Adolescent Mental Health Problems Research Articles

Prevalence and Factors Associated with Psychological Distress Among Adolescents in Sierra Leone in 2017

Adolescent mental health problems are a public health challenge around the world and particularly in a country like Sierra Leone that has experienced war and the Ebola virus epidemic. Adolescents may suffer from psychological distress with school and family determinants. The goal of this study was to determine the prevalence and factors associated with psychological distress among school-going adolescent in Sierra Leone. This involved the secondary analysis of the data from the Sierra Leone, 2017 Global School-based Student Health Survey (GSHS). The dependent variable was “psychological distress,” which was assessed using two questions: 1) “In the past 12 months, how often have you worried about something to the point of not being able to sleep at night?” and 2) “In the past 12 months, how often have you felt lonely?” A weighted analysis of the data was performed using the software STATA version 12.0 (Stata Corporation, College Station, Texas, United States). One in two adolescents surveyed was male (51.53%). The average age of these school-going adolescents was 15.32±1.73 years. The average age of the boys was 15.37±1.74 years and that of girls was 15.15±1.66 years. The prevalence of psychological distress in this population was 26.81% CI95%=[24.91 - 28.70]. The boys seemed to suffer more of psychological distress than the girls (28.95% CI95%=[26.12 - 31.78] vs 24.54% CI95%=[22.05 - 27.01]). The factors associated with psychological distress among school-going adolescents were bullying, lack of respect for their privacy, alcohol and/or cannabis use, multiple sexual partnerships and sedentary lifestyle. The psychological distress among adolescents in Sierra Leone is real. Knowing the risk factors for psychological distress in adolescents will improve its prevention and promote the mental health of these future adults.

Development of a transdiagnostic stepped care programme for common adolescent mental health problems in Indian secondary schools: lessons from a pilot study examining acceptability and feasibility

AbstractBackgroundThe ‘PRemIum for aDolEscents’ (PRIDE) project has developed a school-based, transdiagnostic stepped care programme for common adolescent mental health problems in India. The programme comprises a brief problem-solving intervention (‘Step 1’) followed by a personalised cognitive-behavioural intervention (‘Step 2’) for participants who do not respond to the first step.MethodsA mixed-method design was used to evaluate the acceptability and feasibility of the stepped care programme in five schools in New Delhi. Participants were N = 80 adolescents (mean age = 15.3 years, females = 55%) with elevated mental symptoms and associated distress/impairment.Results61 (76%) of the enrolled sample were assessed following Step 1, from which 33 (54%) met non-remission criteria. Among these 33 non-remitted cases, 12 (36%) opted for Step 2 and five (42%) completed the full programme. The remaining non-remitted cases (n = 21, 64%) opted out of further treatment. Perceived resolution of the primary problem (n = 9, 43%) was the most common reason for opting out. The median time to complete each step was 22 and 70 days respectively, with a gap of 31 days between steps. Qualitative feedback from adolescents and counsellors indicated requirements for a shorter delivery schedule, greater continuity across steps and more collaborative decision-making.ConclusionsThis study provides preliminary evidence for a stepped care programme aimed at common adolescent mental health problems. Modifications are recommended to enhance the acceptability and feasibility of the programme in low-resource settings.

Association Among Self-Injury, Suicidal Tendency, and Personality and Psychological Characteristics in Korean Adolescents.

ObjectiveTo compare mental health problems and personality characteristics between adolescents with self-injury (SI) and suicidal tendency (ST), including suicidal ideation and suicide planning. Methods The participants completed the Adolescent Personality and Mental Health Problems Screening Questionnaire, Third version (AMPQ-III), and Korean version of the Strengths and Difficulties Questionnaire (SDQ-Kr), and gave their demographic information. Based on the answered SI and ST items in AMPQ-III, the participants were divided into groups: without SI and ST, with SI and without ST, without SI and with ST, and with SI and ST. Analysis of variance (ANOVA) and post-hoc Scheffe test were used to determine group differences, stepwise multiple linear regression, and factors associated with SI and ST. ResultsANOVA yielded results for all categories of mental health problems. Significant differences were observed between the four groups. Conversely, for personality characteristics, only the sense of community item between the group without SI and with ST and the group without SI and ST were significantly different; sense of community was associated with ST (β=-0.054, p=0.005). Among the mental health subscales, SI was significantly associated with conduct problems (β=0.211, p<0.001), emotional problems (β=0.173, p<0.001), peer problems (β=0.085, p<0.001), and prosocial behavior (β=0.073, p<0.001). ST was significantly associated with emotional symptoms (β=0.317, p<0.001), peer problems (β=0.130, p<0.001), conduct problems (β=0.106, p<0.001), hyperactivity (β=0.050, p=0.010), and prosocial behavior (β=0.062, p<0.001). ConclusionThe findings highlight the necessity of assessing psychological strength, difficulties, and personality characteristics for the prevention and early intervention of adolescent SI.

Physical development and mental health in South African perinatally HIV-positive adolescents on antiretroviral therapy and their caregivers with and without household food insecurity.

BackgroundPerinatally acquired HIV-infected (PHIV+) adolescents have shown impairments in neurocognitive function and mental health problems compared with their peers. The contribution of food insecurity to such impairments has not been explored.ObjectivesThe aim of this report has been to explore the contribution of food insecurity to neurocognitive impairment and mental health problems in adolescents with perinatally-acquired HIV infection.MethodA total of 248 PHIV+ adolescents and healthy controls aged between 9 and 12 years completed a neuropsychological battery, the Childhood Behaviour Checklist (CBCL) and the Becks Youth Inventory. Head circumference, body mass index (BMI), height for age (HAZ), Tanner pubertal staging, albumin, haemoglobin, CD4 and viral loads were also measured. Participants’ caregivers were interviewed about their mental health and household food security. T-tests were used to assess for differences in food secure and food insecure households.ResultsCaregivers of PHIV+ adolescents reported higher levels of depressive symptoms and household food insecurity. Increased food insecurity was associated with more behavioural problems in adolescents, as well as lower haemoglobin and albumin levels, faster processing speed and increased Tanner staging in boys. Body mass index and HAZ were not affected by food insecurity.ConclusionThese findings suggest that household food insecurity is associated with some altered behavioural, physical and physiological outcomes, which could complicate and compound the existing difficulties in PHIV+ households.

Sleep Disorders in Early Childhood and the Development of Mental Health Problems in Adolescents: A Systematic Review of Longitudinal and Prospective Studies.

The association between sleep problems, particularly sleep disorders, and mental health has long been studied and recognized. However, the causal relationship between sleep disorders, particularly during early childhood, on mental health problems in adolescence are yet to be established. From a preventive perspective, it is important to understand the causality of mental health problems in adolescents so that intervention measures can be derived and implemented as early as possible for maximum effectiveness. To provide more precise information on the effect of early childhood sleep disorders on mental health problems during adolescence, a systematic review was conducted on longitudinal and prospective studies reported in the literature. Following the PRISMA guidelines with an extensive search of the literature 26 studies were identified. Seven of these identified studies satisfied all selection criteria with sufficient data on the effect of early childhood sleep disorders and mental health problems in adolescence. Information was extracted and analyzed systematically from each study and tabulated. The overall results obtained from these studies indicate a significant and possible causal relationship between early childhood sleep disorders and the development of mental health problems, such as anxiety, depression, and ADHD in adolescence. These results are discussed with regards to the theoretical and practical implications as well as preventive strategies.

The social gradient in adolescent mental health: mediated or moderated by belief in a just world?

PurposeA social gradient in adolescent mental health exists: adolescents with higher socioeconomic status (SES) have fewer mental health problems than their peers with lower SES. Little is known about whether adolescents’ societal beliefs play a role in this social gradient. Belief in a just world (BJW) may be a mediator or moderator of the social gradient in adolescent mental health.MethodsUsing data from 848 adolescents (Mage = 17) in the Netherlands, path analyses examined whether two indicators of BJW (general and personal) mediated or moderated the associations between two indicators of SES (family affluence and perceived family wealth), and four indicators of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity, and peer problems).ResultsAdolescents with lower family affluence and lower perceived family wealth reported more emotional symptoms, and the association between perceived family wealth and emotional symptoms was mediated by lower personal and general BJW. Furthermore, higher personal BJW amplified the negative association between SES and peer problems.ConclusionThis study suggests BJW may both mediate and amplify the social gradient in adolescent mental health. Adolescents’ beliefs about society may be important to include in research aimed at understanding this social gradient.

Potential drug-drug interaction prevalence and risk factors associated with QT interval prolonging psychotropic use in children and adolescents

BackgroundChild and adolescent mental health problems are common in the community, but the scientific basis for the treatment of many of these conditions is still in its infancy. Prescriptions of psychotropic medications have become an important intervention for many children and adolescents with mental disorders, and the rise of these prescriptions is debated intensively both among experts and the public. The overall prescription rates of psychotropics in general and the major medication subgroups prescribed to children and adolescents vary substantially between countries. Therefore, they are also at escalated risk of QT interval protracting drug-drug interactions. ObjectivesTherefore, we have analyzed the prescribing pattern of QT-prolonging drugs and drug-drug interactions in children and adolescent psychiatric patients. MethodsThis was a cross-sectional prospective study conducted in Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand from October 1, 2016, to December 31, 2018, employing the pertinent prescriptions. ResultsPrescriptions for 1682 patients (aged 0 to 18 years) during the aforementioned study period were investigated. 1146 patients were males and 536 were females in our study. 1317 (78.3%) patients were using drugs with a capacity to induce TdP. 2894 QT-prolonging drug-drug interaction pairs have been identified. As per CredibleMeds (AzCERT) Classification, 2881 (53.2%), 1982 (36.6%), and 472 (8.7%) interacting drugs were identified with known, possible and conditional risk of TdP, respectively. The common interacting medications belong to psychostimulant (968), antimicrobial (548), proton pump inhibitor (517), antinausea (467), antitubercular (462), antidepressant (436), and antipsychotic (421) therapeutic categories. ConclusionsMany children and adolescent psychiatric patients in the OPD were prescribed drugs and drug combinations. Many of these have an elevated risk of prolonging QT interval and precipitating TdP. Therefore, it is imperative to adopt precautionary measures, be watchful, and prevent QT prolongation in clinical settings. Various online evidence based drug-drug interaction resources can help physicians to select appropriate medications judiciously for children and adolescent psychiatric outpatients.

Engaging parents in preventive programs for adolescent mental health: A socio‐ecological framework

AbstractPreventive parenting programs have been demonstrated to decrease the risk of adolescent mental health problems. Despite this, recruitment and engagement rates in these programs are low, which could lead to an underreporting of the effectiveness of these programs and parents not adequately developing the key skills required to prevent mental health problems in their adolescent. We propose a framework for understanding parental initial engagement using a socio‐ecological lens, by considering a variety of factors that apply across several levels: intrapersonal, interpersonal, organizational, community, and public policy. Implications of this conceptual framework and future directions for research and practice are then discussed.

WITHDRAWN: Impact of psychological abuse and depression in children from a physical well-being perspective

Childhood sexual abuse (CSA) has been associated with multiple adverse medical, psychological, behavioral, depression, and social effects. Moreover, there can be a lack of awareness of the possible psychological resources that could reduce childhood emotional abuse's negative results. Hence in this paper, Deep learning assisted impact of psychological abuse and depression (DL-IPAD) in children from a physical well-being perspective has been proposed to effectively manage serious health problems for their children and synchronize that role with daily living requirements. DL-IPAD examined the association between parental psychological abuse of their children and adolescent mental health problems. The proposed method identifies convergent evidence of a life spirit that reduces the effects of childhood mental abuse and neglect in a testing procedure of mood and depression on subsequent depressive symptoms. Emotional abuse in childhood is mediated by emotional dysregulations and the following behavioral issues concerning depressive symptoms. The purpose of this paper is to reveal that Child Protective Services can be careful to detect and prevent childhood emotional abuse. Finally, strategies aimed at regulating emotions and emotional well-being can help reduce depression. The numerical results recommended DL-IPAD increase accuracy ratio (96.2%), Predication ratio (98.25%), depression ratio (96.4%), prevalence ratio (94.1%) and rehabilitation ratio (97.8%).

Trends in adolescent mental health problems: Differences by SES and gender

Abstract Background Studies in Sweden and elsewhere have shown that mental health problems have increased among adolescents in recent decades. Unlike the previous studies, we extend the investigation to the trends of various mental health problems, namely: psychosomatic symptoms, suicide attempts, depressive symptoms, and suicide ideations in the last two decades, from 2004 to 2020. We also investigate the moderating role of gender and SES on these trends. Methods Data were collected through repeated bi-annual cross-sectional surveys between 2004 and 2020 among 32061 adolescents (49% girls) in middle and upper secondary schools in a county of Sweden. We fitted two linear and two logistic regressions with gender and socioeconomic status (SES) as predictors, and by interacting them with year of survey, we examined if they are associated with trends in mental health problems. Results Psychosomatic and depressive symptoms remained stable overtime (β = -0.04, p = 0.12; and β = 0.007, p = 0.69, respectively). Trend in depressive symptoms has declined overtime only for girls (β = -0.07, p &amp;lt; 0.005) while gender did not have effect on the trend in psychosomatic symptoms. Both psychosomatic (β = -0.09, p &amp;lt; 0.001) and depressive (β = -0.08, p &amp;lt; 0.001) symptoms have declined overtime only among those with high SES. Trends in both suicidal ideations and attempts were stable. Suicidal ideations declined overtime only for the girls (OR = 0.86, CI = 0.82 - 0.91, p &amp;lt; 0.001). However, gender did not have significant effect on trends in suicidal attempts. Both suicidal ideations (OR = 0.97, CI = 0.95 - 0.99, p = 0.02) and suicidal attempts (OR = 0.98, CI = 0.96 - 0.99, p = 0.007) declined overtime among those with higher SES. Conclusions Mental health problems seem to decrease from 2004 to 2020, however only for girls and adolescents with high SES. This indicates an increase in health inequalities especially for youth with low SES. Key messages Mental health problems declined in the last two decades, especially among girls. Adolescents with low SES did not show the same mental health improvement, which indicated that health inequalities in adolescent mental health seem to have increased in the last two decades.

Parenting Style and Adolescent Mental Health: The Chain Mediating Effects of Self-Esteem and Psychological Inflexibility.

Based on interpersonal acceptance–rejection theory, family systems theory, and psychological inflexibility theory, this study aimed to examine the mediating roles of a protective factor (self-esteem) and a risk factor (psychological inflexibility) on the influence of parenting style on adolescent mental health. A sample of Chinese adolescents (n = 916, 46% male, mean age = 14.44 years, SD = 1.84 years) completed the Short Egna Minnen Barndoms Uppfostran, the Rosenberg Self-esteem Scale, the Avoidance and Fusion Questionnaire for Youth, the Satisfaction with Life Scale, and the Depression Subscale of the Youth Self-Report. Results show that the self-esteem and psychological inflexibility play a chain mediating role in the relationship between parenting style and adolescent mental health. Specifically, parental emotional warmth had a positive effect on adolescent mental health through the chain mediating effects of self-esteem and psychological inflexibility. Parental rejection and parental over-protection had negative effects on adolescent mental health by lowering self-esteem but increasing psychological inflexibility. These results provide further guidance in the prevention of and intervention in adolescent mental health problems.

Coping with COVID-19: Longitudinal Impact of the Pandemic on Adjustment and Links with Coping for Adolescents with and without ADHD.

Understanding factors that foster resilience and buffer against the negative psychological impact of COVID-19 is critical to inform efforts to promote adjustment, reduce risk, and improve care, particularly for adolescents with neurodevelopmental disorders. This prospective longitudinal study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health and substance use, and by assessing specific positive coping strategies among adolescents with and without attention-deficit/hyperactivity disorder (ADHD). Using multi-group autoregressive cross-lagged path models, the present study explored the reciprocal influence of positive coping behaviors on multiple adjustment outcomes including mental health symptoms, substance use, stress, and worry. Participants included 238 adolescents (132 male participants; ages 15–17; 118 with ADHD). Parents provided ratings of adolescent routines, and adolescents provided ratings of coping behaviors and psychological adjustment in spring (May/June), summer (July/August), and fall (October/November) 2020. All models included the effects of adjustment at the prior timepoint as well as relevant covariates including adolescent race, ethnicity, sex, medication status, and family income. Adolescents with ADHD were at greater risk for experiencing increases in mental health symptoms and substance use throughout the pandemic, relative to adolescents without ADHD. The use of positive coping strategies and adolescent routines buffered against increases in substance use and mental health problems for adolescents with ADHD. These findings have important clinical and public policy relevance for parents, schools, and employers who may aim to prioritize keeping schedules as consistent as possible to promote healthy adjustment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10802-021-00857-2.

35.2 Trust and Childhood Maltreatment: Evidence of Bias in Appraisal of Unfamiliar Faces

Child maltreatment is associated with poorer social functioning and increased risk of mental health problems in adolescence and adulthood, but the processes underlying these associations remain unclear. Although crucial for establishing and maintaining relationships, trust judgments have not been experimentally investigated in children who have experienced abuse and neglect. A community-based sample of 75 children and adolescents aged 8 to 16 years with maltreatment documented on the basis of social services records, and a group of 70 peers selected to be of similar age, cognitive ability, socioeconomic status, gender, and ethnicity, took part in a facial trustworthiness judgment task. Children judged 10 computer-generated facial stimuli with each identity at 1 SD increments from –3 to +3 SD from the mean along a computationally modeled trustworthiness dimension. A generalized-linear multilevel model (GLMM) with a probit link function was carried out to estimate parameters at the group level while assigning random effects to the face identities. The bias (corresponding to the level of trustworthiness at which the child was equally likely to respond “trustworthy” or “not trustworthy”) was significantly greater in the group of children with documented histories of maltreatment (95% CI, 0.79-2.36) than in children without maltreatment histories (95% CI, –0.48 to 0.28). This study provides experimental evidence that children and adolescents with documented maltreatment perceive others as less trustworthy than their peers. Given that facial trustworthiness judgments have been linked to approach and avoidance, over time, alterations in trust processing may disrupt the development of social bonds and contribute to “social thinning” (a reduction in the extent and quality of social relationships), leaving children more vulnerable to environmental stressors, increasing the risk of mental health difficulties.

Adolescents’ mental health status and influential factors amid the Coronavirus Disease pandemic

BackgroundThe preventive measure of Coronavirus Disease pandemic, such as nationwide lockdown, might lead to stress, depression, and anxiety, prominently in adolescents. Many factors were indicated to influence its severity. This study aimed to investigate the magnitude of COVID-19-related mental health problems in adolescents and the associated factors.MethodsThis cross-sectional study gathered 2018 adolescents throughout Indonesia from April 22nd-28th 2020. The questionnaire was spread through social media and included Kessler-10 Psychological Distress scale and closed-ended questions about the risk and protective factors. The results were analyzed using Mann-Whitney U test, Kruskal-Wallis test, and Logistic Regression.ResultsThe participants were mostly males (91.8%) with a median age of 19. The results showed 54.1% experienced varying degrees of distress. All variables were significantly related with psychological distress during Mann-Whitney-U and Kruskal-Wallis test. The logistic regression analysis showed maintaining or improving dietary pattern and sleep quality was found to be protective against psychological distress (OR = 0.497,95%CI = 0.34–0.725 and OR = 0.515,95%CI = 0.372–0.714, respectively), while others were risk factors, i.e.: Not having a confidant (OR = 1.539,95%CI = 1.226–1.931), frequent argument with parents (OR = 1.735,95%CI = 1.343–2.24), feeling worried (OR = 2.364, 95%CI1.528-3.656), chronic diseases (OR = 2.601,95%CI = 1.468–4.606), and mental illnesses (OR = 9.866,95%CI = 3.855–25.249).ConclusionMore than half of adolescents experienced distress. The findings called for initiatives by experts in providing psychosocial support for adolescents.

45.9 An Innovative Approach to Address the Child and Adolescent Psychiatry Shortage: Extended Consultation Model

Novel approaches are needed to address the shortage of child and adolescent psychiatry providers in the United States. As of 2018, 1 in 5 children in the United States have a mental, emotional, or behavioral disorder, yet only 20% of those children receive care from a specialized mental health provider. Exacerbation of child and adolescent mental health problems were evident amidst the COVID-19 pandemic; from mid-March to October 2020, the proportion of pediatric emergency department visits that were mental health–related rose by 44%. The Massachusetts Child Psychiatry Access Program (MCPAP) provides one-time consultation from a child and adolescent psychiatry provider to support primary care providers (PCPs) in treating mental health patients. However, PCPs continue to feel overwhelmed regarding the ongoing lack of direct care by specialists that is often necessary for complex mental health cases. Inspired by the Chronic Care Model, we propose an extended consultation model that includes 6 to 9 months of evaluation, treatment initiation, and reevaluation with treatment plan adjustments as indicated by a child and adolescent psychiatry provider with subsequent referral back to the PCP after stabilization.

Dyadic parent-adolescent relationship quality as pathways from maternal childhood abuse to adolescent psychopathology.

Children of maternal caregivers abused in childhood are at increased risk for mental health problems including anxiety and depression. To date, most studies exploring the intergenerational transmission of trauma have focused on younger children, with far fewer studies investigating adolescent mental health. Previous research suggests that maternal childhood abuse negatively impacts the parent-adolescent relationship, which may contribute to the development and maintenance of adolescent mental health problems. The current study examined dyadic reports of maternal-adolescent relationship quality as mediators linking maternal reports of childhood abuse to adolescent depression and anxiety. The bootstrapped indirect effects from maternal childhood abuse to adolescent symptoms of anxiety and depression were significant through adolescent reports of relationship quality, but not through maternal reports of relationship quality. Findings suggest that an adolescent's perception of their maternal-adolescent relationship may mediate the relationship between their maternal caregiver's childhood abuse and their own symptoms of anxiety and depression.

Effectiveness and costs associated with a lay counselor-delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12-month outcomes of a randomized controlled trial.

Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor-delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor-delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = -0.75, 95% confidence interval [CI] = -1.47, -0.03, p = 0.04; SDQ Total Difficulties: AMD = -1.73, 95% CI = -3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = -0.98, 95% CI = -1.51, -0.45, p < 0.001; SDQ Total Difficulties: AMD = -1.23, 95% CI = -2.37, -0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study's methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. In this study, we observed that a lay counselor-delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents' access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. ClinicalTrials.gov NCT03630471.

Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings

ABSTRACT Objective The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. Method The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. Results Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach’s α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. Conclusions Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.

Trust and childhood maltreatment: evidence of bias in appraisal of unfamiliar faces.

Child maltreatment is associated with poorer social functioning and increased risk of mental health problems in adolescence and adulthood, but the processes underlying these associations remain unclear. Although crucial for establishing and maintaining relationships, trust judgements have not been experimentally investigated in children who have experienced abuse and neglect. A community-based sample of 75 children aged 8-16 years with maltreatment documented on the basis of social services records, and a group of 70 peers matched on age, gender, cognitive ability, socioeconomic status, and ethnicity took part in the study. Children completed a trustworthiness face-judgement task in which they appraised the trustworthiness of unfamiliar facial stimuli varying along a computationally modelled trustworthiness dimension. In line with clinical observations that childhood maltreatment is associated with an atypical pattern of trust processing, children with maltreatment experience were significantly less likely than their peers to rate unfamiliar faces as trustworthy. Moreover, they were more variable in their trust attributions than their peers. The study provides compelling experimental evidence that children with documented maltreatment perceive others as less trustworthy than their peers and are less consistent in their estimates of trustworthiness in others. Over time, alterations in trust processing may disrupt the development of social bonds and contribute to 'social thinning' (a reduction in the extent and quality of social relationships), leaving children more vulnerable to environmental stressors, increasing risk of mental health difficulties.

Trajectories of participation, mental health, and mental health problems in adolescents with self-reported neurodevelopmental disorders

Purpose Having a neurodevelopmental disorder (NDD) increases the risk of mental health problems and lower participation. We investigated the trajectories of mental health problems and participation in adolescents with NDD and compared these with trajectories for peers without NDD. In addition, the relationship between participation, mental health (well-being), and mental health problems were investigated. Materials and methods Data from a Swedish longitudinal survey study (LoRDIA) was used and adolescents with and without self-reported NDD were followed from 12/13 to 17 years, in three waves. Mental health problems were measured using the Strength and Difficulties Questionnaire, and well-being was measured with the Mental Health Continuum short form. Results Adolescents with NDD experience more mental health problems than adolescents without NDD. Hyperactivity, a key feature of NDD, remains stable, while emotional problems and psychosomatic complaints, increase over time for girls, independent of NDD. Participation is stable over time but is more related to well-being than to NDD or mental health problems. Conclusions Gender is an important factor with girls exhibiting more problems. Mental health explains more of the variation in participation than mental health problems and NDD. Probably participation intervention can enhance mental health which may protect from mental health problems. Implications for rehabilitation Mental health, i.e., emotional-, social-, and psychological well-being is more strongly related to participation and to reduced levels of mental health problems than having an NDD or not, thus assessing mental health separately from measuring NDD is important. Interventions focusing on participation may lead to higher mental health and having high mental health (flourishing) may facilitate participation. Girls with self-reported NDD seem to have a higher burden of mental health problems, especially if they also are languishing, i.e., having low mental health, therefore a strong focus on this group is needed both in research and clinical practice. Half of all adolescents are flourishing, independently of NDD or not, even if they are experiencing some symptoms of mental health problems, adolescents with NDD who are also languishing, have much higher ratings of mental health problems.