Rates Of Mental Health Disorders Research Articles

Assessing Attendance Frequency and Duration at a Drop-In Animal Visitation Program Among First-Semester University Students Separated From Their Pets

ABSTRACT Anxiety and stress among incoming university students are associated with higher rates of mental health disorders and decreased academic success. One approach universities employ to prevent these problems is the implementation of Animal Visitation Programs (AVPs). While efficacy trials suggest positive effects, little is known about students’ program uptake (e.g., attendance frequency and duration) or students’ characteristics (e.g., current mood and past mental health, pet ownership, and pet separation anxiety) that shape program uptake. This study identified student characteristics that predicted AVP uptake in a subsample (n = 209) of randomly selected first-year university students (n = 2,000) who were screened for pet ownership and randomly assigned to attend a semester-long drop-in AVP program (i.e., seven 2-hour sessions) (n = 105) with registered therapy dogs or a waitlist control group (n = 104). Using logistic and multiple regression modeling, participants’ mental health history, current mood, and relationship with their childhood pet were modeled on students’ attendance frequency and duration. Students’ early session uptake was negatively associated with mental health history (B frequency = –0.876, p = 0.03, OR = 0.417) and perceived stress (B frequency = –0.177, p = 0.04, OR = 0.838; β duration = –0.433, p = 0.02, d = 0.61) and positively associated with current anxiety (B frequency = 0.179, p = 0.01, OR = 1.196; β duration = 0.513, p = 0.01, d = 0.66). Overall attendance was negatively associated with levels of pet separation anxiety (β frequency = –0.342, p = 0.004, d = 0.70; β duration = –0.286, p = 0.03, d = 0.53) and identifying as male (β frequency = –0.308, p = 0.003, d = 0.72; β duration = –0.321, p = 0.004, d = 0.68) and was positively associated with early uptake (β frequency = 0.627, p < 0.001, d = 1.40; β duration = 0.532, p < 0.001, d = 1.08). Findings suggest that program attendance may be enhanced by prioritizing access to students experiencing anxiety upon arrival to campus, rather than students experiencing stress, pet separation anxiety, or those reporting a history of mental health problems. Administrators should strongly promote attendance to the first session as this is significantly associated with greater program uptake.

90 Screening Test Accuracy and Reliability of the Parent-Report Preschool Strengths and Difficulties Questionnaire (P-SDQ) in Primary Care Settings

Abstract Introduction/Background Previous research shows that mental health disorders can be identified in preschoolers. Detecting disorders early in life is key for early intervention and prevention of life-long behavioural and emotional issues. Individuals who experience mental health issues before the age of 14 years are at increased risk of a mental health disorder in adulthood, contrary to the idea that issues seen in young children are transient. Although the rate of mental health disorders in preschoolers is similar to the rate in older children, there is no agreed upon standard of care for routine screening or case identification of psychiatric problems in young children. Improving mental health and long-term outcomes for children requires early identification and monitoring of children at risk, including a screening tool that can be used in primary care settings. Objectives To evaluate the criterion validity (screening test accuracy) and test-retest reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings for a sample of 2-4 year olds. Specifically, we were interested in evaluating the screening test accuracy of the P-SDQ for presence of DSM-5 diagnoses. Design/Methods Children 24-48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2 and 12 weeks. At 12 weeks, parents participated in the Preschool Age Psychiatric Assessment (PAPA). We assessed the criterion validity of the baseline P-SDQ using three different criterion measures. We compared the Total Difficulties Score (TDS) with presence of any DSM-5 diagnoses on the PAPA. For the internalizing subscale score, the criterion was presence of any internalizing disorder. For the externalizing subscale score, the criterion was presence of any externalizing disorder. Criterion validity was evaluated using area under the curve (AUC) and calculating screening test properties for a range of threshold values of the TDS and two subscale scores. Optimal thresholds were selected based on the maximal value of both sensitivity and specificity. Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient (ICC). Results 183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed the P-SDQ at 2 weeks, 107 (58%) completed the PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 22 (21%) had an internalizing disorder, 9 (8%) had an externalizing disorder, and 5 (5%) had both. TDS identified any diagnosis with AUC = 0.67 (95% CI: 0.55, 0.79); the internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); the externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity for TDS were 50% and 78%; for internalizing subscale were 18% and 99%; for externalizing subscale were 78% and 71%. Test-retest reliability (ICC) for the TDS was 0.72 (95% CI: 0.62, 0.80); internalizing subscale was 0.62 (95% CI: 0.49, 0.71); externalizing subscale was 0.79 (95% CI: 0.72, 0.86). Conclusion The parent report P-SDQ externalizing subscale has sufficient accuracy and reliability for identifying externalizing disorders in primary care. The TDS and internalizing subscale perform less well. Table 3: Screening test properties of the P-SDQ compared with the PAPA (n=107)

Parent and Therapist Perceptions of the Feasibility, Acceptability, and Benefits of a Weekly Therapist-Led Massage Program for Extremely Preterm Infants in Neonatal Intensive Care.

Mothers of extremely preterm infants experience high rates of mental health disorders that impair maternal-infant interaction and lead to worse infant developmental outcomes. Therapist Education and Massage for Parent-Infant Outcomes (TEMPO) is a therapist-led program that standardizes the nature and frequency of parent education through weekly scheduled therapy sessions. Using a family-centered approach, the therapist facilitates positive maternal-infant interactions and massage interventions from birth throughout hospitalization with the goal of improving maternal mental health. This qualitative study presents the results of 19 parent interviews and of a focus group of four TEMPO interventionists to elicit feedback about the program. Overall, parents and therapists viewed the program positively. Parents and therapists valued the focus on parent education and engagement to increase parent competence and bonding opportunities. Both groups acknowledged that infant massage had both infant-centered and parent-centered benefits. One area where parent and therapist views did not align was regarding feasibility of TEMPO. Parents noted multiple logistical challenges to regular NICU visitation, but ultimately agreed that attending weekly therapy sessions was feasible. Therapists noted increased time and effort required of TEMPO and felt that institutional and system-level changes would be necessary to implement weekly parent education as standard of care.

Breaking Cyclic Intergenerational Literacy Deficits: Describing Linguistic Interactions Between Adolescent Mothers and Their Young Children

Adolescent mothers (AMs) often experience limited academic and financial attainment and higher rates of mental health disorders, which may affect their relationships with their children. Although children of AMs are at higher risk for developmental delays, there is no clear evidence of the relationships between mother characteristics and child outcomes. This descriptive study explored AMs’ and their children’s sociodemographic characteristics and language skills, home literacy environment, and the quality of mother–child interactions. Eight AM–child dyads were recruited from local school districts. Data were collected through questionnaires, standardized measures of language, and mother–child interactions. Most AMs demonstrated below-average language skills and most children had language scores that fell within the average range. AMs demonstrated strong affectionate behaviors, and emerging responsive, encouraging, and teaching behaviors when interacting with their children. This study provides unique data on AMs’ language characteristics that have not been clearly published in the literature.

The impact of imprisonment on individuals’ mental health and society reintegration: study protocol

BackgroundPrison sentences are a particular type of penalty that aim to reintegrate individuals into society. Nonetheless, research suggests that prison sentences have a null or a criminogenic effect on recidivism and a critical impact on inmates’ mental health, negatively interfering with their successful reintegration into society and recidivism. Prevalence rates of mental health disorders among individuals who commit crimes are high, but little is known about how incarceration perpetuates and/or worsens mental health symptoms. In the Portuguese context, no studies focused on understanding the impact of imprisonment on prisoners’ mental health. Thus, this project aims to understand incarceration’s mental health and well-being impact on male and female individuals convicted to prison, both while incarcerated and after release.MethodsThe study will follow a quantitative cross-sectional design of male and female individuals in prison and parole, aiming to assess different samples at different moments of the prison sentence. It will also follow a longitudinal design in a subsample of male and female individuals sentenced to prison and on parole who will be followed for one year.DiscussionThis study intends to have a meaningful impact on the understanding of imprisonment effects, giving important clues for developing and implementing evidence-based prevention and intervention strategies to address prisoners’ and ex-prisoners’ mental health and improve their ability to successfully reintegrate into society and reduce recidivism.

RWD153 Investigating Trends of Behavioral Healthcare Resource Utilization Burden in Children and Adolescents with Suicidal Symptoms in the United States: An Analysis of Electronic Health Record Data

The increasing rates of mental health disorders and suicide among children and adolescents have highlighted the importance of understanding the burden of healthcare resource utilization for this population. This study aims to investigate trends in the utilization of behavioral health services by minors with suicidal or self-harm symptoms in the United States.

Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates.

The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations. Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.

The Impact of COVID-19 on Access to Mental Health Care Services

The COVID-19 pandemic increased the rate of mental health disorders, as well as demand for mental health services. It remains unclear, however, the extent to which it impacted access to mental health care. Using data from an audit field experiment, which ran from January to May 2020 and overlapped with the onset of the COVID-19 pandemic, we examine the impact of COVID-19 on access to mental health care appointments in the United States. We find that increased intensity of COVID-19–measured by daily cases, daily fatalities, and weekly excess deaths–is associated with decreased access to mental health care appointments.

Rising Racial Disparities in Opioid Mortality and Undertreatment of Opioid Use Disorder and Mental Health Comorbidities in Virginia

There were more than 100,000 fatal drug overdoses in the U.S. in 2021 alone. In recent years, there has been a shift in opioid mortality from predominantly White rural communities to Black urban communities. This study aimed to identify the Virginia communities disproportionately affected by the overdose crisis and to better understand the systemic factors contributing to disparities in opioid mortality. Using the state all-payer claims database, state mortality records, and census data, we created a multivariate model to examine the community-level factors contributing to racial disparities in opioid mortality. We used generalized linear mixed models to examine the associations between socioecologic factors and fatal opioid overdoses, opioid use disorder diagnoses, opioid-related emergency department visits, and mental health diagnoses. Between 2015 and 2020, racial disparities in mortality widened. In 2020, Black males were 1.5 times more likely to die of an opioid overdose than White males (47.3 vs 31.6 per 100,000; p<0.001). The rate of mental health disorders strongly correlated with mortality (β=0.53, p<0.001). Black individuals are not more likely to be diagnosed with opioid use disorder (β=0.01, p=0.002) or with mental health disorders (β= -0.12, p<0.001), despite higher fatal opioid overdoses. There are widening racial disparities in opioid mortality. Untreated mental health disorders are a major risk factor for opioid mortality. Findings show pathways to address inequities, including early linkage to care for mental health and opioid use disorders. This analysis shows the use of comprehensive socioecologic data to identify the precursors to fatal overdoses, which could allow earlier intervention and reallocation of resources in high-risk communities.

Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial

BackgroundThe first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders.MethodsThe trial will be conducted in a sample (planned N = 351) of individuals aged 16–22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention).DiscussionThis trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people.Trial registrationhttps://www.drks.de, DRKS00027384. Registered on 21 February 2022—prospectively registered.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Epidemiology of mental health disorders in the citizens of Tehran: a report from Tehran Cohort Study

BackgroundMental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data.MethodsWe utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders.ResultsAlmost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25–34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city.ConclusionsTehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.

Adapting Community Health Worker Care Models to Advance Mental Health Services Among LGBTQ Youth

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth of color experience high rates of mental health disorders, yet they experience challenges to accessing mental health services. Community health worker (CHW) models of care have potential to promote equitable mental health services among LGBTQ youth. Our aim was to understand how CHW models could be adapted to better support LGBTQ youth of color in accessing mental health services. Semi-structured qualitative interviews were conducted with LGBTQ youth of color (n = 16), caregivers of LGBTQ youth (n = 11), and CHWs (n = 15) in Massachusetts and California. Interviews were coded by 8 members of the research team. A Rapid Qualitative Analysis was conducted to identify themes. Caregivers, youth, and CHWs all endorsed the value of CHW models for this population. They also almost universally suggested multiple adaptations are needed for the model to be effective. Four main categories of themes emerged related to intervention adaptations: (1) Why adaptations are needed for LGBTQ youth, (2) Who should serve as CHWs providing care, (3) How CHWs should be trained, and (4) What content needs to be included in the intervention. Broadly, findings suggest the relevance of having CHW models for LGBTQ youth of color to address stigma and discrimination experienced, access to culturally and linguistically relevant services, and the need for caregiver support of LGBTQ youth. CHWs need increased training in these areas.

Development and user testing of a patient decision aid for cancer patients considering treatment for anxiety or depression

BackgroundDespite high rates of mental health disorders among cancer patients, uptake of referral to psycho-oncology services remains low. This study aims to develop and seek clinician and patient feedback on a patient decision aid (PDA) for cancer patients making decisions about treatment for anxiety and/or depression.MethodsDevelopment was informed by the International Patient Decision Aid Standards and the Ottawa Decision Support Framework. Psycho-oncology professionals provided feedback on the clinical accuracy, acceptability, and usability of a prototype PDA. Cognitive interviews with 21 cancer patients/survivors assessed comprehensibility, acceptability, and usefulness. Interviews were thematically analysed using Framework Analysis.ResultsClinicians and patients strongly endorsed the PDA. Clinicians suggested minor amendments to improve clarity and increase engagement. Patient feedback focused on clarifying the purpose of the PDA and improving the clarity of the values clarification exercises (VCEs).ConclusionsThe PDA, the first of its kind for psycho-oncology, was acceptable to clinicians and patients. Valuable feedback was obtained for the revision of the PDA and VCEs.

Mental Health Disorders Due to Disaster Exposure: A Systematic Review and Meta-Analysis.

Natural disasters are complex, global issues that affect people individually, families, and communities, upsetting their emotional wellbeing. This research aims to comprehend the connections between disasters and their effects on mental health.We conducted a systemic review and meta-analysis on the effect of disasters on mental health disorders using defined search terms across three major databases. The search technique adhered to the PECO framework. The study locations were dispersed across Asia, Europe, and America. An electronic search was established in the Cochrane Central Register of Controlled Trials in the Cochrane Library, PubMed, and Medline databases. A random-effects meta-analysis was carried out. The I2 statistic was used to explore heterogeneity. In the random-effects analysis, Tau-squared, τ2, or Tau2 evaluates the effects seen between the study variances. Publication bias was examined. The outcomes of the included studies on mental health issues (n = 48,170) brought on by catastrophic disasters were pooled using a random-effects meta-analysis. The three main mental health illnesses attributed to the disaster catastrophe in most studies weregeneralized anxiety disorder (GAD), depression,substance use, adjustment disorder, and post-traumatic stress disorder (PTSD). Storms, including cyclones and snowstorms, had an impact on 5,151 individuals. 38,456 people were harmed by flooding, and 4,563 people were affected by the earthquake. The included studies showed prevalence rates for mental health disorders ranging from 5.8% to 87.6%. The prevalence rates were between 2.2% and 84% for anxiety, 3.23% and 52.70% for depression, and 2.6% and 52% for PTSD, respectively. The point effect estimates of studies included the flood, storm/cyclone, and earthquake were 0.07 (95% confidence interval [CI]: 0.02-0.12), 0.18 (95% CI: 0.03-0.32), and 0.15 (95% CI: 0.03-0.27), respectively, which revealed a statistically significant positive effect (p-value: < 0.05) with a narrow 95% CI indicating more precise population estimates. However, the pooled effect estimates were not of a large effect size of 0.129 (95% CI: 0.05-0.20). This study found a link between disaster and poorer outcomes for mental health. The risk of psychological morbidity and fatalities increased with relocation and disruption of essential services. Flooding was the most frequent calamity. The "medium human development countries" were found to have the highest prevalence rate of mental health disorders in our meta-analysis. The "very high human development" and "high human development" nations, however, also had a higher prevalence rate of mental health disorders following catastrophic events.This study could aid in the creation of thorough strategies for the mitigation and avoidance of mental health problems during natural disasters. Increased community resilience, improved access to healthcare services, and a suitable mitigation strategy can all help to improve the situation of the disaster's vulnerable population.

The patient population of a no-cost, student-run LGBTQ + mental health clinic: A case for equitable and trauma-informed care

Introduction LGBTQ + individuals experience disproportionately high rates of mental health disorders. Subpopulations of this community experience unique risk factors and barriers to accessing care. Method This study analyzes chart review data of patients (n = 49) of an LGBTQ+-specific, student-run, free mental health clinic in NYC between March 2019 and July 2021. Result Most common diagnoses were mood disorders (55%) and anxiety disorders (53%). Eighty-eight percent of patients reported experiencing lifetime traumatic events; 20% of patients met criteria for PTSD. Conclusion Further research is needed to characterize vulnerable subpopulations to create equitable, accessible, and competent mental health care resources for the LGBTQ + community.

Cultural Aspects of Mental Health in South Asians

South Asians tend to experience high rates of mental health disorders, which are often unaddressed. Factors including acculturative stress, social determinants, gender predisposition, and cultural beliefs must be considered in diagnostic assessment and determination. Mental health symptoms are generally interpreted as physical illnesses by South Asians, who typically present with somatic symptoms and tend not to seek the required psychological help due to perceived stigma. Treatment models incorporating social and culture-specific interventions (eg, use of native language, involvement of family members, inclusion of traditional and/or religious principles) have been shown to improve mental health outcomes in South Asians. More research focusing on violence, substance abuse, and socioeconomic factors—along with a clearer understanding of the epidemiology and conceptualizations of mental illness—is needed to develop interventions that promote the mental well-being of South Asians in the US. [ Psychiatr Ann . 2023;53(3):117–121.]

Resultados de una evaluación y seguimiento online de problemas de salud mental en universitarios chilenos

The exponential increase in higher education students and the new university profile that incorporates more vulnerable social groups are associated with an increase in mental health problems in this population. Likewise, the complex stage of the life cycle in which these young people find themselves and the stress of the transition between adolescence and adulthood are other risk factors for the development of mental health problems. The emergence of mental health problems in this group could then be due to a confluence of factors, also facilitating risk behaviors. National and international researches have reported the worrying rates of mental health disorders in university students, mainly in relation to the presence of depression, anxiety, stress, alcohol or drug use, eating disorders, and suicidal ideation. These disorders tend to be aggravated, because the university population is prone not to seek help. The stigma of presenting mental health problems, skepticism about treatments, not wanting to worry the closest family and the few economic resources or not having a health plan, lead to not seeking help or do this late. Studies have found that more than half of students who need mental health and support services are not receiving them. On the other hand, a high percentage seeks help late, which implies that the disorders are accentuated or become chronic, which makes subsequent treatment and improvement difficult, even becoming a public health problem due to the high economic and professional demand that these treatments require. Given these antecedents and the exponential increase in these high rates of mental health, it was proposed to carry out a complete process of Mental Health Problems Screening, feedback, and follow-up in a large sample of university students, in order to determine both the prevalence of mental health symptoms, such as the impact of the use of information technologies on feedback and guidance in seeking help. To do this, a battery of questionnaires aimed at investigating hopelessness and suicide risk, depressive symptoms, anxiety, stress, eating disorders and perceived social support were applied through the university online platform to 1 707 students. Once the instruments were answered, the students received feedback about their levels of symptoms and information about networks and establishments to seek help and receive care in the required cases. In the middle of the following year, a follow-up survey was conducted with 577 of the students who had previously answered all the questionnaires. The results of the battery of questionnaires applied indicate high rates of mental health symptoms, with statistically significant differences according to sex, with women having the highest prevalence. These results are consistent with various studies that show high percentages of mental health problems in university students and various associations. In turn, the subsequent follow-up showed that the feedback provided triggered the search for help, with positive correlations between feeling better and having sought mental health treatment or having asked friends or family for help. In addition, the most of the young people surveyed consider that the use of computer platforms are useful to obtain help on mental health issues and that they are useful to better understand what is happening to them and learn about mental health problems. Both the increase in the university population and the high prevalence of morbidity have led to the need to implement various resources that make mental health more accessible to young people. The use of information technologies in mental health research and prevention would have a positive outreach, being a useful, accessible and close tool for young people. https://doi.org/10.16888/interd.2023.40.2.16

The Impact of COVID-19 on Access to Mental Healthcare Services

The COVID-19 pandemic increased the rate of mental health disorders, as well as demand for mental health services. It remains unclear, however, the extent to which the pandemic impacted access to mental health services. Using data from an audit field experiment, we examine the impact of COVID-19 on access to mental health care appointments in the United States. This experiment ran from January to May 2020 and overlapped with the initial onset of the COVID-19 pandemic. We find that increased intensity of COVID-19—measured by daily cases, daily fatalities, and weekly excess deaths—is associated with decreased access to mental health care appointments.

Adapting DIALOG+ in a School Setting-A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study.

Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders' (teachers' and students') perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents' data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374. DERR1-10.2196/40286.