Youth Mental Health Research Articles

The Effect of Screen Time and Positive School Factors in the Pathway to Child and Youth Mental Health Outcomes.

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Early intervention in eating disorders

Early intervention in eating disorders Over the COVID-19 pandemic, youth mental health was severely compromised. Increased prevalence of mental health problems among adolescents aged 12 to 17 was over-represented by eating disorders (50%) compared to depression (36%) and anxiety (31%). It is predicted that sustained effects of the pandemic will continue to be experienced by youth. An urgent investment in early intervention for eating disorders in youth is required.

Depressive symptoms and suicidal ideation in sexual minority adolescents: An examination of social reward responsiveness and support as moderators

Sexual minority (SM) youth are at increased risk of depression and suicidal ideation (SI), due in part to discrimination and other stressors. This raises questions about social factors that may increase risk or resilience to stressors commonly faced by SM youth. The goal of this multimethod study was to examine both neural processing of social feedback and perceived social support as potential moderators of the association between SM identity, depressive symptoms, and endorsement of SI in adolescents. For this study, 165 adolescents aged 14–17 (22.42 % identifying as SM) were oversampled for current depression. Participants self-reported social support, depressive symptoms, and SI. Electroencephalogram (EEG) was recorded while participants completed a computerized peer interaction task in which the reward positivity (RewP) component was measured in response to social acceptance vs. rejection feedback. We tested social RewP and social support as moderators of associations between SM identity, depressive symptoms, and whether SI was reported. SM youth reported lower social support and elevated depressive symptoms and were more likely to endorse SI compared to non-SM youth. Social RewP moderated the associations between SM identity, depressive symptoms, and SI such that SM youth with blunted neural responses to social acceptance had higher depression and were more likely to endorse SI. Lower social support was associated with greater depressive symptoms and SI, but social support was not a significant moderator of the association between SM identity and symptoms. This is among the first studies to use affective neuroscience methods to examine social processes in SGM youth and our findings underscore the role of social factors in SGM youth mental health.

Gender and Lower Economic Status Moderate the Relation between Positive Youth Development and Mental Health.

Adolescent mental health problems account for almost half of overall health problems globally with a risk to mental health in adulthood. Since most mental health problems begin in adolescence, this developmental period should be a focus of strengths-based approach and prevention. The most researched positive youth development framework shown to be associated with youth mental health is The Five C model which distinguishes five indicators: competence, character, confidence, caring, and connection. The aim of the present study is to examine whether sociodemographic differences moderate the association of Five Cs positive youth development indicators and depression and anxiety symptoms in adolescence. The participants of the study were 3,438 students enrolled in the first year of secondary schools in Croatia who completed the Short Measure of the Five Cs, Depression Anxiety and Stress Scales and reported the perception of the socioeconomic status of their family. Gender and socioeconomic status main effects were shown for seven out of ten models with depression and anxiety as criterion variables. Results show that girls with lower levels of competence, confidence, and connection and lower socioeconomic status reported the highest depression and anxiety scores. These results imply that confidence, competence, and connection could be sensitive to equality and distribution of resources for youth. Reducing youth mental health problems should include social justice perspective and more available public services for families. Supportive environments are key for positive development; therefore, promotive and preventive efforts should target factors operating on societal level as well.

Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited? Working with police forces to improve mental health crisis care for young people.

The last few years have seen a mental health crisis for children and young people in the UK, with more young people presenting to services at crisis point. Young people have reported that there is a general lack of support before reaching the point of crisis and police forces in the UK have seen a rise in callouts related to youth mental health problems. We provide an overview of the evidence for joint responses from police and mental health services and highlight the importance of including people with lived experience in the development of crisis services. Most of the available data relates to interventions for adults, with very few studies including children and young people. We outline a new study in the UK aiming to evaluate a joint response for young people experiencing a mental health crisis. Whilst resources for children and young people's crisis services remain limited, joint response models with police forces can help to provide much needed intervention.

Training Needs for School Staff Supporting Students Returning to School After a Psychiatric Hospitalization

AbstractSupporting students returning to school after a mental health crisis often involves more training than many school staff members receive. With the increase in youth mental health diagnoses, there has also been an increase in the number of youth requiring psychiatric emergency department visits and hospitalizations. As such, this study employed a basic qualitative design to gather the perspectives of school staff who support students’ mental health about their experiences and training needs related to supporting youth returning to school after psychiatric hospitalization. Semi-structured interviews were conducted with 10 school mental health professionals or administrators. Thematic analysis was used to analyze the data. Three themes were identified: (1) most participants received minimal formal training in graduate school on hospital-to-school transition, (2) most participants learned about hospital-to-school transition on the job, and (3) participants made recommendations and identified specific training needs. Implications for training are discussed including a need for variety (e.g., some practitioners need basic training while others need more advanced training) and different format preferences (in-person may be preferred but online asynchronous is more convenient).

Impact of Social Media On Mental Health Of Youth

Impact of Social Media On Mental Health Of Youth

Age-Dependent Relationship between Self-Esteem and Depressive Symptoms in Korean Adolescents: a Meta-Analysis of Longitudinal Studies.

Self-esteem is a powerful protective factor against depressive symptoms, with cognitive vulnerability theory suggesting that early self-esteem more strongly predicts later depressive symptoms than vice versa. While some meta-analyses have examined these relationships, limited knowledge exists on the prospective relationship between self-esteem and depressive symptoms, particularly how it changes with age. This study conducted a longitudinal meta-analysis of nine studies (20,733 participants) on the prospective relationship between self-esteem and depressive symptoms in Korean children and adolescents. Relationships were analyzed by integrating the effect sizes of 22 zero-order correlations and 17 partial correlations and examining age-related changes. The results indicated significant negative correlations in both zero-order and partial correlations. Age-related changes showed a reverse U-shape trend in partial correlations, with the strongest negative association during childhood, weakening until age 14, and then strengthening again. Moderator analysis revealed no significant effect size variation based on publication type or gender proportion, but more recent birth cohorts exhibited a stronger negative relationship in zero-order correlations. Significant differences were also found based on the measurement instrument of depressive symptoms. These findings highlight the importance of tailored interventions to enhance self-esteem and mitigate depressive symptoms, extending the cognitive vulnerability model within Korea's cultural context and providing insights into Korean youth mental health.

Project Yarn Circle: development and pilot evaluation of a cultural connection suicide prevention program for Aboriginal and Torres Strait Islander young people

ABSTRACT Background Aboriginal and Torres Strait Islander young people experience markedly higher suicide mortality than non-Indigenous youth in Australia, yet there is little evidence of effective preventative strategies. Many are misaligned to the needs of First Nations young people due to a lack of consideration of protective factors such as community and cultural connection. Objective To date no research has examined whether increasing cultural connectedness may reduce Aboriginal and Torres Strait Islander youth suicidality. The current study outlines the development, implementation, and pilot evaluation of Project Yarn Circle, a school-based suicide prevention initiative utilising cultural education and connection. Method Project Yarn Circle was piloted by an Indigenous owned and managed youth mental health organisation, delivering 5 weekly sessions to 276 young people at 9 schools in Southeast Queensland, Australia, between 2019 and 2023. Sessions connected students to cultural knowledge and practices (stories, painting, dance, Indigenous languages) with Elders and local cultural knowledge facilitators. Results Pre- and post-program evaluation questionnaires completed 6–8 weeks apart found that participants had significantly lower suicidal ideation (GHQ-18-SS), pre 7.16, post 6.61, p = .043 higher positive ideation/reasons for living (PANSI-PI) pre 22.44, post 23.60, p = .009, and higher self-esteem (RSES) pre 16.55, post 23.60, p = .005. Analyses of cultural connectedness items co-designed for this evaluation study and validated using Exploratory Factor Analysis found that students demonstrated greater cultural identity clarity, peer cultural competence, strength from culture, salience of cultural continuity and sense of belonging. Conclusions These findings provide new evidence towards utilising cultural connectedness as an intervention mechanism in Indigenous youth suicide prevention.

Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status.

Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions. To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions. All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions. Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles. Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

The role of caregiver emotion regulation in youth mental health during the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (M age = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Mental health at the intersections: understanding South Asian Muslim youth mental health in Peel Region, Toronto, Canada

Purpose The purpose of this study was to understand the unique mental health concerns and access barriers experienced by South Asian Muslim youth populations living in the Peel Region of Toronto, Canada. Design/methodology/approach For this qualitative exploratory study, interviews (n = 15) were conducted with mental health professionals, educators and spiritual leaders (n = 11) who work with South Asian Muslim youth living in Peel Region, as well as with South Asian Muslim youth themselves (n = 4, aged 20–23). Interview transcripts were analyzed using reflexive thematic analysis. Findings Four primary themes emerged from the data: challenges and stressors, barriers, facilitators and hope and recovery. South Asian Muslim youth navigate a number of unique stressors related to the domains of culture, religion and family dynamics, as well as the impact of migration. Practical implications The findings stress the necessity of creating culturally safe, multilevel strategies to meet the nuanced challenges and diverse needs of South Asian Muslim youth communities. Originality/value This is one of the few papers to the knowledge that addresses the mental health needs and service access barriers of youth populations at the intersections of South Asian diasporic community belonging and Muslim faith in Canada.

Effects of racial teasing on adolescent marijuana use and nicotine vaping: An analysis of the Virginia Youth Risk Behavior Surveillance System

BackgroundDespite adverse effects of tobacco and marijuana use on the adolescent brain, its use among youth remains high. Previous research shows associations between bullying and risks of substance use; less is known about racial teasing. This study examines associations of racial teasing, marijuana and/or electronic vapor products (EVP) use among adolescents, using 2021 Virginia Youth Risk Behavior Surveillance System (VYRBSS). MethodsVYRBSS is a self-reported survey which collects information on experiences with racial teasing and substance use. This analysis included 3,083 high school students ≥ 12 years old. Descriptive analysis and logistic regression models were performed for categorical variables. Multivariable models were adjusted for confounders. ResultsRacial teasing was associated with marijuana (AOR 1.89; CI 1.43–2.48) and EVP use (AOR 2.52; CI 1.91–3.31). Compared to Whites; Asians, Blacks, and Latinos were more likely to report racial teasing. Older heterosexual females reported higher use of marijuana and EVP. Blacks reported greater use of marijuana, whereas Whites were more likely to use EVP. EVP use was higher in females (AOR 1.73, CI 1.34–2.23), bisexual youth (AOR 1.68, CI 1.23, 2.30) and poor mental health (AOR 1.49, CI 1.16, 1.92). Marijuana use was associated with bisexuality (AOR 1.75, CI 1.28–2.39) and poor mental health (AOR 1.62, CI 1.27–2.07) as well. ConclusionsEvery effort should be made by public health professionals in Virginia to prevent racial teasing among adolescents because it increases the odds of substance use, particularly in older females, youth who identify as bisexual, and those reporting poor mental health.

Youth Mental Health in the Wake of the COVID-19 Pandemic.

In this article we examine the current state of youth mental health across the United States and in Delaware, and discuss the impact of the COVID-19 pandemic on the mental health and well-being of children and adolescents. We review available literature detailing the short- and long-term effects of the COVID-19 pandemic on youth mental health and discuss the resultant programmatic and legislative efforts in Delaware and nationally. The COVID-19 pandemic had a severe impact on the mental health of young people. The prevalence of depression and anxiety among children and adolescents, which was already increasing pre-pandemic, spiked after the pandemic's onset. Even as public health precautions have lifted, young people continue to struggle with mental health in conjunction with lower levels of educational achievement, hindered social development, increased screen time, diminished access to effective mental healthcare, and economic instability. The negative impact of the pandemic will continue to have ramifications on the health and wellbeing of young people for years to come. Compiling evidence examining mental health trends is an important first step to understanding the impact of the pandemic on child and adolescent mental health and developing effective solutions. Although the official state of emergency is over, the effects of the COVID-19 pandemic are far-reaching and long-lasting. It is imperative that legislators and program administrators in Delaware and nationally work to ensure that young people and their families have access to affordable, high quality mental healthcare.

Relevance of ACE Scores in Teens with Depression and Anxiety: A Maui Pilot Study.

In the aftermath of the Covid pandemic and the notable rise of teen depression and anxiety (DA), there is an urgent need to focus on youth mental health. Another important variable to consider is the presence of adverse childhood experiences (ACE), which can be associated with chronic mental and physical health conditions. This pilot study explores how ACEs relate to DA for adolescents in Maui, Hawai'i. The cohort was 75 patients seen at a Kaiser Pediatric Clinic in the spring of 2022. Data was collected from standard questionnaires and the Pediatric ACEs and Life-Events Screener (PEARLS). There were significant associations between DA and a high ACE score (4+), as well as female sex. A high ACE score can alert providers to initiate a trauma informed dialogue with patients. The effects of trauma are not often discussed at routine visits. Mental health care needs and community support can also be addressed as needed. The PEARLS questionnaire is a standard tool to help clinicians be more trauma-informed. This study explores its relevance at routine adolescent visits.

Incorporating Complexity and System Dynamics into Economic Modelling for Mental Health Policy and Planning.

Care as usual has failed to stem the tide of mental health challenges in children and young people. Transformed models of care and prevention are required, including targeting the social determinants of mental health. Robust economic evidence is crucial to guide investment towards prioritised interventions that are effective and cost-effective to optimise health outcomes and ensure value for money. Mental healthcare and prevention exhibit the characteristics of complex dynamic systems, yet dynamic simulation modelling has to date only rarely been used to conduct economic evaluation in this area. This article proposes an integrated decision-making and planning framework for mental health that includes system dynamics modelling, cost-effectiveness analysis, and participatory model-building methods, in a circular process that is constantly reviewed and updated in a 'living model' ecosystem. We describe a case study of this approach for mental health system policy and planning that synergises the unique attributes of a system dynamics approach within the context of economic evaluation. This kind of approach can help decision makers make the most of precious, limited resources in healthcare. The application of modelling to organise and enable better responses to the youth mental health crisis offers positive benefits for individuals and their families, as well as for taxpayers.

A model of community youth mental health support services in the global South: A description and use of school-based services delivered by a non-governmental organisation in South Africa

ObjectiveYoung people in low- and middle-income countries (LMICs), including South Africa, are disproportionately affected by multiple risk factors for developing mental health problems and there are numerous barriers to accessing mental health care. In such contexts non-governmental organisations (NGOs) play a key role in providing support. We report on the mental health care services provided by NGO Community Keepers in South Africa. MethodCommunity Keepers (CK) offers psychosocial support to young people, parents, and teachers, during regular school hours, and free of charge. At the end of 2019, CK was based at 23 schools in 12 areas in the Western Cape Province, South Africa. In this paper we describe the model of service provision and present descriptive statistics from retrospective observational service data using routinely collected quantitative data from 2019, including details about referrals received, referral sources and reasons, and feedback received from children, parents, and teachers on the psychosocial support CK delivered. ResultsDuring 2019, 34 676 individuals accessed 18169 psychosocial support sessions rendered by CK. The most common referral source of learners to CK was self-referrals (40.6%), and the main referral reasons were emotional (psychological) problems, behaviour problems, or family (community) problems. At termination of therapy 320 (79.2%) learners said they strongly agreed that they would recommend CK to someone at their school. At termination of therapy with learners, 95 (39.3%) teachers rated CK’s services as excellent, 139 (57.4%) teachers gave a rating of good, and 204 (79.7%) parents reported an improvement in their relationship with their children. ConclusionsCK is an example of how psychosocial support can be embedded in schools in a LMIC. CK’s multifaceted model of service delivery could be used by other school-based mental health care service providers in other LMICs to inform and/or refine the services that they wish to offer.

State-level variation in the prevalence of child psychopathology symptoms in the US: Results from the ABCD study

ObjectiveTo estimate the prevalence of clinically meaningful youth mood, anxiety, behavioral, and attention symptoms across US states. MethodData are drawn from the Adolescent Brain Cognitive Development (ABCD) study baseline wave, which included 11,876 children ages 9-10. Statistical weighting strategies generated projected state-specific prevalence estimates for the 17 states where ABCD collected data based on state socio-demographics. Twenty dimensions of mental health were assessed with the Child Behavior Checklist using recommended cut-scores to assess clinical and sub-threshold symptoms. ResultsPsychopathology symptom prevalence varied by state and outcome. Projected prevalence of internalizing problems ranged from 11.0% [95% CI: 9.8%, 12.2%; Oklahoma] to 7.9% [95% CI: 6.9%, 9.0%; Maryland] across states. Projected prevalence of externalizing problems ranged from 6.9% [95% CI: 6.1%, 7.8%; South Carolina] to 4.5% [95% CI: 3.7%, 5.4%; California]. Regions with high symptoms included sections of the South (e.g., Oklahoma, South Carolina) and Vermont. Conduct problems had the most variability across states (i.e., greatest state-level prevalence 91% higher than the lowest). Attention problems had the least variability across states (greatest state-level prevalence 26% higher than the lowest). ConclusionsClinically meaningful psychopathology symptoms are common in children across the US, with substantial state-level variability in prevalence. Understanding variability in the prevalence of psychopathology symptoms across the US can help to inform resource allocation to increase the availability of youth mental health services.

Using Intervention Mapping to co-design a psychosocial service with youth experiencing mental illness

BackgroundDescriptions of service development processes in the youth mental health sector are lacking. Further, youth with lived experience of mental illness are rarely involved in service design. Intervention Mapping (IM) is a well-established framework for program development, implementation and evaluation, yet its applicability in the youth mental health sector is unknown. This paper describes the use of IM methodology to co-design and develop a psychosocial service to support youth aged 10-25 years experiencing mental illness in Tasmania, Australia. MethodsThe six steps of IM were followed: 1) needs assessment; 2) define program outcomes and objectives; 3) program design; 4) program production; 5) implementation planning; and 6) evaluation planning. ResultsKey outputs of each IM step are described. The service was successfully co-designed with young people at the centre of each step. The service includes wrap-around psychosocial support from lived-experience peer-support workers; outreach; and flexible frequency/intensity/duration to achieve young people’s psychosocial goals. ConclusionsThis is the first study to document the use of IM in co-designing a psychosocial service with youth experiencing mental illness. IM may provide a valuable roadmap for the youth mental health sector in supporting collaborative service design, implementation and evaluation planning, and systematic documentation of service development.

Cross-Cultural Comparison of the Strengths and Difficulties Self-Report Questionnaire in 12 Asian and European Countries

The self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries. This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N= 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country. Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales. The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally.