Levels Of Mental Health Problems Research Articles

Can a warm and supportive adult protect against mental health problems amongst children with experience of adversity? A twin-differences study.

Adverse childhood experiences (ACEs) are associated with mental health problems, but many children who experience ACEs do not develop such difficulties. A warm and supportive adult presence in childhood is associated with a lower likelihood of developing mental health problems after exposure to ACEs. However, it is unclear whether this association is causal, as previous research has not accounted for genetic and environmental confounding. We used the twin-difference design to strengthen causal inference about whether a warm and supportive adult presence protects children exposed to ACEs from mental health problems. Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a UK population-representative birth cohort of 2,232 same-sex twins. ACEs were measured prospectively from ages 5 to 12. Maternal warmth was assessed at ages 5 and 10 through maternal speech samples. Adult support was assessed through child reports at age 12. Mental health problems were assessed through interviews at age 12 with parents and teachers and participants at age 18. Among children exposed to ACEs, those who experienced greater maternal warmth and adult support had lower levels of mental health problems at ages 12 and 18. In monozygotic twin-difference analyses, the protective effects of maternal warmth and adult support on mental health were attenuated by 70% for maternal warmth and 81% for adult support, compared to phenotypic analyses. Twins who experienced greater maternal warmth and adult support had minimal or no difference in mental health compared to their co-twins, concordant for ACE exposure. The apparent protective effect of a warm, supportive adult against mental health problems following ACEs is largely explained by genetic and environmental confounding. This suggests that interventions which boost maternal warmth and adult support should be supplemented by components addressing wider family environments and heritable vulnerabilities in children exposed to adversity, to improve mental health.

Abstract Strengths and difficulties Lithuania

Abstract Background Most mental health disorders begin before the age of 18, peaking at 14.5 years (Solmi, 2022) and manifest as emotional and behavioural difficulties that are more frequent in institutional social care (ISC): former foster care recipients have higher rates of depression and PTSD than the general population (Pecora, 2009). The rate of children living in residential care facilities in Europe and Central Asia is double the global average (UNICEF, 2024). This study aims to assess and compare the mental health of children in ISC centers and regular high schools. Methods A cross-sectional study was conducted in ISC centres and high schools in 2022-2023. The sample size consisted of children aged 11-17 living in ISC (n = 49) or in families (n = 193). Online anonymous survey was applied to assess the prevalence of endured violence, substance use and measure mental health outcomes using the Strengths and Difficulties Questionnaire (SDQ-25). Results A total of 242 respondents (age mean 14.6, SD = 2.12) in ISC and families showed similar poor mental health rates (42% and 44%, respectively). Prosocial behaviour problems were exhibited more by boys (p < 0.05), whereas emotional symptoms were more common in families (p < 0.001): 90% normal SDQ-25 scores in ISC vs 60% in families. Enduring psychological (38% vs 60.2%) violence was more prevalent among children in families (p < 0.05); smoking - in ISC, alcohol use - in families (p < 0.05). In both groups enduring physical violence was associated with smoking and alcohol use (p < 0.05), and overall poor SDQ-25 results strongly correlated (p < 0.001, r = 0.815, r = 0.610, respectively) with hyperactivity. Conclusions A significant part of study participants reported poor mental health outcomes with most problems in relationships with peers. Mental health risk factors such as violence or substance abuse are associated with poor emotional wellbeing while being more common among children living with families. Key messages • Children living in ISC and in families demonstrate similar level of mental health problems. • Varying prevalence of substance abuse among children living in different settings highlights the importance of environmental factors when addressing the issue.

Close relationships with caregivers as protective factor for the mental health and functioning of war-affected Congolese youth

BackgroundSupportive social connections are a crucial determinant of the mental health and adjustment of youth in conflict-torn regions. Conflict-affected youth face particular risks to their well-being due to high levels of trauma exposure and perpetration of violent acts as members of armed groups and post-conflict discrimination. However, little is known about the possible protective role of close relationships with caregivers in the aftermath of trauma. This study examined whether a higher perceived quality of relationships with caregivers would attenuate the associations between exposure to traumatic experiences and four indicators of adjustment (posttraumatic stress symptoms [PTSS], emotional problems, behavioural problems, criminal behaviour) in a sample of 268 war-affected youth (61.2% male, Mage = 16.31 years) living in Bukavu, Democratic Republic of Congo. More than half of the present sample (56.7%) were former members of armed groups.MethodsData were collected using quantitative structured interviews and analyzed through regression models using the PROCESS macro.ResultsHigher cumulative trauma exposure was significantly related to higher levels of PTSS and emotional problems, while more frequent perpetration of war-related violence was significantly related to higher levels of PTSS, behavioural problems, and criminal behavior. The perceived quality of relationships with caregivers significantly moderated the associations between youth’s cumulative trauma exposure and all four outcomes. At higher perceived quality of relationships with caregivers, the associations between trauma exposure and emotional problems, behavioural problems, and criminal behaviour were no longer significant and the association with PTSS was significantly weakened. Higher perceived quality of relationships with caregivers was also directly significantly related to lower levels of mental health problems and criminal behaviour.ConclusionsThe findings suggest that interventions that focus on strengthening relationships with caregivers are crucial for supporting the mental health and functioning of youth who experienced and perpetrated war-related violence.

Trajectories of mental health problems in unaccompanied young refugees in Germany and the impact of post-migration factors - a longitudinal study.

Unaccompanied young refugees (UYRs) are at an elevated risk of continuing psychological distress, including posttraumatic stress symptoms (PTSS), depression, and anxiety. The post-arrival situation in a host country plays an important role in increasing or reducing mental health risks for UYRs. This study aimed to examine the trajectory of psychological distress and post-migration factors experienced by UYRs in Germany with five assessments every six months over a two-year period.Standardised self-report questionnaires were used to assess PTSS (CATS-2), depression (PHQ-9), and anxiety (GAD-7) symptoms. Material and social stressors (DSSYR), sociocultural adjustment (BSAS), frequency of contact with family members, and distress regarding asylum status were included as post-migration factors. N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.1% male) living in residential care facilities in Germany were included in this study. There was a significant loss to follow up with n = 77 after 12 months at T2 (59% attrition), and n = 37 after 24 months at T4 (28% attrition).At baseline, clinically relevant symptom scores were found in 48.1% for PTSS, 42.0% for depression, and 22.9% for anxiety. Analysis of latent growth curve models revealed that the symptom severity of depression and anxiety did not change substantially over one year, but PTSS showed a significant decline. The number of traumatic events affected initial levels of mental health problems but not their trajectory over time. The impact of post-migration factors varied between measurement points and outcome measures and did not result in a homogeneous pattern.Despite limitations, this study demonstrated the persistence of high levels of psychological distress in UYRs. Effective interventions are required at an early stage to prevent chronic trajectories and support systems should adapt to constantly changing circumstances.Trial registration number/date of registration: DRKS00017453/11th December 2019.

Teacher-Rated Mental Health of Siblings of Children with Chronic Disorders

AbstractSiblings of children with chronic disorders are at a heightened risk for internalizing and externalizing problems. Studies on sibling mental health typically use parent report, and sometimes sibling self-report, but do not include the perspectives of teachers. We investigated how teachers and parents in Norway rated sibling mental health to gain a more coherent picture of siblings’ well-being and functioning across the home and school contexts. We compared how siblings aged 8–16 years (45% boys, 54% girls) were scored on the strengths and difficulties questionnaire by teachers (n = 125), mothers (n = 115), and fathers (n = 81) with population norms and clinical cutoffs. For boys, the mean teacher scores did not indicate problems for total difficulties or any subscale except hyperactivity–inattention, but mean parent scores were higher for total difficulties and most subscales (d = .44 to .96). For girls, teachers indicated higher than norm scores for total difficulties, emotional problems, hyperactivity–inattention and peer problems (d = .26 to .46), while parents indicated higher total difficulties and problems across most subscales (d = .31 to .54). Prosocial behavior was as a relative strength of siblings across all raters. Siblings may not display the same level of mental health problems in school as at home, and teachers can offer an important perspective on siblings’ mental health and functioning.

Concurrent Use of Tobacco and Cannabis and Internalizing and Externalizing Problems in US Youths

Little is known about whether concurrent use of tobacco and cannabis is associated with higher or lower levels of mental health problems than use of either substance alone among youths. To examine the association between concurrent use of tobacco and cannabis and mental health problems in a national sample of US youths. This cross-sectional study analyzed publicly available wave 6 data within the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study of US youths aged 14 to 17 years, collected from March to November 2021. This analysis used wave 6 single-wave weights to obtain statistically valid estimates for cross-sectional analyses generalizable to the wave 4 cohort sample. Data were analyzed from November 15, 2023, to April 20, 2024. Past 30-day use of any tobacco and cannabis products was self-reported and categorized into 4 exclusive patterns: concurrent, tobacco only, cannabis only, and nonuse. Self-reported past-year internalizing and externalizing mental health problems were measured using the modified version of the Global Appraisal of Individual Needs-Short Screener and separately categorized into 3 levels: low (0-1 symptoms), moderate (2-3 symptoms), and high (≥4 symptoms). A total of 5585 youths were included in the study, with a weighted proportion of 51.3% being male and 72.5% aged 15 to 17 years. In terms of race and ethnicity, 1606 youths (25.7%) were Hispanic, 626 (12.7%) were non-Hispanic Black, 2481 (50.5%) were non-Hispanic White, and 555 (11.0%) were non-Hispanic other. The prevalence of concurrent use (3.4% [95% CI, 2.9%-4.0%]) was comparable to tobacco-only use (3.9% [95% CI, 3.2%-4.6%]), but greater than cannabis-only use (2.5% [95% CI, 2.1%-2.9%]). High levels of internalizing and externalizing problems were most common for the concurrent use group (internalizing: 47.4% [95% CI, 39.2%-55.9%]; externalizing: 61.6% [95% CI, 54.1%-68.7%]), followed by the cannabis-only use group (internalizing: 44.8% [95% CI, 35.7%-54.1%]; externalizing: 48.5% [95% CI, 39.1%-57.9%]), the tobacco-only use group (internalizing: 41.4% [95% CI, 33.7%-49.5%]; externalizing: 46.3% [95% CI, 38.3%-54.5%]), and the nonuse group (internalizing: 22.4% [95% CI, 21.1%-23.8%]; externalizing: 30.4% [95% CI, 28.9%-31.9%]). After controlling for covariates in ordinal logistic regression models, concurrent use of tobacco and cannabis was associated with greater odds of reporting higher levels of externalizing problems compared with tobacco-only use (adjusted odds ratio [AOR], 1.83 [95% CI, 1.15-2.91]) and cannabis-only use (AOR, 1.85 [95% CI, 1.11-3.06]). However, there were no statistically significant differences in the odds of internalizing problems between concurrent use and use of tobacco or cannabis alone. In this cross-sectional study of the PATH Study wave 6 youth data, concurrent use of tobacco and cannabis was linked to higher levels of externalizing mental health problems than use of single substances, indicating a potential need to combine mental health support with tobacco and cannabis cessation interventions for youths.

Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

High levels of mental health problems among young people were reported during the COVID-19 pandemic, but studies of the post-pandemic period are scarce. We assessed mental health problems among Finnish youth before, during, and after the COVID-19 pandemic using nationwide population-based samples. Our aim was to examine in which direction the heightened levels of adolescent mental health problems have developed after the pandemic. In this national, repeated cross-sectional, population-based study in Finland, we recruited students at lower and upper secondary level (aged 13-20 years) who were taking part in the Finnish School Health Promotion (SHP) survey in 2015-23 (119 681-158 897 participants per round). The SHP is based on total sampling and conducted biennially between March and May. Self-reports covered the seven-item Generalized Anxiety Disorder Scale; the two-item Patient Health Questionnaire for depression; the Mini Social Phobia Inventory for social anxiety; the Short Warwick-Edinburgh Mental Wellbeing Scale for mental wellbeing; loneliness; the Sick, Control, One Stone, Fat, Food measure for disordered eating; and suicidality (suicidal ideation, deliberate self-harm, and suicide attempts). Scales were dichotomised using validated cutoffs. Presence of any and comorbid mental health problems was assessed. Logistic (for dichotomised outcomes) and linear (for Short Warwick-Edinburgh Mental Wellbeing Scale) mixed effects models were used to analyse the effect of survey year on mental health, controlling for sociodemographic background factors and stratified by gender and school level. Cisgender and transgender youth were compared. Between 2015 and 2023, the SHP study recruited 722 488 students (371 634 [51·6%] girls and 348 857 [48·4%] boys) with a mean age of 15·8 years (SD 1·3) who were either in the eighth and ninth grades of comprehensive school or the first and second years of general and vocational upper secondary schools in Finland. The proportion of participants with generalised anxiety, depression, and social anxiety symptoms above the cutoff increased from pre-COVID-19 levels to 2021 and remained at these higher levels in 2023 among all study groups. Among girls in lower secondary education, prevalence of generalised anxiety, depression, and social anxiety symptoms increased from 2021 to 2023, as did social anxiety among girls in upper secondary education. Among boys, the proportion with social anxiety symptoms decreased between 2021 and 2023. Mental wellbeing scores decreased in all groups between 2021 and 2023, and disordered eating increased in girls, and in boys in lower secondary education. Suicidality increased in girls but not in boys. Loneliness was the only measure to show improvement in all groups from 2021 to 2023. In 2023, 55 895 (72·6%) of 76 994 girls and 22 718 (32·8%) of 69 205 boys reported at least one mental health problem, and 37 250 (48·4%) girls and 9442 (13·6%) boys reported comorbid mental health problems. Among both transfeminine and transmasculine youth, the prevalence of generalised anxiety and depression symptoms decreased from 2021 to 2023, but compared with cisgender youth, the proportions were significantly higher throughout. The effects of the COVID-19 pandemic on youth mental health could be long lasting. In this study, the substantial change for the better among transgender youth was a positive exception. Providing adequate support and treatment for young people with poor mental health is essential, but solutions to the mental health crisis need to address a wider societal perspective and should be developed in partnership with young people. NordForsk, Research Council of Finland. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Mental health, negative life events and resilience among adolescents in contact with the child welfare services

Adolescents in contact with the child welfare services (CWS) are at increased risk of experiencing negative life events (NLE) and mental health problems compared to the general population. There is, however, limited knowledge of whether protective factors can promote resilience in the CWS population in the context of NLE. Data stem from the population-based youth@hordaland study conducted in 2012, comprising 9492 adolescents aged 16–19 years. In total, 283 youth confirmed contact with the CWS and were categorized as receiving in-home services (IHS; n = 138) or living in foster care (FC; n = 145). The youth provided self-report information on NLE, mental health problems and protective factors. The IHS- and FC groups reported significantly more NLE, mental health problems and fewer protective factors compared to the general population. Adolescents receiving IHS consistently reported the most problems compared to the general population. Approximately 30 % of the association between contact with the CWS and mental health problems was mediated by NLE. Further, higher scores on the protective factors predicted lower levels of mental health problems, independent of the number of experienced NLE. Small interaction effects were found for the protective factors Goal Orientation and Family Cohesion and NLE. The results highlight that protective factors can buffer against mental health problems among adolescents receiving CWS interventions. More research is needed to further disentangle the mechanisms leading to better outcomes in this high-risk group of adolescents.

Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review

ABSTRACT Teachers who work with students with disabilities may have high levels of mental health problems, such as burnout or stress. The aim of this systematic review was to summarise the evidence on mental health outcome assessments among teachers of students with disabilities in different work spaces and to compare the levels of burnout and stress among teachers from general/regular versus special schools. The results reveal high levels of symptoms of burnout or stress in teachers of students with disabilities, regardless of the type of school. Due to the heterogeneity and low quality observed across the studies, evidence remains unclear.

Social media addiction: associations with attachment style, mental distress, and personality.

Social media bring not only benefits but also downsides, such as addictive behavior. While an ambivalent closed insecure attachment style has been prominently linked with internet and smartphone addiction, a similar analysis for social media addiction is still pending. This study aims to explore social media addiction, focusing on variations in attachment style, mental distress, and personality between students with and without problematic social media use. Additionally, it investigates whether a specific attachment style is connected to social media addiction. Data were collected from 571 college students (mean age = 23.61, SD = 5.00, 65.5% female; response rate = 20.06%) via an online survey administered to all enrolled students of Sigmund Freud PrivatUniversity Vienna. The Bergen Social Media Addiction Scale (BSMAS) differentiated between students addicted and not addicted to social media. Attachment style was gauged using the Bielefeld Partnership Expectations Questionnaire (BFPE), mental distress by the Brief Symptom Inventory (BSI-18), and personality by the Big Five Inventory (BFI-10). Of the total sample, 22.7% of students were identified as addicted to social media. For personality, it was demonstrated that socially media addicted (SMA) students reported significantly higher values on the neuroticism dimension compared to not socially media addicted (NSMA) students. SMA also scored higher across all mental health dimensions-depressiveness, anxiety, and somatization. SMA more frequently exhibited an insecure attachment style than NSMA, specifically, an ambivalent closed attachment style. A two-step cluster analysis validated the initial findings, uncovering three clusters: (1) secure attachment, primarily linked with fewer occurrences of social media addiction and a lower incidence of mental health problems; (2) ambivalent closed attachment, generally associated with a higher rate of social media addiction and increased levels of mental health problems; and (3) ambivalent clingy attachment, manifesting a medium prevalence of social media addiction and a relatively equitable mental health profile. The outcomes are aligned with previous research on internet and smartphone addiction, pointing out the relevance of an ambivalent closed attachment style in all three contexts. Therapeutic interventions for social media addiction should be developed and implemented considering these findings.

The Impacts of Visible Green Spaces on the Mental well-being of University Students

The benefits of green spaces on individuals’ health have been widely acknowledged due to their inherent natural qualities. Currently, university students are experiencing significantly higher levels of mental health problems than other social groups. There is a scarcity of studies examining the association between built environment factors and mental health issues among university students, particularly in the Chinese context. University campuses in China are physically isolated, secluded communities, and in this respect, they differ markedly from the spatial organisation patterns of Western universities. Therefore, this study focuses on the correlation between the extent of green space exposure within closed university campuses and the occurrence of mental health issues among resident students. A deep-learning methodology incorporating streetscape images, remote sensing data, and multilevel linear modelling is employed in order to facilitate a comprehensive analysis. The results demonstrate a negative correlation between green space exposure on campus and the level of mental health issues among university students. Individual socio-demographic characteristics, such as whether a person has a partner, are also found to influence the level of mental health issues that they experience. In addition, a significant relationship is found between travel patterns and mental health issues, with students who walked regularly having a lower incidence of mental health issues than those who drove. Our research indicates that, in order to foster healthier communities and enhance social inclusion, urban planners should prioritise the development of greener campuses and urban transport services to improve accessibility to green spaces.

Trajectories and latent classes of school enjoyment in adolescence: Associations with peer victimization and mental health.

School enjoyment, as a measure of how much adolescents enjoy or value their school experience, has been extensively studied in Western cultures. However, our knowledge of school enjoyment, and particularly its changes and trajectories among adolescents living in non-Western cultures, is limited. The present study used 3-year longitudinal data to examine changes and trajectories in school enjoyment and their associations with social and relational factors, such as mental health problems and peer victimization, among Japanese middle school students. Participants were 281 Japanese students from two public middle schools (Time 1 Mage = 12.72, SD = .45, 50% female). Data included five time points at 6-month intervals (Grades 7-9). The growth curve model showed quadratic changes in school enjoyment overall; the mean of school enjoyment was relatively stable in Grades 7 and 8 but increased rapidly in Grade 9. In terms of individual differences in trajectories of school enjoyment, growth mixture modeling identified three distinct groups (i.e., groups of 44.8% increasing, 9.8% decreasing, and 45.4% stable). Compared to students in the other groups, students in the increasing group initially reported lower levels of mental health problems and experienced less relational and overt victimization. In contrast, the decreasing group reported higher levels of mental health problems and experienced more relational and overt victimization than the increasing group. The results inform us about the most adaptive group, which continued to show high levels of school enjoyment, and the most maladaptive group, which initially had lower levels of school enjoyment and decreased their levels over time. The latter group of students is at risk and requires immediate intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

“I Learned to Bottle Up My Feelings From a Young Age”: A Narrative Analysis of Latina Young People’s Family Mental Health Socialization

Latina young people report high levels of mental health problems and low levels of help-seeking compared with their white peers, but little research has examined factors influencing their mental health views. Inductive analysis of 25 participants’ narratives revealed that Latina young people described three stages in the development of their mental health-related beliefs, attitudes, and behaviors: undergoing a process of family mental health socialization, suffering in silence, and attaining a new perspective. Within each of these phases, participants shared stories that attest to their agency and resilience. This research uncovers a novel theoretical construct, “family mental health socialization,” which elucidates how young people internalize mental health-related beliefs, behaviors, and norms within their cultural and family context. Implications for social work practice include the need for culturally sensitive, family-centered interventions that promote open communication about mental health.

Norwegian Adolescents in the Initial Stages of COVID-19 Restrictions

Abstract: In response to the COVID-19 pandemic outbreak in March 2020, the Norwegian government closed schools and limited leisure activities. In this cross-sectional study, we examined how different types of digital versus in-person social interactions and digital media use were associated with loneliness and mental health problems among adolescents during the initial COVID-19 lockdown. Participants ( N = 703, 79.7% girls , Mage = 17.3 years) completed a questionnaire assessing loneliness, mental health problems, digital media use, and in-person interactions. Both in-person and digital social interaction (texting) with friends were negatively associated with adolescents’ mental health problems and loneliness. By contrast, time spent alone on screen and on social media was positively related to mental health problems. The findings highlight that during the first weeks of the pandemic and of social distancing, increased interactions (either in-person or digital) among adolescents and their friends coincided with lower levels of mental health problems and less loneliness.

English

In the years following the COVID-19 pandemic, children and adolescents around the world continue to experience unprecedented levels of mental health problems. Governments’ failures to protect children from the development of mental health problems, and to treat and mitigate the effects of mental health problems after onset, violates children’s fundamental human rights under Articles 24 and 39 of the United Nations Convention on the Rights of the Child (CRC). As child and youth mental health has become a global health priority, the global accountability systems embedded in the CRC present opportunities to hold governments accountable for their obligations to children and to promote holistic health by improving the conditions of the environments that children are raised in. This paper presents avenues for child mental health promotion through the human rights and policy framework and pays particular attention to the Canadian context.

College Student Mental Health and Wellbeing Prior to and during the COVID-19 Pandemic

Student mental health was a growing concern globally prior to the onset of the COVID-19 pandemic. The aim of this study was to assess the impact of the pandemic and associated restrictions on the psychological wellbeing of college students. Baseline data were collected pre-pandemic in September 2019 among students attending a university in Northern Ireland and an Institute of Technology in the Republic of Ireland. Surveys were also conducted with this cohort during the pandemic, at the start of the academic years 2020 and 2021 (499 students fully completed all three waves). A follow-up survey was conducted at the end of their third year, in summer 2022 (n = 229). High levels of mental health problems were already present among students commencing college. The subsequent pandemic had a very negative impact on student’s academic experience and other aspects of life. Rates of depression (PHQ-9) increased significantly from the onset of the pandemic and remained high. Anxiety (GAD-7) initially decreased but then escalated at the end of college. The study highlights the importance of early intervention and makes recommendations for addressing the needs of students during times of stress. Additional supports may be required to deal with the long-lasting impact of the pandemic.

Time trends in the prevalence of depressive disorder symptoms in the Danish workforce, 2012 to 2018

Abstract Background Over the last decade, and well-before the COVID-19 pandemic, the prevalence of mental health problems has increased in many European countries, particularly in youth, raising public health concerns. Yet, there has been little focus on the mental health status of the working population, and it is unknown if the proportion of workers with impaired mental health is growing as well. In this paper, we report change in the prevalence of depressive disorder in a large nationwide sample of the Danish workforce (N = 76,802) from 2012 to 2018. Methods We used data from the Work Environment and Health in Denmark study, a bi-annual nationwide survey on working conditions and health. We measured depressive symptoms using the Major Depression Inventory and defined prevalence of depressive disorder by a score ≥21, in accordance with previous clinical validation studies. Using a log-binomial regression model, we estimated change in prevalence of depressive disorders from 2012 to 2018 with 95% confidence intervals (95% CI). Results From 2012 to 2018, the prevalence of depressive disorder increased from 7.0% (95% CI: 6.7-7.4) to 9.4% (9.0-9.9) corresponding to an adjusted increase of 36.1% (27.4-45.4) over the 6-year period. We observed a statistically significant increase in the prevalence in every wave, from 2012 to 2014 (adjusted change in prevalence: 10.8%, 3.2-18.9), from 2014 to 2016 (8.6%, 1.3-16.4)), and from 2016 to 2018 (13.1%, 6.0-20.7)). The increase occurred in both sexes, all age groups and for all types of occupational status, but was more pronounced among women, younger workers and workers of low occupational status. Conclusions In a large nationwide sample of the Danish workforce, we observed an increasing prevalence of depressive disorder from 2012 to 2018. The results indicate that the general trend towards increased levels of mental health problems also encompasses the workforce and underlines the need for public health action. Key messages • The prevalence of depressive disorder in the Danish workforce increased considerably from 2012 to 2018. • The increase in prevalence of depressive disorder was observed in all groups, but was particularly pronounced for women, younger workers and basic-skilled workers.

Urban biodiversity and adolescent mental health and well-being

Biodiversity may play a role in the mental health and well-being of people living in urban areas, but there is limited research on this. We investigated the association between proximity to Sites of Importance for Nature Conservation (SINCs) and mental health and well-being in 10- to 15-year-old adolescents living in London. SINCs are a key component of London's biodiversity and designated for their importance for the local habitat. We hypothesised that close proximity to a SINC (i.e., living within 1000 m from a SINC) would be a proxy for good access to it, which, in turn, would be associated with lower levels of mental health problems, and higher levels of self-esteem and happiness. In linear regression models, adjusted for individual and neighbourhood confounders, we did not find evidence to support our hypothesis. We discuss possible explanations for our null findings (e.g., definitions of biodiversity and access, and low statistical power) and highlight that, from our findings, we cannot infer that there is no association and that further research is needed.

Mental health problems associated with idiopathic anaphylaxis

BackgroundIdiopathic Anaphylaxis (IA) is the most common anaphylactic syndrome in adults. Mental health problems associated with IA are not well recognised. We aimed to assess if patients diagnosed with IA were more likely to experience mental health problems compared to a normative Australian population. We additionally hypothesised that the number of anaphylactic episodes would correlate with symptoms of anxiety.MethodsA total of 34 patients with at least one episode of IA were recruited from an adult immunology clinic. Patients were recruited as part of a separate study evaluating alternative aetiologies in IA. Mental health problems were measured using the Depression, Anxiety and Stress Scale (DASS-21). An extension of the survey included questions specifically focused on the psychological impact of IA.ResultsCompared to population norms, those with IA had significantly higher levels of mental health problems. Statistically significant DASS-21 scores were identified for depression 4.24 vs. 2.57 (p < 0.001), anxiety 4.76 vs. 1.74 (p < 0.012), stress 7.35 vs. 3.95 (p < 0.001) and total score 16.35 vs. 8.00 (p < 0.001). There was no association between two or more episodes of anaphylaxis and increased anxiety levels (β = 0.52, CI -2.59–3.62, p = 0.74).ConclusionsThis is the first paper to demonstrate that patients living with idiopathic anaphylaxis are more symptomatic for mental illness than those in the community. Screening for mental illness and referral for psychological support should be undertaken in people with IA.

The impact of social connectedness on mental health in LGBTQ + identifying individuals during the COVID-19 pandemic in Germany

BackgroundRecent studies report that LGBTQ + people have experienced high levels of mental health problems during COVID-19-related social distancing. Given the well-established association between social isolation and mental health, the main aim of the current study was to investigate differences in mental health and (perceived) social isolation and social support in LGBTQ + individuals compared to heterosexual, cisgender people and to explore whether the hypothesized higher mental health burden in LGBTQ + individuals is (partly) mediated by (perceived) social isolation or social support.MethodsN = 531 participants indicating belonging to the LGBTQ + community and N = 1826 not identifying as LGBTQ + participated in a cross-sectional online survey during the initial COVID-19-related lockdown in Germany. Standardized questionnaires were used to assess depression, anxiety, suicidality, loneliness and social support. Further, perceived social isolation and face-to-face communication during the lockdown were assessed.ResultsLGBTQ + people had higher levels of depression, anxiety and suicidal thought, were lonelier and experienced less social support than non-LGBTQ + identifying individuals. Mediation analysis showed that the higher levels of mental health burden in LGBTQ + people were (partly) mediated by reduced social connectedness. Further face-to-face contact positively affected mental health by reducing feelings of loneliness.ConclusionGiven the high impact of loneliness on mental health, governmental actions should be taken to promote social connectedness particularly among LGBTQ + identifying individuals to ensure that the COVID-19 pandemic does not exacerbate the health inequalities that already exist between LGBTQ+-identifying and heterosexual, cisgender people.