Mental Health Symptom Severity Research Articles

The Impact of Parental Solid Self, Treatment Involvement, Stress, and Parenting Styles on Children’s Mental Health Symptom Severity

AbstractWith the increasing rate of mental health disorders among youth in the United States (U.S.) and the essential role of parents in children’s development, many studies have investigated the relationship between parental factors and children’s mental health. The current study expanded on this research by exploring the impact of parent solid self (i.e., one subcategory of differentiation of self), parenting stress, parenting styles, and parent involvement in treatment on children’s mental health symptom severity. The sample included 216 parents (U.S. residents; Mage = 33.84, SDage = 5.384) with at least one youth aged 3–17 years actively or historically in mental health treatment. Participants completed an online survey that included a demographic questionnaire and measures of parenting styles, parental solid self, parental stress, and children’s symptom severity. A simple linear regression found that parental solid self and stress levels were associated with the severity of children’s symptoms. A two-way ANOVA revealed that parenting styles had a significant main effect on children’s symptom severity. Results also showed that the level of authoritative parenting style mediated the relationship between parental solid self and children’s symptom severity. This study further highlighted the importance of promoting individual therapy or psychoeducation for parents and how it might benefit children’s treatment. Future research may consider children’s perspectives, how parents engage with their child’s treatment, incorporating more expansive assessment methods, and longitudinal designs to further explore the impact of parents’ differentiation of self, parental stress, parenting styles, and parental involvement in treatment on children’s symptom severity.

Impact of ataxia aetiology on self-reported mental health, fatigue, cognition and ataxia symptom severity

IntroductionIt has been increasingly recognised that the impact of Ataxia extends beyond physical and motor symptomology. However, it is less known whether self-reported non-motor and ataxia symptom severity varies across ataxias of differing aetiology, which would have important implications for providing more targeted treatment.AimThis study aimed to investigate the impact of ataxia aetiology (hereditary, acquired or idiopathic) on self-reported depression, anxiety, fatigue, cognitive deficits, and ataxia symptom severity. Comparisons were also made between the ataxia sample as a whole and a neurologically healthy control group.MethodResponses were collected using a cross-sectional online survey to recruit a national UK sample of people with ataxia.ResultsThe study recruited 110 participants with ataxia (hereditary = 51, acquired = 16, idiopathic = 43) and 32 healthy controls. No significant differences were found across study variables for different causes of ataxia. However, participants with ataxia did report significantly higher levels of depression, anxiety, fatigue, cognitive deficits, and ataxia symptom severity compared to healthy controls.ConclusionThis study found that participants with ataxia self-reported increased non-motor symptoms compared to healthy controls, which was a generally homogenous experience across different causes of ataxia. There was also considerable comorbidity of symptoms which requires further exploration. This study highlights the need for early assessment and intervention to address these non-motor symptoms in ataxia populations.

Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study.

Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions. This preregistered (see https://osf.io/vh2et/) retrospective cohort intent-to-treat study with 2,819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes. Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Overall, the MHP was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

Impact of sleep and mental health in adolescence: an overview.

Sleep deprivation is known to affect multiple aspects of mental health, physical health, and daily functioning. With increasing reports of sleep disturbances and increasing mental health needs in adolescents, it is imperative that healthcare providers have a strong understanding of the relationship between sleep and mental health, the impact of poor sleep on the school experience, and an understanding of behavioral interventions targeting sleep practices. Recent studies have shown that the relationship between sleep and mental health is complex and multifaceted. While mental health diagnoses and symptoms can negatively influence sleep quality and quantity, so too does poor sleep increase the risk of mental health diagnoses, symptom severity, and suicide risk. Sleep likewise affects the school experience, both positively and negatively. Targeted interventions and prevention programs may be effective in treatment of sleep disturbances for adolescents. Clinicians must be aware of the above associations and their clinical implications. Patients with either mental health or sleep concerns should be screened for potential co-morbid conditions. Improving sleep hygiene practices can improve the sleep experience in adolescents, however, there remains a gap in understanding the best method to improve sleep hygiene practices in this population.

Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs.

Whether Latinx families use youth mental health services (MHS) depends on complex influences of barriers and facilitators within and outside of the home. This research sought to shed light on caregiver strain as part of the equation focused on parental identification and responses to youth mental health needs. We examined multiple dimensions of caregiver strain as potential mediators between youth mental health symptom severity and psychological counseling utilization. The present sample consisted of 598 Latinx caregivers to youths ages 6-18 who provided information on youth internalizing and externalizing problems, caregiver strain, and youth psychological counseling service utilization within the last year. Our findings suggest that youth symptom severity (internalizing and externalizing problems) was generally positively associated with dimensions of caregiver strain. Youth symptom severity through objective and subjective internalized strain pathways were associated with greater odds of youth MHS utilization. In contrast, youth symptom severity through subjective externalized strain reduced the odds that Latinx caregivers would report utilizing youth MHS. These models only partially mediated the relationship between youth problems and service use. Findings suggest that Latinx caregivers may navigate conflicting sources of strain related to their child's mental health problem severity in ways that may differentially impact the odds that they access youth MHS. Along with addressing structural and systemic barriers to care, utilization of psychological counseling services may also be improved through interventions that help Latinx caregivers view youth services as avenues for addressing caregiver strain and providing psychoeducation that frames externalized strain within a mental health lens.

Crisis responders in Sri Lanka: Exploring impact and treatment considerations through the perspectives of mental health professionals

Purpose – South Asian mental health professionals were invited to identify influences on mental health symptom severity among responders during crisis events in Sri Lanka. Further consideration was given to the treatment that could be applied to improve the mental wellbeing of such individuals. Methodology – Twenty-nine mental health professionals (14 civilian and 15 military based) completed a semi-structured interview that incorporated a guided discussion on the mental health experiences observed in crisis responders. Key findings – Thematic Analysis was conducted, yielding two categories. The first understanding from mental health professionals of the impact of trauma that crisis responders in Sri Lanka can experience providing 10 themes capturing the diversity of impact on mental health and social structures. The second category was effective intervention for crisis mental health responders and yielded two main themes. A number of subthemes underpinned each theme across the two categories. Originality – The current study is one of the first to explore mental health symptomology and treatment considerations for crisis responders in a South Asian sample, through the perspective of mental health responders.

E049 Including psychosocial approaches in paediatric and adolescent rheumatology: a service evaluation of an online art therapy group intervention for children, young people, and families

Abstract Background/Aims Children and young people with long-term physical conditions may develop mental health problems that have an impact upon their daily lives and families. Rates of anxiety and depression in children with juvenile idiopathic arthritis are higher than in peers without this diagnosis. The impact of long-term conditions on children and young people’s mental health and the pressure it puts on family life has been observed and reported in paediatric rheumatology clinics in the UK. Art therapy has long been considered to be a developmentally appropriate way to support children and young people with long-term conditions and it is routinely provided in some NHS services. A service evaluation of manualised online art therapy groups was carried out at the Great North Children’s Hospital to seek further understanding about the accessibility, acceptability, and uptake of this service. Methods A service evaluation was registered and undertaken at the Great North Children’s Hospital, Newcastle Upon Tyne. Art therapy groups consisted of six online 90min sessions with additional resources provided to parents to encourage conversations at home prior to the young people attending the group. Groups were facilitated by a HCPC registered art psychotherapist and included completion of structured activities/worksheets and art making time. Young people who attended the rheumatology service art therapy groups were asked for feedback about their experiences and a audio-recorded focus group style discussion with the art therapy delivery team was conducted. In addition, children and parents were asked to comment on the acceptability of standardised assessment measures that could be utilised in future outcome studies of psychosocial interventions of this kind. Results Thirteen young people who had accessed the art therapy group were included in the service evaluation which was carried out by members of the therapy team and nursing staff. Young people attending the group reported experiencing personal benefits, including valuing opportunities to speak with other young people who had a long-term condition and engagement and sharing a group experience through art activities. Parents responded positively to having time to reflect using the home-based resources and some observed their children appearing calmer and more able to express themselves. Online and digital access difficulties did create barriers to consistent attendance for some group members. Measures of outcome that were considered acceptable for completion by young people and family members included a validated quality of life assessment. Parents and staff reported underestimating the severity of mental health symptoms (anxiety and depression) indicated in young people’s response to completion of a validated measure. Conclusion Online group art therapy was considered to be accessible and acceptable as routinely provided in a paediatric and adolescent rheumatology service. Future research could be undertaken to formally assess the effectiveness of these types of psychosocial interventions. Disclosure S.S. Hackett: None. S. Jandial: None. L. Craig: None. P. Watts: None.

Assessing the patient's affective perception of their psychotherapist: validation of the in-Session Patient Affective Reactions Questionnaire.

Psychotherapists need effective tools to monitor changes in the patient's affective perception of the therapist and the therapeutic relationship during sessions to tailor therapeutic interventions and improve treatment outcomes. This study aims to evaluate the factor structure, reliability, and validity of the in-Session Patient Affective Reactions Questionnaire (SPARQ), a concise self-report measure designed for practical application in real-world psychotherapy settings. Validation data was gathered from (N = 700) adult patients in individual psychotherapy. These patients completed the SPARQ in conjunction with additional measures capturing sociodemographic details, characteristics of therapeutic interventions, individual personality traits, mental health symptom severity, elements of the therapeutic relationship, and session outcomes. This comprehensive approach was employed to assess the construct and criterion-related validity of the SPARQ. The SPARQ has a two-factor structure: Positive Affect (k = 4, ω total = .87) and Negative Affect (k = 4, ω total = .75). Bifactor confirmatory factor analysis (CFA) yielded the following fit indices: X2[df] = 2.53, CFI = .99; TLI = .98; RMSEA = .05; and SRMR = .02. Multi-group CFAs demonstrated measurement invariance (i) across patients who attended psychotherapy sessions in person versus in remote mode, and (ii) across patients with and without psychiatric diagnoses confirmed metric invariance. Furthermore, the SPARQ showed meaningful correlations with concurrently administered measures. The SPARQ proves to be a valuable instrument in clinical, training, and research contexts, adept at capturing patients' session-level affective responses towards their therapist and perceptions of the therapeutic alliance. Comprehensive descriptive statistics and a range of score precision indices have been reported, intended to serve as benchmarks for future research.

Gender Identity and Mental Health Symptom Severity Among Adolescents Admitted to an Inpatient Psychiatric Hospital.

Transgender youth are at an increased risk of suicide, substance use, experiencing violent assaults, and reporting major depressive episodes and greater psychological distress compared to their cisgender counterparts. This study examined mental health symptom severity in adolescents admitted to an inpatient psychiatric hospital who wished they were of a different gender compared to those who did not. A group of 180 adolescents admitted to an inpatient psychiatric hospital completed assessments to measure mental health symptom severity at admission. Gender diverse (n = 90) and cisgender (n = 90) groups were established. Analyses of variance (ANOVA) were used to examine between group (gender diverse vs. cisgender) difference on depression, anxiety, suicide risk, nighttime sleep quality, and emotion regulation problems. Results revealed significant differences in emotion regulation difficulties at admission, specifically in nonacceptance and awareness. There were no significant differences on measures of depression, anxiety, suicide risk, and nighttime sleep quality at admission. This study is one of the first to measure mental health symptom severity in gender diverse adolescents while admitted to an inpatient psychiatric setting. Adolescents in the gender diverse group had significantly higher level of difficulty with emotion regulation, which may indicate an increased risk of developing psychiatric symptoms such as depression and anxiety. This paper demonstrates the importance of using targeted interventions to address difficulties with emotion regulation in at-risk adolescents.

Validating the efficacy and value proposition of mental fitness vocal biomarkers in a psychiatric population: prospective cohort study.

The utility of vocal biomarkers for mental health assessment has gained increasing attention. This study aims to further this line of research by introducing a novel vocal scoring system designed to provide mental fitness tracking insights to users in real-world settings. A prospective cohort study with 104 outpatient psychiatric participants was conducted to validate the "Mental Fitness Vocal Biomarker" (MFVB) score. The MFVB score was derived from eight vocal features, selected based on literature review. Participants' mental health symptom severity was assessed using the M3 Checklist, which serves as a transdiagnostic tool for measuring depression, anxiety, post-traumatic stress disorder, and bipolar symptoms. The MFVB demonstrated an ability to stratify individuals by their risk of elevated mental health symptom severity. Continuous observation enhanced the MFVB's efficacy, with risk ratios improving from 1.53 (1.09-2.14, p=0.0138) for single 30-second voice samples to 2.00 (1.21-3.30, p=0.0068) for data aggregated over two weeks. A higher risk ratio of 8.50 (2.31-31.25, p=0.0013) was observed in participants who used the MFVB 5-6 times per week, underscoring the utility of frequent and continuous observation. Participant feedback confirmed the user-friendliness of the application and its perceived benefits. The MFVB is a promising tool for objective mental health tracking in real-world conditions, with potential to be a cost-effective, scalable, and privacy-preserving adjunct to traditional psychiatric assessments. User feedback suggests that vocal biomarkers can offer personalized insights and support clinical therapy and other beneficial activities that are associated with improved mental health risks and outcomes.

Perceived social support moderates the relations between mental health symptoms and current suicidal ideation.

Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the relationship between mental health (MH) symptoms and current SI among men and women have been hampered by limitations. To address knowledge gaps, data from the Comparative Health Assessment Interview Research Study was used to evaluate whether (a) perceived social support moderates the relationship between mental health symptoms (posttraumatic stress, anxiety, alcohol use, depressive) and current SI among veterans and nonveterans; (b) the strength of this moderating effect varies by gender and veteran status; and (c) the strength of this moderating effect varies by social support source (significant other, friend, family). Results suggest that perceived social support is more protective against SI for those with lower levels of mental health symptoms (≤ 25th percentile) than for those with higher symptom levels (≥ 75th percentile). Findings were largely consistent across study groups, support sources, and mental health symptoms examined; however, a significant moderating effect on the alcohol use-SI relationship was only observed for veteran men. Those with a lower mental health symptom severity may receive more benefit from strategies aimed at increasing perceived social support compared to those with higher symptom severity. Research is needed to match protective factors to individual phenotypes, with the goal of engaging those living with SI in more effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Influence of mental health service provision on the perceived quality of life among psychiatric outpatients: associations and mediating factors.

ObjectiveTo investigate the relationship between perceived mental health service provision and quality of life (QoL) as perceived by patients in psychiatric outpatient care.MethodsA total of 373 adult patients registered at 15 psychiatric outpatient clinics in three regions in central and southern Sweden were included in the study. Survey data were collected using a questionnaire on mental health service provision, symptom severity, recovery, clinical diagnosis, sociodemographics (serving as independent variables) and QoL (serving as the dependent variable). Three aspects of mental health service provision were used: patients’ perceived quality of care, perceived staff-patient interaction, and patient reported psychiatric treatments. Structural equation modelling was used to model the relationship among the variables.ResultsVariables in mental health service provision showed few direct associations with patients’ perceived QoL. Instead, the associations of mental health service provision on QoL were mainly mediated through symptom severity and recovery. These relationships were retained after adjusting for sociodemographic variables and clinical diagnoses. The final model achieved excellent goodness of fit (χ2 = 49.502, p = 0.230, RMSEA = 0.020, CFI = 0.997 and a SRMR = 0.024).ConclusionThis study shows that mental health service provision is associated with patients’ perceived QoL; however, this association is mostly indirect and mediated by reduced symptom severity and increased recovery. This finding can help inform the design of future interventions to enhance service provision to improve patients’ QoL.

The value of HoNOS in assessing mental health symptom severity and social functioning in forensic outpatients

ABSTRACT The Health of the Nation Outcome Scales (HoNOS) is used for routine outcome measurement in forensic outpatient mental health care. Until now, no research has been done on its psychometric properties and clinical value in this population. Statistical analyses on 3,951 forensic outpatients (general violence, domestic violence, property offense, and sexual offense) showed that at domain level internal consistency coefficients varied between .30 and .58. The item scores were heavily skewed with scores in the subclinical range. Non-parametric analyses revealed that, at item level, aggressive offenders scored significantly higher (but still subclinical) than other offender subgroups. Compared to general mental health samples, forensic outpatients scored significantly lower (mainly large effects) on the total rating. Based on these results, it is concluded that the HoNOS does not provide good psychometric properties nor clinical value for ROM purposes in forensic outpatients.

Improvements in sleep problems and their associations with mental health symptoms: A study of children and adolescents participating in a digital mental health intervention.

A growing number of youth are utilizing digital mental health interventions (DMHIs) for treatment of mental health problems such as anxiety, depression, and ADHD. Although these mental health symptoms are closely related to sleep problems, it is unknown whether nonsleep DMHIs indirectly confer improvements in sleep. Using retrospective data, the current study assesses (1) whether youth sleep problems improve over participation in a nonsleep DMHI, and (2) whether mental health symptom severity and improvement are correlated with sleep problem severity over time. Sleep problems and mental health symptoms were assessed every 30 days among children (ages 5-12) and adolescents (ages 13-17) participating in a pediatric digital mental health intervention (DMHI; N = 1219). Children and adolescents with elevated sleep problems (39.3%; n = 479) were older (P < .001), more predominantly female (P < .001), and more likely to have elevated anxiety (P < .001), depressive (P < .001) and inattention symptoms (P = .001), as compared to those with nonelevated sleep problems (60.7%; n = 740). From the baseline to last assessment, 77.3% (n = 269) of members with elevated sleep problems exhibited improvements, with sleep problems decreasing significantly over each month in care (P < .001). Members with improvements in anxiety, depressive, and/or ADHD symptoms had larger improvements in sleep over time compared to their peers with no improvement in their mental health symptoms (Months in care*Change type: P < .001 for all). Our results provide preliminary evidence that participation in a pediatric DMHI is associated with improvements in sleep problems, even when youth are not being treated directly for sleep problems. These findings highlight a valuable secondary benefit of participating in mental health care within pediatric DMHIs and warrant further experimental research.

Assessing Pain Severity in Sickle Cell Disease Using Animations and a Graphical Body Image

Introduction: Adults living with sickle cell disease (SCD) most frequently seek medical care due to pain. To determine the most efficacious treatment plan for patients presenting with pain, providers must first accurately assess and diagnose the pain. Unfortunately, the current approaches for assessing pain are inadequate. Combined with medical provider biases, patients can often have their pain symptoms misinterpreted, ignored, or blatantly dismissed. To address this issue, we partnered with stakeholders, human-centered designers, and software engineers to design a novel pain assessment tool, called Painimation. Painimation allows patients to communicate their pain quality, intensity, and location using abstract animations and a paintable body image. Painimation has been validated in a general population with chronic pain, but there is limited data validating this approach in SCD. Preliminary data on the use of Painimation by adults with SCD (N = 67) found that those who described their pain using the “throbbing” animation had less severe pain symptoms than those endorsing the “shooting” animation. Objective: To replicate and extend prior findings by determining whether pain animations and body image data are associated with pain outcomes in a large cohort of adults with SCD. We hypothesized that the presence of shooting pain and greater body surface areas affected by pain would be associated with more severe pain outcomes and mental health symptoms. Methods: We performed a secondary analysis on baseline data from the “Cognitive Behavioral Therapy and Real-Time Pain Management Intervention for Sickle Cell via Mobile Application (CaRISMA)” Trial-a multisite randomized, controlled trial in adults with SCD and chronic pain. Eligible patients were randomized 1:1 to either digital cognitive behavioral therapy or digital education; in addition, both arms received at least 12 weeks of health coach support. At baseline, participants completed a battery of questionnaires and tracked their pain intensity (0-10) by the Visual Analog Scale (VAS) and mood daily via a mobile app. The Painimation app presents a front and back 2-dimensional body image that is paintable to indicate areas affected by pain. Users choose from abstract animations intended to represent different pain qualities; the intensity of the animations can be adjusted, and up to three can be selected. For the purpose of the analyses, participants were categorized into “Shooting Pain” vs “No Shooting Pain” and “Throbbing with Shooting and Stabbing” vs “Throbbing Alone,” based on our prior study. Participants were also split into groups based on whether the proportion of the body image painted was less than the median (&amp;lt;9.8% vs &amp;gt;=9.8%). Baseline characteristics and demographics were compared between groups, and multivariable regressions were used to estimate covariate-adjusted associations with the following outcomes at baseline: daily pain, Patient Reported Outcomes Measurement Information System (PROMIS) pain interference scale, Pain Catastrophizing Scale (PCS), Current Opioid Misuse Measure (COMM-9), and Adults Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) pain severity and frequency. Results: The trial enrolled 359 adults, mean age 36.3 (SD = 10.5), 66% female, 93% Black race. The “Shooting” painimation and greater body image scores were associated with all outcomes in univariate analyses (all p&amp;lt;0.01; Table 1) except for the proportion of “happy” mood days and anxiety scores. After controlling for age, depression, anxiety, % body image, and site, the shooting animations were independently associated with greater daily pain intensity (beta = 0.64; p = 0.046). After controlling for age, depression, and site, greater body image score was associated with daily pain intensity (beta = 1.18; p &amp;lt; 0.001), pain interference (beta = 2.87; p &amp;lt; 0.001), ASCQ-Me pain frequency (beta = 3.91; p =&amp;lt; 0.005), and ASCQ-Me pain severity (beta = 4.50; p = 0.002). Conclusion: Both the “shooting” animation and body image measures were associated with more severe pain outcomes. This study demonstrates that animations and body image data can be used to assess pain severity in SCD, more objectively than the 0-10 numeric VAS scale. Future studies should explore whether pain location and specific animation selected are associated with pain etiology, and determine whether this approach can differentiate different types of pain in SCD.

Abstract 12776: Sustained Impact of Peripartum Cardiomyopathy on Mental Health Disorders and Quality of Life

Introduction: Mental health diagnoses such as depression, post-traumatic stress disorder (PTSD), and anxiety are common after acute cardiovascular events. Peripartum cardiomyopathy (PPCM) affects women near the end of pregnancy or in the near post-partum period and occurs during a period of heightened psychosocial stress. There is limited data on the prevalence of mental health diagnoses after the acute PPCM event. Methods: Patients with self-identified PPCM enrolled in the online PPCM Registry (PPCM-R at ppcmr.org) and completed validated surveys for depression (Patient Health Questionnaire - 9, PHQ-9), anxiety (Generalized Anxiety Disorder -7, GAD-7), PTSD ( Posttraumatic Stress Disorder Checklist- Civilian, PCL-C) and quality of life (Rand SF-36). Patients were recruited on PPCM support groups, social media, and physician referral. Results: After 4 months, 103 patients enrolled and 55 (54%) completed the mental health and QOL surveys. Mean age was 32.3 (SD 4.7) and median time since diagnosis was 4.2 years (IQR 1.7, 10.4 years). Mean (SD) PHQ-9 score was 8.1 (7.3) and 27% had a score (≥10) indicating moderate or severe depressive symptoms. Mean (SD) GAD-7 score was 7.3 (6.7) and 36% of participants had scores (≥10) consistent with moderate or severe anxiety symptoms. Mean (SD) PCL-C score was 20.7 (19.3) and 33% screened positive for PTSD. Overall, 30% of participants reported that QOL was ‘fair’ or ‘poor’ with lower domain scores for physical function, emotional function, energy/fatigue and general health compared to the general population. Characteristics of participants stratified by mental health symptom severity and QOL scores are presented in the Table. Conclusions: Half (51%) of participants had at least one mental health screening tool which indicated current moderate or severe symptoms of depression, anxiety or PTSD. These findings confirm a significant burden of mental health symptoms in this PPCM survivor cohort.

Believing in Change Matters! The Role of Emotion Malleability Beliefs in Emotion Regulation and Paranoid Ideation

Abstract Purpose Beliefs that emotions can be changed (i.e., malleability beliefs) are relevant to emotion regulation. Emotion regulation plays a crucial role in severe mental health symptoms, such as paranoid delusions, but it remains unknown to which extent malleability beliefs contribute to a dysfunctional pattern of emotion regulation in individuals experiencing paranoid ideation. Therefore, we investigated whether malleability beliefs are associated with paranoid ideation and whether emotion regulation accounts for this association. Methods We conducted a cross-sectional assessment in a sample of individuals with psychotic disorders (n = 50) and a community sample (n = 218) and collected self-report data on malleability beliefs, the use of emotion regulation strategies (reappraisal, acceptance, rumination, expressive suppression, experience suppression), and paranoid ideation. Results Multivariate regressions showed that greater beliefs that emotions are malleable predicted more reappraisal and acceptance in both samples and less rumination in the community sample. Malleability beliefs did not predict the strategies of suppressing an emotion or its expression. In the community sample, but not in the clinical sample, greater beliefs that emotions are malleable were associated with less frequent paranoid ideation and emotion regulation accounted for significant variance in the relationship. Conclusions The findings indicate that malleability beliefs do not contribute to paranoid delusions in individuals with psychotic disorders. However, in individuals with subclinical paranoid ideation, a failure to perceive emotions as malleable could hinder adaptive attempts to regulate emotions leading to increased negative affect and thereby pave the way for paranoid ideation. Malleability beliefs may thus represent a promising target for prevention.

Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis

Background Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses. Objective The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths’ groups. Methods This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables. Results In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1%, 95% CI 12.5%-13.7%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The “sad mood-appetite” edge was strongest in the gay or lesbian network; the “irritability-exaggerated startle response” edge was strongest in the bisexual network. Conclusions For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms.

Mental health and care utilization in survivors of adolescent and young adult cancer.

Adolescent and young adult cancer survivors experience mental health challenges, yet little is known about the evolution of these difficulties. This study explored mental health symptoms and utilization among long-term adolescent and young adult cancer survivors. Using 30 432 respondents from the 2019 National Health Interview Survey, this study compared adults with a history of adolescent and young adult cancer (diagnosed when patients were between 15 and 39 years of age) to adults without adolescent and young adult cancer. Mental health symptom severity was measured using the Patient Health Questionnaire depression scale and 7-item Generalized Anxiety Disorder questionnaires. Care utilization constituted psychotherapy and mental health medication use. Inverse propensity score weights were used to balance demographics and combined with survey weights. Descriptive statistics, multivariable generalized linear models, and structural equation modeling with 2-sided tests were used for analysis. We compared 639 adolescent and young adult survivors with 29 793 controls. Survivors were, on average, 20.5 years (SE = 0.74) past their cancer diagnosis dates. After adjusting for survey and propensity score weights, adolescent and young adult survivors reported more severe depression (incidence rate ratio = 1.42, 95% confidence interval [CI] = 1.09 to 1.84, P < .01) and anxiety (incidence rate ratio = 1.85, 95% CI = 1.55 to 2.21, P < .001). They were more likely to use psychotherapy (odds ratio = 1.91, 95% CI = 1.16 to 3.17, P < .05) and mental health medications (odds ratio = 1.89, 95% CI = 1.15 to 3.11, P < .05). Time since diagnosis was negatively associated with symptoms and utilization. Structural equation modeling demonstrated mediation of utilization effect by symptom severity. Adolescent and young adult survivors experience worse mental health in late survivorship, despite small improvements over time. We highlight the importance of survivorship care that addresses the long-term mental health needs of these survivors.

Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults.

Previous research has shown that autistic individuals report high levels of perceived stress and have an increased likelihood of developing mental health difficulties. Increase in individuals' negative emotions in relation to perceived stress (i.e. affective reactivity to stress) is a known risk factor for mental health difficulties. In this study, we investigated perceived daily stress and affective reactivity to stress in autistic (n = 39, age = 18.4) and non-autistic (n = 55, age = 18.1) adolescents and young adults. We used the ecological momentary assessment, a technique that allows to assess individuals repeatedly in their daily life using their smartphone. Moreover, participants filled a questionnaire to evaluate the strategies they use to regulate emotions when faced with difficulties. Finally, a clinical interview and a parent-report questionnaire were used to assess mental health symptoms. Autistic youth reported higher levels of perceived daily stress compared with non-autistic peers. Moreover, they showed increased affective reactivity to stress related to their daily activities. Autistic participants reported more emotion regulation difficulties (e.g. more repetitive thinking of difficulties) compared with non-autistic participants. Difficulties in emotion regulation increased negative emotions in relation to stress and might contribute to the severity of mental health symptoms. We conclude that adolescents and young adults with autism report high perceived stress in their daily lives. To minimize the negative impact of stress and the development of mental health symptoms, people supporting autistic young people could focus on stress management skills and the strategies that the youth use to manage emotions.