Mental Health Distress Research Articles

548-P: The Effects from Type 2 Diabetes Management Programs on Mental Health and Diabetes Distress

Impaired mental health among patients with type 2-diabetes (T2DM) constitutes a major challenge as it has negative influence on T2DM self-management, HbA1c and complications. Inclusion of mental health issues in municipal rehabilitation is important as patients need to cope both physical, practical, and mental aspects of a life with T2DM. The aim of this study was to assess whether T2DM management program influences mental health including diabetes distress and overall wellbeing. Methods: During 2018-2021, all patients referred for T2DM management programs were invited to the study. Included patients completed a series of validated questionnaires including WHO-5, PAID-1 and PAID-5 at baseline, at end of the program and at 6 months follow-up. A total of 131 completed all three questionnaires and were included in the study. Based on a person-centered and differentiated approach to diabetes management programs, the intervention consists of teaching, physical training, cooking and/or individual conversations. Results: The study population consist of 60% men, age range primarily from 55-79, 57% have a short education level. At baseline, mean WHO-5 score was 61.6 points (IQR: 48.0-80.0). At end of rehabilitation a statistically significant increase of 4.6 points (95%CI: 1.1-7.8, p=0.003) was observed. At 6 months follow-up the WHO-5 score was leveled and unchanged when compared to baseline. According to PAID-5, 47% of included patients had diabetes distress at baseline. This was reduced to 30% and 26% at end of the program and at 6 months follow-up, respectively. Conclusion: T2DM management programs has a positive effect on mental health including general well-being and diabetes distress. Nonetheless there is still room for improvement which is why we have now initiated a project in collaboration with a research institute, aiming to improve identification of individuals and develop interventions targeting patients with moderate to high degrees of diabetes distress. Disclosure C.Glümer: None. A.D.Hvidberg: None. L.A.Helgstrand: None.

A Human-Centered and Adaptive Robotic System Using Deep Learning and Adaptive Predictive Controllers

The rise of single-person households coupled with a drop in social interaction due to the coronavirus disease 2019 (COVID-19) pandemic is triggering a loneliness pandemic. This social issue is producing mental health conditions (e.g., depression and stress) not only in the elderly population but also in young adults. In this context, social robots emerge as human-centered robotics technology that can potentially reduce mental health distress produced by social isolation. However, current robotics systems still do not reach a sufficient communication level to produce an effective coexistence with humans. This paper contributes to the ongoing efforts to produce a more seamless human-robot interaction. For this, we present a novel cognitive architecture that uses (i) deep learning methods for mood recognition from visual and voice modalities, (ii) personality and mood models for adaptation of robot behaviors, and (iii) adaptive generalized predictive controllers (AGPC) to produce suitable robot reactions. Experimental results indicate that our proposed system influenced people’s moods, potentially reducing stress levels during human-robot interaction.

The use of experiential knowledge in the role of a psychiatrist.

There is increasing interest in the use of experiential knowledge and the development of experiential expertise in mental health. Yet, little is known about how best to use this expertise in the role of a psychiatrist. This study aims to gain insight into the concerns of psychiatrists using their lived experiences with mental health distress as a source of knowledge for patients, colleagues and themselves. Eighteen psychiatrists with lived experience as patients in mental health care were interviewed with a semi-structured questionnaire. The interviews were analyzed using qualitative narrative thematic analysis. The majority of the respondents use their lived experience implicitly in the contact with patients, which makes the contact more equal and strengthens the treatment relationship. When explicitly using experiential knowledge in the contact with patients, thought should be given at forehand to its purpose, timing and dosage. Recommendations are that the psychiatrist should be able to reflect on his/her lived experience from a sufficient distance and should take patient factors into account. When working in a team, it is advisable to discuss the use of experiential knowledge in advance with the team. An open organizational culture facilitates the use of experiential knowledge and safety and stability in the team are vital. Current professional codes do not always offer the space to be open. Organizational interests play a role, in the degree of self-disclosure as it can lead to conflict situations and job loss. Respondents unanimously indicated that the use of experiential knowledge in the role of a psychiatrist is a personal decision. Self-reflection and peer supervision with colleagues can be helpful to reflect on different considerations with regard to the use of experiential knowledge. Having personal lived experiences with a mental disorder affects the way psychiatrists think about and performs the profession. The perception of psychopathology becomes more nuanced and there seems to be an increased understanding of the suffering. Even though harnessing experiential knowledge makes the doctor-patient relationship more horizontal it remains unequal because of the difference in roles. However, if adequately used, experiential knowledge can enhance the treatment relationship.

Psychological and educational effects of the COVID-19 pandemic on online students and faculty of a ghanaian university

This is a qualitative study that employed exploratory design to inquire from 15 participants of Central University (Ghana) about their experience with the COVID-19 pandemic in Ghana. An in-depth interview was conducted, and data were analyzed using thematic analysis. The findings indicate that participants experienced fear expressed in four key domains reported under four key themes thus: Experiencing psychological distress; Burden of economic hardships; Fear of inefficient health system; and Educational disruptions and worries involved in online teaching and learning. The study concludes that the upsurge of COVID-19 has triggered psychological, economic, and educational conundrums that have to be addressed. This paper contributes to the growing body of studies on COVID-19 and effects on lecturers and students. The burgeoning evidence of the mental health distress following COVID-19 should be a wake-up call for universities and Ghana as a whole to invest both in infrastructure and manpower in this area of health care delivery. Vaccine hesitancy research must be conducted to improve upon health educational campaigns. The significant disruption from the pandemic is a fair warning to all stakeholders to make educational e-learning infrastructure resilient against similar future shocks. The implications of the findings for health and educational policies in Ghana are addressed.

Does labour protection influence mental-health responses to employment shocks? Evidence on older workers in Europe

This paper investigates if and how Employment Protection Legislation (EPL) influences mental-health responses to older workers’ job disruptions in Europe. It exploits labour market shocks during the first wave of the COVID-19 pandemic, and it is based on European data from the SHARE survey, in which each country is characterised by a different level of EPL. The analysis controls for workers’ individual characteristics and other contextual factors via propensity score matching. Results show that mental-health distress following job disruptions depends on the level of EPL, with significantly higher distress in countries in which EPL is more binding, especially among individuals with a lower education level. These findings suggest to consider the costs and benefits of mitigating measures for European countries with a high EPL, especially for older citizens with disadvantaged backgrounds.

Prevalence and predictors of depression, anxiety, and stress among recovered COVID-19 patients in Vietnam.

During the COVID-19 pandemic, a high prevalence of mental health distress has been reported among people who have recovered from the disease. To assess the prevalence of depression, anxiety, and stress as well as identify predictors among recovered COVID-19 patients after more than six months of being discharged in Dong Thap Province, Vietnam. The cross-sectional study was conducted among 549 eligible participants recruited by stratified sampling. Data was collected using the depression, anxiety and stress scale - 21 items had Content Validity Index = 0.9, and Cronbach's alpha for depression, anxiety and stress sub-scales were 0.95, 0.81, and 0.86, respectively. Descriptive statistics were used to measure the prevalence levels and distribution of characteristics of the participant, while factors influencing depression, anxiety, and stress were predicted using binary logistic regression. The overall prevalence of depression, anxiety, and stress were 24.8% (95% CI: 21.2-28.6), 41.5% (95% CI: 37.4-45.8), and 25.3% (95% CI: 21.7-29.2), respectively. The predictors of depression were living in urban area (OR = 1.97; 95% CI: 1.27-3.08), holding a bachelor's degree (OR:3.51; 95% CI: 1.13-10.8), having a high monthly income (OR: 2.57; 95% CI: 1.03-6.38), diabetes (OR: 2.21; 95% CI: 1.04-4.68), heart disease (OR: 3.83; 95% CI: 1.79-8.17), respiratory disease (OR: 3.49; 95% CI: 1.24-9.84), and diarrhea (OR: 4.07; 95% CI: 1.06-15.6). Living in the urban area (OR: 1.57; 95% CI: 1.07-2.29), having sleep disturbance (OR: 2.32; 95% CI: 1.56-3.46), and fatigue (OR: 1.57; 95% CI: 1.03-2.39) were predictors for anxiety. Having respiratory disease (OR: 3.75; 95% CI: 1.47-9.60) or diarrhea (OR: 4.34; 95% CI: 1.18-15.9) were predictors of stress. People who have recovered from COVID-19 should be assessed for symptoms of depression, anxiety, and stress. Primary healthcare providers should develop interventions to support their recovery.

Fluctuations in mental health in students accessing a university-wide online mental health promotion intervention before and during the COVID-19 pandemic

ABSTRACT Objective Growing evidence shows that online mental health interventions for university students are a cost-effective means for addressing mental health problems among university students. This study presents data on the numbers and characteristics of students who engaged in an online mental health promotion intervention called YOLO in the context of a university-wide rollout of the program before and after the onset of the COVID-19 pandemic. Methods Participants completed a questionnaire assessing socio-demographics and mental health (wellbeing and distress). A total of 240 students accessed the program over a 12-month period and of these, 164 provided reliable data. Results YOLO was accessed by students representing diverse socio-demographics including domestic vs. international student status, degree level, faculty, ethnicity, and age, although there was an over-representation of females (77.2%). Students who accessed YOLO pre-COVID-19 did not substantially differ across most mental health dimensions from those who accessed it during-COVID-19, although more students reported mild-moderate anxiety symptoms during-COVID than pre-COVID-19. The only socio-demographics significantly associated with mental health were age and degree level. Younger age was related to higher anxiety and 3rd and 4th year undergraduate students reported poorer mental health comparative to students in other years. Additionally, a higher proportion of these students accessed YOLO during-COVID-19 than at pre-COVID-19. Conclusion The present data along with findings from other studies that have evaluated YOLO, suggest that online mental health promotion programs that do not require in-person contact are an important and necessary resource for all university students.

Psychosocial predictors of trajectories of mental health distress during the COVID-19 pandemic: A four-wave panel study

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.

Self-monitoring of blood glucose levels among pregnant individuals with gestational diabetes: a systematic review and meta-analysis.

The World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and self-monitoring blood glucose (SMBG) to inform timely treatment decisions. To expand the evidence base of WHO's guideline on self-care interventions, we conducted a systematic review of SMBG among pregnant individuals with GD. Following PRISMA guidelines, we searched PubMed, CINAHL, LILACS, and EMBASE for publications through November 2020 comparing SMBG with clinic-based monitoring during antenatal care (ANC) globally. We extracted data using standardized forms and summarized maternal and newborn findings using random effects meta-analysis in GRADE evidence tables. We also reviewed studies on values, preferences, and costs of SMBG. We identified 6 studies examining SMBG compared to routine ANC care, 5 studies on values and preferences, and 1 study on costs. Nearly all were conducted in Europe and North America. Moderate-certainty evidence from 3 randomized controlled trials (RCTs) showed that SMBG as part of a package of interventions for GD treatment was associated with lower rates of preeclampsia, lower mean birthweight, fewer infants born large for gestational age, fewer infants with macrosomia, and lower rates of shoulder dystocia. There was no difference between groups in self-efficacy, preterm birth, C-section, mental health, stillbirth, or respiratory distress. No studies measured placenta previa, long-term complications, device-related issues, or social harms. Most end-users supported SMBG, motivated by health benefits, convenience, ease of use, and increased confidence. Health workers acknowledged SMBG's convenience but were wary of technical problems. One study found SMBG by pregnant individuals with insulin-dependent diabetes was associated with decreased costs for hospital admission and length of stay. SMBG during pregnancy is feasible and acceptable, and when combined in a package of GD interventions, is generally associated with improved maternal and neonatal health outcomes. However, research from resource-limited settings is needed. PROSPERO CRD42021233862.

(473) Simultaneous Multidisciplinary Gender Affirming Surgery during COVID-19: Improving Access to Care for Military Patients

Abstract Introduction Access to surgical care for the transgender population has been a persistent challenge. Frequently cited barriers include long waiting lists, strict insurance prior authorization protocols, surgeon scarcity, financial cost, and social stigma. These issues have been magnified throughout the COVID-19 pandemic response, as the diversion of resources has led to the postponement of surgeries deemed “routine” or “non-essential.” Many medical societies and healthcare organizations have classified gender-affirming surgery (GAS) as such despite the World Professional Association for Transgender Health (WPATH) defining surgical care for gender dysphoric individuals as medical necessity. Unfortunately, delays in care for this population contribute to prolonged mental health distress. Another important barrier to access centers on the issue of surgical timing. Many patients cannot afford to postpone school and work obligations to undergo multiple surgeries each with long recovery times. Furthermore, staffing shortages nationwide have limited operating room (OR) availability. To respond to these issues, our center organized a multidisciplinary collaboration among various surgical subspecialties to perform simultaneous GASs (e.g., top and bottom surgeries). In this way, the patient can undergo multiple GASs in a single procedure, thus limiting anesthesia exposure, expediting postoperative recovery, improving patient satisfaction and maximizing limited healthcare resources. Objective To describe a multidisciplinary model for GAS involving simultaneous top and bottom surgery to improve access to care for the transgender population in a resource-limited environment. Methods Case report describing successful multidisciplinary surgical management of a transgender female desiring multiple simultaneous GAS. Results Patient is a 24-year-old active duty transgender female who met WPATH criteria for top and bottom surgery. She desired numerous procedures including simple orchiectomy, breast implants and facial feminization. Given our limited OR availability during COVID-19, the decision was made to perform all of these surgeries under the same anesthetic. She underwent breast augmentation and fat harvesting with plastic surgery, which was immediately followed by simultaneous simple orchiectomy by urology and facial feminizing surgery with otolaryngology. Total operative time was 8.3 hours. Patient was discharged on post-op day 1 and had an uneventful recovery without surgical or anesthetic complications. Conclusions Simultaneous GAS is an effective approach to improve access to care during the COVID-19 pandemic. A single anesthetic enables the patients to achieve their surgical goals sooner and to lessen their overall recovery time compared to staged procedures. Disclosure No

Statistical analysis plans for two randomised controlled trials of the Narrative Experiences Online (NEON) Intervention: impact of receiving recorded mental health recovery narratives on quality of life in people experiencing psychosis (NEON) and people experiencing non-psychosis mental health problems (NEON-O)

BackgroundMental health recovery narratives are a first-hand account of an individual’s recovery from mental health distress, access to narratives can aid recovery. The NEON Intervention is a web-application providing access to a managed collection of narratives. We present the statistical analysis plan for assessing the effectiveness of the NEON Intervention in improving quality of life at 1-year post-randomisation. We pay particular focus on the statistical challenges encountered due to the online nature of this trial.Methods and designThe NEON Intervention is assessed in two trial populations, one for people with experience of psychosis in the last 5 years, and mental health distress in the last six months (NEON Trial) and one for people with experience of non-psychosis mental health problems (NEON-O Trial). Both NEON trials are two-arm randomised controlled superiority trials comparing the effectiveness of the NEON Intervention with usual care. The target sample size is 684 randomised participants for NEON and 994 for NEON-O. Participants were randomised centrally in a 1:1 ratio.ResultsThe primary outcome is the mean score of subjective items on the Manchester Short Assessment of Quality-of-Life questionnaire (MANSA) at 52 weeks. Secondary outcomes are scores from the Herth Hope Index, Mental Health Confidence Scale, Meaning of Life questionnaire, CORE-10 questionnaire and Euroqol 5-Dimension 5-Level (EQ-5D-5L).ConclusionThis manuscript is the statistical analysis plan (SAP) for the NEON trials. Any post hoc analysis, such as those requested by journal reviewers will be clearly labelled as such in the final trial reporting.Trial registrationBoth trials were prospectively registered. NEON Trial: ISRCTN11152837, registered on 13 August 2018. NEON-O Trial: ISRCTN63197153, registered on 9 January 2020.

The association between reproductive rights and access to abortion services and mental health among US women

BackgroundThis study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women. MethodsWe operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status. ResultsIn the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25–34 years old and women with a high school degree. For example, women aged 25–34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies. ConclusionWe found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.

Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey

To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P<.001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.

Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.

Associations Between Adverse Childhood Experiences and Stressful Life Events and Health Outcomes in Pregnant and Breastfeeding Women from Diverse Racial and Ethnic Groups.

Background: This study sought to understand the characteristics of racially/ethnically diverse pregnant and breastfeeding women who have experienced adverse childhood experiences (ACEs) and stressful life events (SLEs) and the relationship among ACEs, SLEs, and health outcomes in this population. Materials and Methods: This was a secondary analysis of cross-sectional data from the Family Matters study. The participants in this study were families with children ages 5-9 (N = 1,307) recruited from Minneapolis-St. Paul primary care clinics representing six racial/ethnic backgrounds (White, Black, Native American, Hmong, Somali, Latino). Primary caregivers completed surveys about personal health, parenting styles, resilience, ACEs, and SLEs. Linear and logistic regression models were used to examine the associations between ACEs and SLEs with health outcomes of pregnant and breastfeeding women at the individual level. Results: A total of 123 racially/ethnically diverse women in this study reported being pregnant or currently breastfeeding. Eighty-eight (72%) reported a history of ACEs or SLEs. Those with both ACEs/SLEs reported more depression, economic strain, and a shorter duration of living in the United States. An increase in one reported ACE or SLE was positively associated with self-reported stress, number of reported medical conditions, substance use, self-efficacy, and permissive parenting (all β coefficients p < 0.05). SLEs independently demonstrated increased predictive probability of severe mental health distress (6.7 percentage points, confidence interval [95% CI: 0.02-0.11; p < 0.01]) and moderate or severe anxiety (7.5 percentage points [95% CI: 0.04-0.11; p < 0.001]). Conclusion: Exposure to ACEs and SLEs appear to have significant impacts on physical health, mental health, and substance use in pregnant racially/ethnically diverse women.

Examining Associations Between Discrimination, Social Cohesion, and Health among White LGBT versus POC LGBT Chicagoans

Consistent with the minority stress perspective, lesbian/gay, bisexual, and transgender (LGBT) individuals on average report worse health than heterosexual individuals in several domains, for example, general health, mental health, physical health, and healthcare access. Intersectionality‐based research shows that LGBT people of color (POC) are, on average, at even greater risk for adverse health outcomes. Discrimination and social cohesion may be two mechanisms underlying these between‐ and within‐group disparities, given that both constructs are frequently reported within marginalized populations, and that both broadly relate to health. This study used data from the Chicago Department of Public Health to examine broad health differences between White LGBT and LGBT POC, and to test specific models in which social cohesion mediated links between discrimination and health. LGBT POC reported experiencing worse general health, lower access to health care, more experiences of discrimination, and lower feelings of social cohesion than did White LGBT individuals. No mediation effects emerged; however, there was a direct effect of experiencing discrimination on mental health distress. Discrimination exposure inversely related to the feelings of social cohesion.

A call to create evidence-based mental health promotion interventions for youth that are equitable across ethnic/racial subgroups: Advocates 4-ALL Youth.

Adolescents from historically racial and ethnic minoritized and low-income communities have higher rates of early-life and chronic difficulties with anxiety and depression compared to non-Hispanic White youth. With mental health distress exacerbated during and in the wake of the COVID-19 pandemic, there is a need for accessible, equitable evidence-based programs that promote psychological well-being, strengthen one's ability to adapt to adversity, and build self-efficacy prior to adolescence. An evidenced-based resiliency-focused health coaching intervention was adapted using a health equity implementation framework to meet the needs of a Title I elementary school in rural Alabama (AL) that serves over 80% Black and Hispanic students. To ensure that the program met local community needs while maintaining core program educational activities, all adaptations were documented utilizing a standard coding system. Leveraging an existing academic-community partnership with Auburn University and a local AL school district, a new program, Advocates 4-All Youth (ALLY), was created. Three major adaptations were required: (1) the use of local community volunteers (ALLYs) to deliver the program versus health coaches, (2) the modification of program materials to meet the challenge of varying levels of general and health-related literacy, and (3) the integration of the Empower Action Model to target protective factors in a culturally-tailored delivery to ensure key program outcomes are found equitable for all students. With continued increases in youth mental health distress, there is a need for the development of universal primary prevention interventions to promote mental well-being and to strengthen protective factors among youth from historically disadvantaged backgrounds. ALLY was created to meet these needs and may be an effective strategy if deemed efficacious in improving program outcomes.

School-based mental health screenings with Ukrainian adolescent refugees in Germany: Results from a pilot study.

Since the Russian invasion of Ukraine in February 2022, high numbers of Ukrainians, mostly women and children, have left the country. As of today, Germany has accepted more than one million refugees fleeing from Ukraine including ~200,000 children and adolescents registered in German schools. Since refugee minors are typically affected by high rates of mental health issues, the identification of potential psychological problems at an early stage after arrival is essential in order to make timely referrals for vulnerable youth to diagnostic or treatment services possible. The aim of the present study was to test the feasibility of a classroom-based mental health screening procedure and to assess symptoms of PTSD, depression, and anxiety in a small sample of adolescents who had fled to Germany. Forty-two adolescents (n = 20 girls) took part in the study. Screening results showed that more than half of the sample had elevated ratings in the Refugee Health Screener (RHS) and about 45% reported clinically significant levels of PTSD. Overall, the amount of both mental health problems and current worries related to the war was significantly higher in girls compared to boys. In general, screenings were well received by the adolescents. The findings of this pilot study point to a considerable level of mental health problems and distress in adolescent refugees affected by the recent war in Ukraine. Brief psychological screenings within the school setting might represent a promising approach to identifying potential mental health disorders as early as possible in newly arriving refugee youth.

Understanding Postpartum Parents' Experiences via Two Digital Platforms

Digital platforms, including online forums and helplines, have emerged as avenues of support for caregivers suffering from postpartum mental health distress. Understanding support seekers' experiences as shared on these platforms could provide crucial insight into caregivers' needs during this vulnerable time. In the current work, we provide a descriptive analysis of the concerns, psychological states, and motivations shared by healthy and distressed postpartum support seekers on two digital platforms, a one-on-one digital helpline and a publicly available online forum. Using a combination of human annotations, dictionary models and unsupervised techniques, we find stark differences between the experiences of distressed and healthy mothers. Distressed mothers described interpersonal problems and a lack of support, with 8.60% - 14.56% reporting severe symptoms including suicidal ideation. In contrast, the majority of healthy mothers described childcare issues, such as questions about breastfeeding or sleeping, and reported no severe mental health concerns. Across the two digital platforms, we found that distressed mothers shared similar content. However, the patterns of speech and affect shared by distressed mothers differed between the helpline vs. the online forum, suggesting the design of these platforms may shape meaningful measures of their support-seeking experiences. Our results provide new insight into the experiences of caregivers suffering from postpartum mental health distress. We conclude by discussing methodological considerations for understanding content shared by support seekers and design considerations for the next generation of support tools for postpartum parents.

The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System.

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (β = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (β = -0.345) and physical health problems of parents (β = -0.305), and youth gender (β = 0.126) and trauma exposure of youth (β = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (β = 0.449). Family type had an indirect effect on youth adjustment through youth gender (β = 0.142), youth trauma exposure (β = -0.165), parent physical health problems (β = -0.202), and parent mental health (β = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.