR-IOR-17013513.

The Addition of Fish Oil to Cognitive Behavioral Case Management for Youth Depression: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial

BackgroundClinical trials suggest that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) may reduce depressive symptoms in adults with major depressive disorder. Therefore, n-3 PUFAs may be a potential treatment for depression in youth. MethodsParticipants were 15- to-25 year-old individuals with major depressive disorder who sought care in one of three government-funded mental health services for young people in metropolitan Melbourne, Perth, or Sydney, Australia. Participants were randomly assigned in a double-blind, parallel-arm design to receive either fish oil (840 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid) or placebo capsules as adjunct to cognitive behavioral case management. All participants were offered 50-minute cognitive behavioral case management sessions every 2 weeks delivered by qualified therapists (treatment as usual) at the study sites during the intervention period. The primary outcome was change in the interviewer-rated Quick Inventory of Depressive Symptomatology, Adolescent Version, score at 12 weeks. Erythrocyte n-3 PUFA levels were assessed pre-post intervention. ResultsA total of 233 young people were randomized to the treatment arms: 115 participants to the n-3 PUFA group and 118 to the placebo group. Mean change from baseline in the Quick Inventory of Depressive Symptomatology score was −5.8 in the n-3 PUFA group and −5.6 in the placebo group (mean difference, 0.2; 95% CI, −1.1 to 1.5; p = .75). Erythrocyte PUFA levels were not associated with depression severity at any time point. The incidence and severity of adverse events were similar in the two groups. ConclusionsThis placebo-controlled trial and biomarker analysis found no evidence to support the use of fish oil for treatment in young people with major depressive disorder.

EPS2.03 How can we achieve self-efficacy instead of helplessness caused by frequent medical interventions in young people with cystic fibrosis?

Children and adolescents with a chronic disease, such as Cystic Fibrosis (CF), will experience many and sometimes-unpleasant examinations. These interventions are often associated with fear and a high level of stress. Studies have found that children exposed to this kind of unexpected stress and fear, show a negative attitude towards the medical system and lower self-efficacy in future. In contrast, expected stress increases the ability to actively cope with stressful situations, thus improving self-efficacy of patients and resulting in better compliance.

Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in a Case of Ultra-High Risk for Psychosis With Emotional Comorbidity

This case study aims to describe the application of the Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders in the case of a 30-year-old patient with a diagnosis of Ultra-high Risk for Psychosis (UHR) and comorbid anxiety and depression. UP is a psychological intervention that uses cognitive-behavioral techniques whose objective is to reduce emotional dysregulation, which is one of the transdiagnostic mechanisms of emotional disorders. UP has demonstrated its efficacy in samples of patients with emotional disorders. Frank was a 30-year-old man diagnosed with UHR and other emotional disorders (major depressive disorder, bulimia nervosa, generalized anxiety disorder, and social anxiety disorder) who underwent the UP intervention in 15 group and online sessions, lasting 2 hours each, over the course of 4 months. At the 6-month follow-up evaluation, Frank presented significant improvement in all emotional and functioning variables: anxious and depressive symptoms, negative and positive affect, neuroticism and extraversion, emotional dysregulation, maladjustment, and quality of life. There was also a reduction in subthreshold psychotic symptoms. Frank no longer met the criteria for any emotional disorder. We also found an improvement trend, although not significant, in other variables such as insight and cognitive biases measured with specific questionnaires for psychosis. Frank attended all treatment and follow-up sessions and rated the program very positively. UP may be a clinically useful treatment for young people with comorbid UHR and emotional disorders in the early stages of mental health illnesses that could improve clinical and functional outcomes.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Proactive psychiatry of addiction: toward the normalization of early prevention

AbstractMost substance use disorders (SUDs) emerge in adolescence and young adulthood. Early interventions in young people may reduce the risk and severity of SUD and other mental disorders. However, we are not able to reach our young people early enough for prevention and treatment, and when we do, they often already show a high concentration of comorbid mental disorders and signs of a chronic intermittent course of SUD. Hence, we must reach our addicted young patients at an earlier stage, when symptoms are still mild or transient, or perhaps even before that – when they only show precursors of possible dysfunction.One of the most prominent precursors of dysfunction is our ability – or lack thereof – to control or "self-regulate" our behaviors, cognitions, and emotions. Many scientists argue that poor self-regulation is perhaps the core determinant of the development of mental health disorders, including addiction. Several prospective general population studies have shown that poor childhood self-control early in life is a strong predictor of many negative outcomes later in life, up to 20 to 30 years later in adulthood. Although correlational in nature, these findings suggest that early childhood interventions that are deliberately aimed at improving self-regulation may be effective in preventing these negative life outcomes, and that early prevention and intervention targeted at improving self-control may reduce the risk of a broad array of psychiatric and social problems, including addiction. Indeed, several recent large-scale systematic reviews have suggested that self-regulation skills are malleable and can be learned through instruction and practice, and perhaps most so in the early years, roughly around 3 to 6 years, when there is a steep increase in learning curve, when the plasticity of the brain is still high, and when self-regulation skills are still very much in development.This presentation provides an overview of the rationale and study findings of early prevention of substance use disorders and other mental health disorders. In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of early prevention at the pre- and elementary school level.Disclosure of InterestNone Declared

Physical activity as a promising alternative for young people with juvenile idiopathic arthritis: Towards an evidence-based prescription.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in young people. Although biologics now enable most children and adolescents with JIA to enjoy clinical remission, patients present lower physical activity and spend more time in sedentary behavior than their healthy counterparts. This impairment probably results from a physical deconditioning spiral initiated by joint pain, sustained by apprehension on the part of both the child and the child's parents, and entrenched by lowered physical capacities. This in turn may exacerbate disease activity and lead to unfavorable health outcomes including increased risks of metabolic and mental comorbidities. Over the past few decades, there has been growing interest in the health benefits of increased overall physical activity as well as exercise interventions in young people with JIA. However, we are still far from evidence-based physical activity and / or exercise prescription for this population. In this review, we give an overview of the available data supporting physical activity and / or exercise as a behavioral, non-pharmacological alternative to attenuate inflammation while also improving metabolism, disease symptoms, poor sleep, synchronization of circadian rhythms, mental health, and quality of life in JIA. Finally, we discuss clinical implications, identify gaps in knowledge, and outline a future research agenda.