Prevention Of Mental Disorders Research Articles

The prevalence of confirmed childhood trauma and its’ impact on psychotic-like experiences in a sample of Chinese adolescents

Adolescents with childhood trauma may be associated with psychotic-like experiences (PLEs) and is at high risk for later development of psychoses. Exploring early age risk factors for childhood trauma may provide useful information for prevention of mental disorders and improvement of mental health, yet no studies have examined the association between exposure to specific forms of trauma and different types of PLEs in a sample of Chinese adolescents. Thus, the Childhood Trauma Questionnaire-Short Form was used to measure five types of childhood trauma (emotional abuse, EA; physical abuse, PA; sexual abuse, SA; emotional neglect, EA; physical neglect, PA) in junior middle school students. And the positive subscale of Community Assessment of Psychic Experiences divided into four types (bizarre experiences, perceptual abnormalities, persecutory ideation and magical thinking) was used to measure PLEs. Then the possible associations among demographic information and specific types of childhood trauma on specific forms of PLEs was compared. The rates of EA, PA, SA, EA and PA were 14.2%, 13.0%, 16.1%, 60.0%, and 78.6%, respectively. Moreover, childhood trauma seems to be a main role in the development of PLE, and EA and SA patients are particularly likely to experience PLEs.

Perspectives, Experiences, and Practices in the Use of Digital Information Technologies in the Management of Depression and Alcohol Use Disorder in Health Care Systems in Colombia.

Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.

Prevention of mental health disorders: A yogic perspective

This universal prayer of Vedic lineage clearly indicates the concern of community health care because someone with a “healthy mind” has clear thoughts, the ability to solve the problems of daily life, enjoys good relationships with friends, family, and work colleagues, is spiritually at ease, and can bring happiness to others. Where as Mental Health Disorders can be defined as any illness experienced by a person which affects their emotions, thoughts or behavior, is out of keeping with their cultural beliefs and personality, and produces a negative effect on their lives or the lives of their families. Symptoms of illness can appear in the form of persistent changes in mood, perception of reality, or capacity to organize or maintain thoughts. Such changes will interfere with the person’s usual beliefs, personality or social function. Results of a recent assessment of 184 of 196 World Health Organization (WHO) member states (representing 95% of WHO member states and 98% of the world’s population) have indicated that there is a growing burden of neuropsychiatric & Psychological disorders and that mental health resources remain insufficient (WHO 2011). Regarding psychosocial interventions, only 44% of countries providing these services. Upper-middle income and high income countries provide more psychosocial care at a majority of facilities (61% and 59% respectively) compared to lower-middle (34%) and low income countries (14%). Yoga today is gaining popularity, today, yoga has been considered the science of correct living and therefore is intended to the imbibed in daily life. It not just works on any single aspect of a persons life, rather it works on the physical, the emotional, the mental as well as the spiritual level, and yoga is considered a means of harmonizing and balancing the body, emotion and mind. Keywords: Mental Health Disorders, Yogic Philosophy, Chakras, Pranas.

Mental health of disabled children: a preventive aspect

The aimis to identify the priority directions for preventing mental disorders in disabled children following a comprehensive analysis of clinical, social, psychological, ethnic and cultural characteristics over 2009– 2017.Materials and methods. 2,204 people were included in the study: disabled children, students of remedial schools aged 7–18 years old (n = 834); parents of disabled children (n = 772); teachers working in various educational facilities (n = 217); respondents of the survey identifying people’s attitude towards children with disabilities (schoolchildren, students, adults, n = 381). Clinical, psychological and statistical methods were used in the study. To identify depression and anxiety in children, Children’s Depression Inventory (CDI), Childhood Myositis Assessment Scale (CMAS), PedsQL inventory, survey on coping strategies (E. Heim) and adapted questionnaires for suicidal risk and alexithymia were used. For adult participants, the Quality of Life Scale, Hamilton Anxiety Rating Scale, Hospital Anxiety and Depression Scale (HADS), and a questionnaire identifying the attitude towards children with disabilities were applied.Results. A high prevalence of mental disorders in children with disabilities (62.7–95.2%) was identified, and the levels of anxiety, suicidal risk, alexithymia were determined. Children’s families were characterized by impaired structure (50%), parenting styles resulting in pathologies (71.5%), low income level (60%), low qualifications of parents and unemployment (13%), alcohol abuse (17.6%), victimized attitudes and low satisfaction with the psychological criteria of quality of life, combined with low level of anxiety. For teachers, the levels of anxiety and depression and signs of burnout were revealed, and the features of their interaction with disabled children in the educational process were described. The attitude of different social groups to children with disabilities was studied. The methodological conditions for carrying out research and organizing medical and psychological care were formulated.Conclusion. Prevention of mental disorders in disabled children includes identification of early signs of anxiety, depression, suicidal risk and assessment of the quality of life and work. This is ensured by a reasonable choice of research methods, psychosocial rehabilitation with involvement of beloved people, and increase in the tolerance level towards children with disabilities in the society.

Current problems and development trends of specific complex methods for the diagnosis of neurotic disorders

The article is devoted to the development and testing of methods for screening and diagnosis of risk factors for the development of neurotic disorders and their initial clinical manifestations. Modern approaches to medicine are aimed at the prevention and early diagnosis of borderline mental disorders in order to provide more effective and personalized care. 87 people were examined, which, on the basis of a preliminary examination, were divided into individuals with low and high levels of neuropsychics resistance. The results of the study show significant differences in the indicators of ECG, EEG, speech signal on the psycho-activating effect between these groups. The data obtained can be used to develop a neuro-interface that has in its structure the ability to record and process ECG, EEG and speech signals, which will allow for holter monitoring of the state of mental health, thereby increasing the percentage of verified diagnosis of diseases of the neurotic spectrum.

SSSPP Position paper: Physical activity and mental health

Promoting physical activity (PA) has not yet been established as a standard procedure in psychiatric care. Psychiatric patients are at higher chance to be physically inactive which contributes to increased morbidity and mortality. Regular PA has shown to improve mental wellbeing in the general population and reduces the risk to develop several mental disorders. Assessing PA and motivation for change should be ­established as routine in psychiatric practice. The recommended dose of exercise for optimal health benefits should be achieved and recommendations on exercise-prescription as well as coaching-programs tailored for mentally ill patients should be developed. Structured exercise therapies should become part of standard psychiatric care. A network of “mental health friendly” sports-clubs could help to facilitate PA for psychiatric populations. Public awareness of mental health benefits of exercise specifically in the prevention of mental disorders is an important topic addressed by the Swiss Society of Sports-Psychiatry and -Psychotherapy. This includes interdisciplinary and interprofessional coordination of efforts to bring more PA into mental health.

Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review.

The role of a properly balanced diet in the prevention and treatment of mental disorders has been suggested, while vegetables and fruits have a high content of nutrients that may be of importance in the case of depressive disorders. The aim of the study was to conduct a systematic review of the observational studies analyzing association between fruit and vegetable intake and mental health in adults. The search adhered to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42019138148). A search for peer-reviewed observational studies published until June 2019 was performed in PubMed and Web of Science databases, followed by an additional manual search for publications conducted via analyzing the references of the found studies. With respect to the intake of fruit and/or vegetable, studies that assessed the intake of fruits and/or vegetables, or their processed products (e.g., juices), as a measure expressed in grams or as the number of portions were included. Those studies that assessed the general dietary patterns were not included in the present analysis. With respect to mental health, studies that assessed all the aspects of mental health in both healthy participants and subjects with physical health problems were included, but those conducted in groups of patients with intellectual disabilities, dementia, and eating disorders were excluded. To assess bias, the Newcastle–Ottawa Scale (NOS) was applied. A total of 5911 studies were independently extracted by 2 researchers and verified if they met the inclusion criteria using a 2-stage procedure (based on the title, based on the abstract). After reviewing the full text, a total of 61 studies were selected. A narrative synthesis of the findings from the included studies was performed, which was structured around the type of outcome. The studies included mainly focused on depression and depressive symptoms, but also other characteristics ranging from general and mental well-being, quality of life, sleep quality, life satisfaction, flourishing, mood, self-efficacy, curiosity, creativity, optimism, self-esteem, stress, nervousness, or happiness, to anxiety, minor psychiatric disorders, distress, or attempted suicide, were analyzed. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. However, it must be indicated that the studies included were conducted using various methodologies and in different populations, so their results were not always sufficiently comparable, which is a limitation. Taken together, it can be concluded that fruits and/or vegetables, and some of their specific subgroups, as well as processed fruits and vegetables, seems to have a positive influence on mental health, as stated in the vast majority of the included studies. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health.

Implementing of mental health training programs for promotion of health affected teenage girls to premenstrual syndrome: A community-based study.

BACKGROUND:Mental health is one of the major determinants of a person's health which has a significant impact on the quality of life. Implementing of mental health training programs for promotion of health affected teenage girls to premenstrual syndrome (PMS) in Shiraz, southern Iran: a community-based study.MATERIALS AND METHODS:This study is randomized controlled trial done on 100 teenage girls affected to PMS in Shiraz-Iran (selected from400 girls). Multistage cluster sampling method was used f or sampling. In the intervention group, six training sessions were held twice a week for 2 h. For data collection, Standard Goldberg Mental Health Questionnaire-28 and Premenstrual Symptoms Screening Tool were used. For data analysis, independent t-test and Chi-square statistics were used at significant level of 0.05.RESULTS:The average age was (16.56 ± 0.92) and (16.24 ± 1.45) in the intervention and control groups, respectively. The average intensity of physical complaints, level of anxiety and sleep disorder, level of social functions disorders and depression were significantly lower in the group of training classes than control group (P < 0.001).CONCLUSION:Appropriate training-care programs are effective in reducing stress and improving mental health, prevention and treatment of mental disorders, emotional growth, and development of communication skills among female students with premenstrual syndrome.

COMORBIDITY OF NON-PSYCHOTIC MENTAL DISORDERS AND NEUROLOGIC SYMPTOMS AMONG YOUNG PEOPLE

The aim: to determine occurrence and structure of non-psychotic mental disorders associated with chronic pain among young people. Materials and methods: The results of examination of 1235 students were analyzed. The following methods were applied: clinical, clinical-psychopathological, clinical-epidemiological, clinical-anamnestic, experimental-psychological and statistical. Results: Students with neurotic disorders associated with stress and somatoform disorders were found to prevail in the main group (F40-48.1) 187 (58,99%), affective mood disorders were on the second position (F30-34.1) - 79 (24,92%) individuals, followed by disorders of a mature personality and behavior of adults (F60-60.7) diagnosed in 31 (9,78%) students, and at last, behavioral syndromes associated with physiological disorders and physical factors (F50-51.4) - 20 (6,30%) respectively. Chronic pain syndrome was diagnosed in 113 (35,65%) students with NMD including 43 (38,05%) men and 70 (61,95%) women. The majority of young people (86 individuals - 76,11%) observed severe pain, and 27 (23,89%) of them - moderate pain. A clear correlation was found between a depressive episode and CPS (γ<0,02). Conclusions: The findings obtained should be considered in development of screening systems concerning diagnostics, prevention of nonpsychotic mental disorders associated with chronic pain syndrome.

Mental Health of Students in the Philippines during Pandemic: An assessment

This research was made to assess the mental health and psychological wellness during the community quarantine of the 500 selected students from the College of Management and Business Technology (CMBT), of Nueva Ecija University of Science and Technology (NEUST). The CMBT was located at Sumacab, Cabanatuan City, Philippines. The outcomes of the present study will be beneficial and valuable to the following: To the students. The result of this study will provide necessary pieces of information of the mental health of the student which could be a great help to the respondents in understanding themselves. It can also help them to be more aware about mental and psychological health through the help of the recommendation of the researchers; To the Parents. The results of this study will be beneficial to the parents having children who have the same age bracket as the respondents. The recommendations will help them in dealing with the problems with their children’s mental health issues which is not easy to know. To the School. The results of this study can help the school as well as the guidance counselors to know what the main problem of the students is and immediately formulate actions to avoid possible negative effects that can harm the well-being of the students under their supervision. To the Philippine Mental Health Association, Inc. The results of this study will strengthen their promotion of mental health and the prevention of mental health disorders. Lastly, this will also be beneficial to future researchers to draw pertinent results to their studies. The researchers used a set of a survey questionnaire in gathering pertinent data. The questionnaires were disseminated via an online Google form survey sent to the respondents. After all the data needed were gathered, the frequencies of answers in each question were tallied and their percentage was obtained. Through these, the researchers obtained well conclusions and suitable recommendations.

Почуття провини та моральний розвиток особистості: психолого-педагогічні аспекти

The role of the phenomenon of guilt in the moral development of the individual is explored in the article. Blame is seen as an adaptive mechanism that participates in the processes of self-regulation and performs a control and evaluation function in them. The psychological nature of the guilt experience is characterized as a feeling that arises in the process of realizing the discrepancy between the moral norms assigned to the individual and his or her actions. It is emphasized that guilt is a regulatory mechanism that ensures the harmonization of external behavioral and internal psychological structures, while fulfilling an integrative function, as well as the function of self-control through the awareness of the inconsistency of one’s own actions with appropriated moral standards. Guilt performs the following basic functions: acts as a moral regulator in maintaining norms of prosocial behavior; participates in the formation of self-esteem; contributes to the prevention of mental disorders. The feeling of guilt gives the person information about his behavior, reflects on the successful interaction with the external environment, the process of socialization and adaptation in society. In the educational process, you can use only the positive function of guilt, the occurrence of which depends on the individual characteristics of the child, features of his experience, as well as features of physiological development. In order to develop a sense of guilt, it is necessary to fulfill three psychological conditions: acceptance by the person of moral values; assimilation of sense of moral responsibility and observance of these values; sufficient capacity for self-criticism as a condition for perceiving contradictions between real behavior and accepted values. At the end of younger school age, children gradually develop the ability to regulate their own volitional behavior, the ability to control their actions and, in general, to obey them. This period is the most favorable for the development of guilt. The child’s sense of guilt is at the heart of the formation of features of further behavior and actions and the development of its moral sphere.

The epigenetics of perinatal stress .

Early life adversity is associated with long-term effects on physical and mental health later in life, but the mechanisms are yet unclear. Epigenetic mechanisms program cell-type-specific gene expression during development, enabling one genome to be programmed in many ways, resulting in diverse stable profiles of gene expression in different cells and organs in the body. DNA methylation, an enzymatic covalent modification of DNA, has been one of the principal epigenetic mechanisms investigated. Emerging evidence is consistent with the idea that epigenetic processes are involved in embedding the impact of early-life experience in the genome and mediating between social environments and later behavioral phenotypes. Whereas there is evidence supporting this hypothesis in animal studies, human studies have been less conclusive. A major problem is the fact that the brain is inaccessible to epigenetic studies in humans and the relevance of DNA methylation in peripheral tissues to behavioral phenotypes has been questioned. In addition, human studies are usually confounded with genetic and environmental heterogeneity and it is very difficult to derive causality. The idea that epigenetic mechanisms mediate the life-long effects of perinatal adversity has attractive potential implications for early detection, prevention, and intervention in mental health disorders will be discussed.

Assessing and Improving the Quality in Mental Health Services.

Background: The mental health of the population consists of the three essential pillars of quality of life, economy, and society. Mental health services take care of the prevention and treatment of mental disorders and through them maintain, improve, and restore the mental health of the population. The purpose of this study is to describe the methodology for qualitative and quantitative evaluation and improvement of the mental health service system. Methods: This is a narrative review study that searches the literature to provide criteria, indicators, and methodology for evaluating and improving the quality of mental health services and the related qualitative and quantitative indicators. The bibliography was searched in popular databases PubMed, Google Scholar, CINAHL, using the keywords “mental”, “health”, “quality”, “indicators”, alone or in combinations thereof. Results: Important quality indicators of mental health services have been collected and presented, and modified where appropriate. The definition of each indicator is presented here, alongside its method of calculation and importance. Each indicator belongs to one of the eight dimensions of quality assessment: (1) Suitability of services, (2) Accessibility of patients to services, (3) Acceptance of services by patients, (4) Ability of healthcare professionals to provide services, (5) Efficiency of health professionals and providers, (6) Continuity of service over time (ensuring therapeutic continuity), (7) Efficiency of health professionals and services, (8) Safety (for patients and for health professionals). Discussion/Conclusions: Accessibility and acceptability of service indicators are important for the attractiveness of services related to their use by the population. Profitability indicators are important economic indicators that affect the viability and sustainability of services, factors that are now taken into account in any health policy. All of the indicators mentioned are related to public health, affecting the quality of life, morbidity, mortality, and life expectancy, directly or indirectly. The systematic measurement and monitoring of indicators and the measurement and quantification of quality through them, are the basis for evidence-based health policy for improvement of the quality of mental health services.

Association of Intrinsic Brain Architecture With Changes in Attentional and Mood Symptoms During Development

Understanding the neurodevelopmental trajectory of psychiatric symptoms is important for improving early identification, intervention, and prevention of mental disorders. To test whether the strength of the coupling of activation between specific brain regions, as measured by resting-state functional magnetic resonance imaging (fMRI), predicted individual children's developmental trajectories in terms of attentional problems characteristic of attention-deficit/hyperactivity disorder and internalizing problems characteristics of major depressive disorder (MDD). A community cohort of 94 children was recruited from Vanderbilt University between 2010 and 2013. They were followed up longitudinally for 4 years and the data were analyzed from 2016 to 2019. Based on preregistered hypotheses and an analytic plan, we examined whether specific brain connectivity patterns would be associated with longitudinal changes in scores on the Child Behavior Checklist (CBCL), a parental-report assessment used to screen for emotional, behavioral, and social problems and to predict psychiatric illnesses. We used the strength of resting-state fMRI connectivity at age 7 years to predict subsequent changes in CBCL measures 4 years later and investigated the mechanisms of change by associating brain connectivity changes with changes in the CBCL. We analyzed data from a longitudinal brain development study involving children assessed at age 7 years (n = 94; 41 girls [43.6%]) and 11 years (n = 54; 32 girls [59.3%]). As predicted, less positive coupling at age 7 years between the medial prefrontal cortex and dorsolateral prefrontal cortex (DLPFC) was associated with a decrease in attentional symptoms by age 11 years (t49 = 2.38; P = .01; β = 0.32). By contrast, a less positive coupling between a region implicated in mood, the subgenual anterior cingulate cortex (sgACC), and DLPFC at age 7 years was associated with an increase in internalizing (eg, anxiety/depression) behaviors by age 11 years (t49 = -2.4; P = .01; β = -0.30). Logistic regression analyses revealed that sgACC-DLPFC connectivity was a more accurate predictor than baseline CBCL measures for progression to a subclinical score on internalization (t50 = -2.61; P = .01; β = -0.29). We then replicated and extended the sgACC-DLPFC result in an independent sample of children with (n = 25) or without (n = 18) familial risk for MDD. These resting-state fMRI metrics are promising biomarkers for the early identification of children at risk of developing MDD or attention-deficit/hyperactivity disorder.

Особенности предупреждения суицидального поведения лиц, осуществляющих свою профессиональную деятельность в экстремальной среде (на примере американских Вооруженных сил)

The relevance of this work is due to the fact that at present the problem of suicide among persons engaged in their professional activities in an extreme environment, which include the military and law enforcement officials, is of great concern to the public and the leadership, the Armed forces and law enforcement agencies in different countries. Most of the previous studies have shown that suicide among the considered category of persons adversely affects the combat readiness of the unit and may even lead to a negative attitude in General to the service in the army or law enforcement. In this regard, the authors attempted to analyze the positive experience associated with the prevention of suicidal behavior in the US Armed forces. In the course of the research General scientific and special methods were applied, which allowed to draw reasoned conclusions. Studying the positive experience of suicide prevention in American servicemen, the authors came to the conclusion that the military and political leadership of the us Armed forces not only realized the importance of countering suicidal behavior, but also takes the necessary measures to minimize the phenomenon under consideration. The authors also note that currently in the Armed forces and law enforcement agencies should focus on the need for commanders and direct managers of mental health of soldiers and personnel, including to mitigate the effects of combat stress. The practical significance of the study is expressed in the possibility of using in our country the positive foreign experience in the prevention of mental disorders and suicidal behavior among specialists of dangerous professions. Due to the urgent need to reduce the psychotraumatic impact of negative factors on the group under consideration.

Between-Individual Differences in Baseline Well-Being and Emotion Regulation Strategy Use Moderate the Effect of a Self-Help Cognitive-Behavioral Intervention for Typical Adults.

Self-help interventions intended to help nonclinical individuals regulate their emotions can have important social benefits (i.e. mental disorder prevention, well-being promotion). However, their mean effect size on well-being is generally low, possibly because there are considerable between-individual differences in the response to these interventions. The present study examined whether individuals' baseline levels of emotional well-being and engagement in emotion regulation strategies moderate the effects on these same variables in a 4-week self-help cognitive-behavioral intervention intended for typical adults. Data were collected from 158 nonclinical French adults (n=95 for the control group, n=63 for the cognitive-behavioral group) using experience sampling. Emotional well-being was assessed, as well as the engagement in three emotion regulation strategies (i.e. cognitive reappraisal, problem solving, and appreciation). As expected, the post-test scores on some variables were significantly predicted by the interactions between the intervention and the pre-test scores on these same variables. In particular, it was the participants with the most negative baseline levels (i.e. low emotional well-being, low engagement in appreciation) who benefitted most from the intervention. Results are discussed in the light of current knowledge on between-individual differences in how individuals respond to interventions.

Incarcerated people in prisons: A public health priority in resource-poor settings

Brazil has the third largest prison population on the planet. In this situational framework, Brazil's state prisons experience brutal riots. Here we show that, the risks of prison violence are exacerbated by a lack of opportunities for inmates once they've entered the penal system. Prisoners in Brazil do not have adequate access to healthcare services and neither is properly reached by the healthcare system. Overcrowding makes it hard for prison authorities to keep rival factions separate. The identification of the presence of mental problems when the individuals are admitted to prisons is a necessary task that may guide the adoption of measures to reduce suffering beyond the penalty of deprivation of freedom. The burden of psychiatric disorders in the prisoner's population is not known. The prevalence of major psychiatric disorders is high. Regardless of whether mental disorders are the cause or consequence of prison, it is elucidated that the stressing factors inherent to the inmate condition do not contribute to the prevention of mental disorders.

Features of the dynamics of the incidence of organic nonpsychotic disorders in the rural population of Ukraine

Based on the reporting forms No. 10 "Report on diseases of persons with mental and behavioral disorders" for the period from 2000 to 2017, a clinical-statistical analysis of the dynamics of the prevalence of organic non-psychotic mental disorders in the rural population of Ukraine is presented, as well as changes in the structure of the incidence of non-psychotic mental disorders. The data presented indicate signifi cant fl uctuations in the incidence and prevalence rates. A significant proportion of organic nonpsychotic mental disorders in the structure of the incidence of nonpsychotic mental disorders in rural residents requires the adoption of appropriate organizational measures to optimize the system of assistance and prevention of mental health disorders in the rural population. Key words: mental and behavioral disorders, organic non-psychotic mental disorders, incidence, prevalence, villagers, psychiatric care

Implementation of the Swedish Guideline for Prevention of Mental ill-health at the Workplace: study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools

BackgroundGiven today’s high prevalence of common mental disorders and related sick leave among teachers, an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools. In 2015, we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace. The existence of guidelines does however not guarantee their usage, as studies show that guidelines are often underused. Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice. The primary aim of the randomized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools. The effectiveness will be compared regarding the extent to which the recommendations are implemented (implementation effectiveness) and with regard to social and organisational risk factors for mental ill-health, absenteeism and presenteeism (intervention effectiveness).MethodsThe trial is conducted among primary schools of two municipalities in Sweden. The single implementation strategy is an educational strategy (an educational meeting). The multifaceted strategy consists of the educational meeting, an implementation team and a series of workshops. The outcome measure of implementation effectiveness is guideline adherence. The primary outcome of intervention effectiveness is exhaustion. Secondary outcomes include demands at work, work organization and job contents, interpersonal relations and leadership, presenteeism, work performance, recovery, work-life balance, work-engagement, self-reported stress, self-perceived health, sickness absence and psychosocial safety climate. Process outcomes as well as barriers and facilitators influencing the implementation process are assessed. Data will be collected at baseline, 6, 12, 18 and 24 months by mixed methods (i.e. survey, focus-group interviews, observation).DiscussionThe study described in this protocol will provide valuable knowledge on the effectiveness of implementation strategies for implementing a guideline for the prevention of common mental disorders within schools. We hypothesize that successful implementation will result in reductions in school personnel’s perceived social and organizational risk factors, mental ill-health and sick-leave.Trial registrationClinicalTrials.gov ID: NCT03322839 (trial registration: 09/19/2017).

School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis

SummaryBackgroundRates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.MethodsWe did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4–18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.Findings1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD −0·65, 95% credible interval −1·14 to −0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.InterpretationConsidering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.FundingUK National Institute for Health Research.