Risk Of Mental Health Difficulties Research Articles

Delivering a sleep intervention across a youth mental health service using non-expert practitioners: A service evaluation.

Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non-expert practitioners in a secondary care youth mental health service. Assistant psychologists were trained to deliver a six-session 1:1 cognitive-behavioural sleep intervention adapted for use with young people with mental health difficulties. A within-subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. High referral, intervention take-up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty-six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.

Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study.

Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health. We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.

Mental health screening in pediatric lower limb deficiency population.

Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established. To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic. Survey. Outpatient specialty care clinic located within a children's hospital. All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75). Not applicable. Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings. Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.

Genetic influences on sibling bullying and mental health difficulties.

Sibling bullying is associated with mental health difficulties; both in the short and long term. It is commonly assumed that sibling bullying leads to mental health difficulties but additional explanations for the relationship between the two are seldom investigated. To address this gap in knowledge, we used a genetically sensitive design with data from the Avon Longitudinal Study of Parents and Children (maximum N = 3,959, 53% female). At ages 11-13 years, individuals self-reported their involvement in sibling bullying, as a victim and perpetrator, and parents reported on their child's mental health difficulties. Polygenic scores, indices of genetic risk for psychiatric disorders (major depressive disorder and attention deficit hyperactivity disorder) were computed using children's genetic data. Regression and structural equation models were fitted to the data. Sibling bullying, victimisation and perpetration, and polygenic scores both predicted mental health difficulties in an additive manner but there was no interaction between them. Polygenic scores for mental health difficulties were also associated with sibling bullying. These findings suggest that sibling bullying, victimisation and perpetration, is associated with mental health difficulties, even after accounting for some genetic effects. Additionally, the relationship between sibling bullying and mental health difficulties may be, at least partly, due to shared genetic aetiology. One possibility is that genetic risk for mental health difficulties influences the onset of mental health difficulties which in turn make children more susceptible to sibling bullying.

Exploring sex differences in trajectories of pubertal development and mental health following early adversity

Despite evidence that early life adversity (ELA) affects mental health in adolescence, we know little about sex differences in how distinct dimensions of adversity affect development and their corresponding effects on mental health. In this three-wave longitudinal study, 209 participants (118 females; ages 9–13 years at baseline) provided objective (salivary hormones, BMI, age of menarche) and subjective (perceived gonadal and adrenal status) measures of puberty and physical development, and reported on levels of internalizing and externalizing symptoms at all timepoints. Participants also reported lifetime exposure to three distinct types of ELA: deprivation, threat, and unpredictability. Using generalized additive mixed models, we tested within each sex whether dimensions of adversity were associated with longitudinal changes in measures of pubertal and physical development, and whether these indices of development were associated with trajectories of internalizing and externalizing symptoms. In females, experiences of threat and unpredictability were significantly associated with earlier pubertal timing (e.g., age of menarche) whereas experiences of deprivation were associated with steeper increases in BMI; further, faster pubertal tempo (i.e., steeper increases in pubertal stage) was associated with increases in internalizing and externalizing symptoms. In males, however, ELA was not associated with any measures of pubertal or physical development or with symptoms. Together, our results suggest that adverse experiences during early life have sex-selective consequences for pubertal and physical maturation and mental health trajectories in ways that may elucidate why females are at higher risk for mental health difficulties during puberty, particularly following exposure to unpredictable and threatening experiences of adversity.

Young People’s Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic

As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical. To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics. For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021). Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored. Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school. This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences.

Parental Support and Gender Moderate the Relationship Between Sexual Orientation and Suicidal Behavior in Adolescents.

The scientific literature indicates that people from sexual minorities may be at increased risk for mental health difficulties. Moreover, parental support could play a protective role against poor mental health. The objective of this study was to examine whether a person's sexual orientation was related to a greater risk of mental health problems in a representative sample of adolescents. In addition, the study analyzed the possible moderating effect of parental support in the relationship between sexual orientation and mental health, as also moderated by participant gender. The sample consisted of 1790 secondary-school students. Indicators of emotional and behavioral difficulties, symptoms of depression, psychotic-like experiences, suicidal behavior, well-being, and self-esteem were assessed. The results indicated significant main effects of gender and sexual orientation. Having a diverse sexual orientation (i.e., lesbian/gay, bisexual and questioning) was related to increased risk of mental health difficulties. Moreover, the results showed a significant interaction effect of gender and sexual orientation on suicidal behavior. Finally, the results showed the moderating effect of parental support and gender in the relationship between sexual orientation and suicidal behavior. These findings highlight the importance of promoting sexual minority youths' mental health and well-being.

Mattering matters for students high in socially prescribed perfectionism as they transition to university: Support for a moderation model

The transition from high school to university demands for life adjustments and leaves young adults at risk for mental health difficulties. The current study tested a moderation model to examine socially prescribed perfectionism, mattering (i.e., feeling important to others), and an interaction between the two as predictors of depressive symptoms during the first year of university. We hypothesized that mattering would be protective such that it would moderate the perfectionism-depressive symptoms relationship. Participants (N = 152) completed self-report measures assessing socially prescribed perfectionism, mattering, and depressive symptoms. Hierarchical regression analyses showed that socially prescribed perfectionism predicted greater depressive symptoms, while mattering predicted lower depressive symptoms. Further, mattering significantly moderated the association between socially prescribed perfectionism and depressive symptoms such that high levels of mattering diminished the relationship. Results suggest that a sense of mattering may mitigate the risk for depressive symptoms in students high in socially prescribed perfectionism as they transition to university.

National Guard Deployment in Support of COVID-19: Psychological and Behavioral Health.

The National Guard (NG) served as a critical component of the USA's response to the Coronavirus Disease 2019 (COVID-19) pandemic, while concurrently managing their personal responses to the pandemic. Determining whether the activation of NG service members in response to the COVID-19 pandemic was associated with a greater psychological strain can identify NG's needs for mental health support. We surveyed 3993 NG unit (NGU) service members (75% Army NG, 79% enlisted, 52% 30-49 years old, and 81% males) during the COVID-19 pandemic, with surveys administered between August and November 2020. Almost half (46%) of NGU service members reported being activated in response to COVID-19 (mean activation length = 18.6 weeks). Activated service members completed the survey approximately 2 to 3 months post-activation. Surveys assessed demographics, service-related characteristics, unit cohesion and positive leadership skills (leadership), and COVID-19 activation, and outcomes including probable post-traumatic stress disorder (PTSD), clinically significant anxiety and depression, and anger. Descriptive and logistic regression analyses were conducted. The study was approved by the Institutional Review Board of the Uniformed Services University of the Health Sciences in Bethesda, MD. In all, 9.7% met the criteria for probable PTSD, 7.6% reported clinically significant anxiety and depression, and 13.2% reported feeling angry/anger outbursts. Multivariate logistic regression analyses, adjusting for demographic and service-related characteristics, indicated that COVID-19 activation was not associated with a greater risk of PTSD, anxiety and depression, or anger. Regardless of activation status, NGU service members with low levels of unit cohesion and leadership were more likely to report PTSD and anger, and low levels of unit cohesion were associated with clinically significant anxiety and depression. COVID-19 activation did not increase the risk of mental health difficulties among NGU service members. However, low levels of unit cohesion were associated with the risk of PTSD, anxiety and depression, and anger, and low levels of leadership were associated with the risk of PTSD and anger. The results suggest a resilient psychological response to COVID-19 activation and the potential for strengthening all NG service members through enhancing unit cohesion and leadership support. Future research on specific activation exposures, including the type of work tasks in which service members are engaged, particularly those associated with high-stress work conditions, is needed to help better understand their activation experience and how it may influence post-activation responses.

Comorbidity of mental health and autism spectrum disorder: perception of practitioners in management of their challenging behaviour

The relationship between mental health problems, Autism Spectrum Disorder (ASD) and challenging behaviour among children and adolescents is complex and multifaceted. The study investigated practitioners’ perception of comorbidity of mental health and ASD in the management of challenging behaviours among children and adolescents in Kenya. Target population was 3490 practitioners. Sample size was 1047, comprising of 38 assessment staff, 27 mental health workers 548 regular teachers, 294 teachers from special schools, and 140 teachers from special units for children with ASD. Stratified and purposive sampling techniques were used. Interviews and structured questionnaires were used. Test-retest yielded a coefficient of 0.78 while Cronbachs’ reliability coefficient was 0.830. There was a positive significant correlation between perception of challenging behaviours and mental health problems (r = .415, p = .000). Challenging behaviour perceptions have a negative significant effect on behaviour management strategies, (β = −0.163, p = .000) implying that the choice of management strategies is dependent on the perceptions. Challenging behaviours accounts for 2.7% variance in the choice of the management strategies, R2 = .027, F(1,1045) = 28.471, p = .000.The practitioners’ perception of mental health and comorbid ASD, showed that children with ASD, when enduring life stressors, can be at a higher risk of mental health difficulties than their peers There is need for multidisciplinary synergy in developing effective challenging behaviour programmes for children and adolescents with ASD

A cluster randomised, 16-week, parallel-group multicentre trial to compare the effectiveness of a digital school-based cognitive behavioural resilience/wellbeing-building intervention targeting emotional and behavioural problems in vulnerable Year 4 primary school children in whole classes, to the usual school curriculum: a study protocol to the “CUES for Schools” trial

BackgroundAround 10% of school-aged children experience mental health difficulties. Many more are ‘vulnerable’: experiencing emotional and/or behavioural problems reaching clinical levels, and thus at greatest risk of future mental illness. The trial aim is to evaluate the effectiveness of the CUES for schools programme in reducing emotional and behavioural problems in vulnerable children.MethodsThe “CUES for Schools” study is a multicentre cluster randomised controlled trial in primary schools in south east England. Schools will be randomised to receive the usual school curriculum, or the CUES programme (1:1). We aim to enrol 74 schools (5550 children including 2220 vulnerable children). CUES is a whole-class teacher-facilitated interactive digital cognitive-behavioural intervention, delivered as 24 short (20-min) modules over 12 weeks, targeting emotional/behavioural regulation skills. Children self-report emotional/behavioural problems at baseline, 8, and 16 weeks, and wellbeing and cognitive vulnerability at 0 and 16 weeks. Adverse events are assessed at 8 and 16 weeks. Teachers rate classroom behaviour at baseline and 16 weeks. School senior leadership teams and individual teachers consent to involvement in the study; parents can opt their child out of CUES sessions, assessments, or research. Children can similarly opt out and assent to research participation. The primary objective of this trial is to evaluate the effectiveness of CUES for schools compared to the usual school curriculum in improving emotional/behavioural problems for vulnerable Year 4 (8–9 years old) children at 16 weeks post-randomisation, as measured using a standardised questionnaire designed for primary schools. The secondary objective is to investigate the impact of the CUES for schools programme on both vulnerable and non-vulnerable children on wellbeing and teacher-rated classroom behaviour.DiscussionThe study will show whether CUES for schools is more effective than the usual curriculum in reducing emotional and behavioural problems in vulnerable Year 4 children, and thus reducing the risk of mental health difficulties in later adolescent and adult life. As a digital, teacher-facilitated intervention, CUES for schools can be readily implemented, at minimal cost. If effective, CUES for schools therefore has the potential to reduce the impact of emotional/behavioural difficulties on children’s learning, behaviour, and relationships and the burden of future mental health morbidity.Trial registrationTrial Registration ISRCTN11445338. Registered on September 12, 2022.

Student-led occupational performance coaching in a university setting

Introduction:University students are at a high risk for mental health difficulties. Occupational performance coaching is an action-oriented and strengths-based approach that can help clients set and accomplish personally valued goals. We carried out a pilot project to evaluate a tele-rehabilitation occupational performance coaching service for university students within an occupational therapy fieldwork placement.Method:A pretest post-test design was used. Severity of symptoms of depression, anxiety and stress and goal achievement were measured before and after the intervention and semi-structured interviews were carried out with student clients and student therapists. Development of student therapist competencies were noted.Results:Thirty-five student clients enrolled in occupational performance coaching and participated in 1–6 sessions. They identified academic, health, social and vocational goals. Through occupational performance coaching, clients made important progress on their goals. Following occupational performance coaching, clients demonstrated statistically significant improvement in anxiety and depression. The occupational therapy students attained competencies comparable in number and level to those achieved in more traditional placements.Conclusion:Occupational performance coaching is a potentially valuable addition to student mental health services. Such a service can be provided by supervised fieldwork students.

Factors influencing the mental health of autistic children and teenagers: Parents' observations and experiences.

Autistic people are more likely to experience mental health difficulties compared to neurotypical people. It is very important that we understand what increases the risk for mental health difficulties, and what helps to protect against them. So far, research on this for children and young people has only investigated a small number of factors and these have been chosen by researchers and clinicians. This study took a different approach in which parents' expertise in their children was recognised. Parents were asked to tell the story of their autistic teenagers' mental health from diagnosis in early childhood through to the present, and to explain the 'theories' they developed about what affected their child's mental health - positively and negatively - and how. Parents believed a wide range of factors played a role. These include: (1) aspects of their child (e.g. their autistic traits, intelligence); (2) aspects of their surroundings (e.g. the efforts parents make to prevent and respond to their child's difficulties, features of the school they attend, availability of social activities); (3) changes their child experienced growing up (e.g. puberty, awareness of being autistic); and (4) life events involving loss and separation. Many of the factors parents identified as important have received little or no research attention to date. The findings suggest issues that should be considered in future research and reveal ways that support for parents and autistic children and teenagers can be improved.

Mental health and addiction in young refugees-Research on prevalence of alcohol and substance use, PTSD and psychological difficulties experienced by young migrants and refugees placed in two refugee centers in Serbia in the time of COVID-19 pandemic

Abstract: IntroductionAs the global resettlement needs are further increasing, the questions on refugee youths’ wellbeing arise. The experience of migration during childhood might interfere with the developmental trajectories in different ways. Refugee youths might be at higher risk of violence, abuse and mental health problems.ObjectivesThis study aimed to explore the prevalence of alcohol and substance use among young refugees, along with the indicators of experienced psychological difficulties.MethodsData collection was followed by numerous difficulties–C-19 pandemic, linguistic diversity and high respondents’ illiteracy rate.ResultsThe sample consisted of 184 participants aged 11–18 years. More than a half of them displayed symptoms of PTSD - more frequently females, those who resided in a greater number of refugee centers and those who were exposed to abuse and domestic violence. Half of the respondents consumed energy drinks, slightly less than a third of them used tobacco, 13% consumed alcohol, 4.6% marijuana, whereby the frequency of other substance use was significantly lower. The significant indicators of individual propensity to use alcohol and substances were shown to be older age (14-18 years), male gender, lower education, being unaccompanied child and exposure to emotional abuse.ConclusionsOur research confirmed that young refugees, especially unaccompanied, might be at higher risk for mental health difficulties. Research on this topic should aim to link scientific data to sustainable practices, applicable in everyday life.Disclosure of InterestNone Declared

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program.

Medical students are at elevated risk for mental health difficulties and may struggle to ask for help. Innovative outreach programs are warranted to reduce barriers and ensure that students receive the professional care they need and deserve. This article provides a 6-year retrospective of the Keck Checks program, a well-established initiative that offered universal 15-minute mental health screenings to every first-year medical student at the Keck School of Medicine of the University of Southern California from fall 2016 to fall 2022. This early detection program was designed to combat barriers to seeking mental health care by normalizing the concept of all students meeting with a psychologist early in their academic careers. The Keck Checks program showed promising feasibility, with a single full-time clinician successfully hosting appointments for entire classes of first-year medical students (mean of 189 students per class) during approximately 4 months, in addition to other work duties. Participation rates were high, with 715 eligible students (76.3%) choosing to attend their Keck Check. Students were frequently referred to follow-up services during the Keck Check, including mental health care (n = 360 [50.4%] referred), occupational therapy (n = 72 [10.1%] referred), and academic support services (n = 60 [8.4%] referred). Next steps include possible expansion of similar programs to medical students in years 2 to 4, residents, and physicians, as well as understanding the effect of brief mental health screenings on long-term help-seeking, adherence to mental health treatment plans, and general educational or professional success. Brief, universal mental health screenings are a relatively low-cost, high-impact approach for medical schools to consider in supporting the mental health of their student body.

Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders

The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21–25) and at three timepoints during the pandemic (ages 27–28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (β = −3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.

Experiences of Young People and Their Carers with a Rural Mobile Mental Health Support Service: A Qualitative Study.

Mental health difficulties during teenage years are common. They are also a risk factor for later mental and physical health problems. Rural young people are at a greater risk for mental health difficulties and have less access to services than their urban counterparts. The purpose of this study was to explore the experiences of young people and their carers with mental health support provided by a rural mobile service, and to identify access enablers from the perspective of the service users. A qualitative descriptive approach was used to analyse twelve interviews with current service users and eight interviews with family members of young people who had accessed the service. Three main themes were identified: (a) access and flexibility, (b) the qualities and strategies of the clinicians, and (c) experiences of change. The mobile service was perceived to be effective in producing a positive change in mental health, relationships, and the attainment of life goals. Key enablers to access included the flexibility of the mobile service, the variety of service delivery modes and therapeutic methods offered, the ease of access facilitated by the location in schools, and the autonomy of young people in how they chose to utilise the service. This study provides information about what is important to rural young people and their families in the provision of mental health services. The findings have implications for changing the way services are organized and operated. Healthcare policies and services could support a user-led model design that incorporates access and use-enablers and removes barriers to rural mental health support.

Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin.

Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD+IDD, in terms of both children's mental health and parental psychological distress. Participants with a copy number variant or single nucleotide variant (5-19years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co-occurring ASD, and co-occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio-economic deprivation. Of the 1904 participants with IDD, 701 (36.8%) had co-occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR=1.84, 95% confidence interval [CI] 1.46-2.32, p<0.0001; emotional disorders: OR=1.85, 95%CI 1.36-2.5, p<0.0001; disruptive behaviour disorders: OR=1.79, 95%CI 1.36-2.37, p<0.0001). The severity of associated symptoms was also greater in those with ASD (hyperactivity: B=0.25, 95%CI 0.07-0.34, p=0.006; emotional difficulties: B=0.91, 95%CI 0.67 to 1.14, p<0.0001; conduct problems: B=0.25, 95%CI 0.05 to 0.46, p=0.013). Parents of children with IDD and ASD also reported greater psychological distress than those with IDD alone (β=0.1, 95% CI 0.85 to 2.21, p<0.0001). Specifically, in those with ASD, symptoms of hyperactivity (β=0.13, 95% CI 0.29-0.63, p<0.0001), emotional difficulties (β=0.15, 95% CI 0.26-0.51, p<0.0001) and conduct difficulties (β=0.07, 95% CI 0.07-0.37, p<0.004) all significantly contributed to parental psychological distress. Among children with IDD of genetic aetiology, one third have co-occurring ASD. Not only do those with co-occurring ASD present with a wider range of associated mental health disorders and more severe mental health difficulties than those with IDD alone, but their parents also experience more psychological distress. Our findings suggest that the additional mental health and behavioural symptoms in those with ASD contributed to the degree of parental psychological distress.

Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial.

Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933. DERR1-10.2196/40707.

Factors Influencing Parental Acceptance of Trans Children and Young People: Findings from Trans Pathways

Trans youth are at high risk of mental health difficulties and negative life events. Strong parental support is highly protective however there is little understanding of what factors facilitate the process of parental understanding and acceptance of a child’s gender identity. We aimed to better understand a) preexisting factors influencing levels of parental acceptance of their child’s gender identity; b) the factors parents find helpful in facilitating acceptance of their child’s gender identity once they become aware; and c) how parents experience extended family, cultural and religious reactions. Using cross-sectional survey data, we explored the experiences of parents and guardians (N = 194). Quantitative data were primarily analyzed using Bayesian regression models and qualitative data were thematically analyzed. Several factors were salient in influencing parental acceptance, including the nature of their child’s gender identity, and levels of awareness and acceptance of the child’s gender identity at time of initial parental awareness. Multiple factors aided acceptance, including information, peer support, and the quality of the dyadic relationship. Findings provide a better understanding of how parental acceptance of a child’s gender identity develops. We provide recommendations on what may help parents to optimally support their child, such as accessible, good-quality information.