Vulnerable Adolescents Research Articles

The Psychosocial Correlates of Non-suicidal Self-Injury Within a Sample of Adolescents With Mood Disorder.

BackgroundAccording to the integrated theoretical model, adolescents' behaviors were the outcome of the complex interplay between multiple levels. Non-suicidal self-injury (NSSI) is a serious and high prevalent problem among adolescents with mood disorders. However, a systematic perspective on psychosocial correlates among Chinese clinical adolescents is still rare.MethodThe impact of several factors at the individual (i.e., sex, age, self-esteem, and psychological distress), family (i.e., family structure, family income, and family support), and social level (i.e., living environment, peer support, and teacher support) on the frequency of NSSI behaviors were investigated in the current study. This research included 621 Chinese adolescents with mood disorders from 20 hospitals.ResultsThree-steps hierarchical regression analyses indicated that lower levels of psychological distress and higher levels of self-esteem were most associated with less frequency of NSSI behaviors. In addition, family support was negatively associated with the frequency of NSSI behaviors. After controlling the factors at individual and family levels, no significant association was found between the factors at the social level and the frequency of NSSI behaviors.ConclusionThese findings provide preliminary support for the notion that adolescent self-esteem and family support may effectively shield them from problematic behavior; nevertheless, adolescents suffering from more emotional pain can be even riskier. Thus, further intervention strategies should consider the non-independence of individual capacities, co-combinatory effects of mood disorder, and family environment in treating those vulnerable Chinese adolescents.

Rethinking climate change through a gender and adolescent lens in Ethiopia

ABSTRACT Ethiopia is increasingly experiencing the impacts of climate change, with stark consequences for the most disadvantaged groups, including youth, women and girls. Within climate action, there is limited understanding of how climate change responses address age and gender vulnerabilities. This article uses a gender and adolescence lens to explore how Ethiopia’s climate mitigation and adaptation responses shape progress towards three Sustainable Development Goal (SDG) 5 (gender equality) targets using a capabilities approach. It draws on qualitative data from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study with adolescents aged 10–20, their parents and key informants, in three diverse regions. It finds that although climate mitigation strategies (including gender-sensitive social protection measures) are impacting gender equality positively by increasing access to water and supporting food-insecure households in times of drought, substantial challenges remain. The findings underscore that while climate actions are increasingly gender-responsive, they are less responsive to the age-specific vulnerabilities of adolescents, especially girls. To accelerate progress and ensure inclusive climate action, adolescent participation should be promoted at all levels, and climate actions should reach the most vulnerable populations, including those in remote rural communities and particularly vulnerable groups such as married adolescents.

“I Personally Wouldn’t Know Where to Go”: Adolescents’ Perceptions of Mental Health Services

The aim of this study was to explore perceptions of mental health services from the perspectives of adolescents with no prior service experience. Thirty students in the Transition Year (fourth year) of secondary school participated in this study: 22 females and 8 males, aged 15 to 16. There was equal distribution across rural and urban settings. Participants had no prior experience of accessing mental health services. Data were collected in secondary school settings in the Republic of Ireland. An interpretive description approach guided this study. Data were collected through individual interviews. To complement interviews, participants drew images of mental health care environments and mental health staff members; drawings were not subjected to analysis. Data (participant interviews) were analyzed using qualitative content analysis. Three themes were identified. Participants suggested that “mental health services” differed from “psychiatric services,” with the latter term perceived more negatively. Uncertainty about how to access these services was voiced. Considering the vulnerability of adolescents to the experience of mental distress, education around mental health services is warranted. It is expected that provision of education in this area would enhance service delivery, improve adolescents’ help-seeking behaviors for mental distress, and reduce stigma.

Association of aggressivity at adolescence and criminality to severe assault exposure among former adolescent psychiatric inpatients

This study investigated the associations of adolescent aggression, and criminality, to severe hospital-treated assault exposures among young adults (n = 508) with a history of adolescent psychiatric inpatient treatment between 2001-2006. Participants were interviewed during hospitalization using K-SADS-PL to assess psychiatric disorders, and to obtain information on aggressivity. Data on crimes committed were obtained from the Finnish Legal Register Centre, and the treatment episodes for assault exposures from the Finnish National Care Register for Health Care, up to end of 2016. Predictors for severe assault exposure were male sex (OR = 2.1), short temperedness (OR = 2.4), non-violent offending (OR = 2.6), and violent offending (OR = 4.8). These results indicate that the participants most vulnerable to severe assaults were those suffering from a continuum of aggressivity across their lifetime. Our findings can be utilized to identify adolescents at risk of severe assault exposure, and to reduce this risk by focusing on appropriate treatments for these vulnerable adolescents.

Unique effects of nicotine across the lifespan

Smoking remains the leading cause of preventable death in the United States. Although combustible cigarettes are largely being replaced by tobacco-free products, nicotine use continues to increase in vulnerable populations, including youth, adolescents, and pregnant women. Nicotine exerts unique effects on specific brain regions during distinct developmental periods due to the dynamic expression of nicotinic acetylcholine receptors (nAChRs) throughout the lifespan. Nicotine exposure is a health concern not only for adults but also has neurotoxic effects on the fetus, newborn, child, and adolescent. In this review, we aim to highlight the dynamic roles of nAChRs throughout gestation, adolescence, and adulthood. We also provide clinical and preclinical evidence of the neurodevelopmental, cognitive, and behavioral consequences of nicotine exposure at different developmental periods. This comprehensive review highlights unique effects of nicotine throughout the lifespan to help elucidate interventions and public health measures to protect sensitive populations from nicotine exposure.

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic.

The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience. Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels. We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], p<0.001). Two thirds of adolescents reported household stress had increased during the pandemic, especially for Syrian adolescents in host communities (10.7pp higher than any other group, p<0.001). Social connectedness was particularly low for girls, who were 13.4 percentage points (p<0.001) more likely than boys to have had no interaction with friends in the past 7 days. Adolescent programming shows signs of being protective, particularly for girls, who were 8.8 percentage points (p<0.01) more likely to have a trusted friend than their peers who were not participating in programming. Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys.

Elevating Married Adolescents' Voices for Responsive Reproductive Healthcare in Syria.

Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria.

The Pandemic's Toll on Young Adolescents: Prevention and Intervention Targets to Preserve Their Mental Health

PurposeAdolescence is characterized by dramatic physical, social, and emotional changes, making teens particularly vulnerable to the mental health effects of the COVID-19 pandemic. This longitudinal study identifies young adolescents who are most vulnerable to the psychological toll of the pandemic and provides insights to inform strategies to help adolescents cope better in times of crisis. MethodsA data-driven approach was applied to a longitudinal, demographically diverse cohort of more than 3,000 young adolescents (11–14 years) participating in the ongoing Adolescent Brain Cognitive Development Study in the United States, including multiple prepandemic visits and three assessments during the COVID-19 pandemic (May–August 2020). We fitted machine learning models and provided a comprehensive list of predictors of psychological distress in individuals. ResultsPositive affect, stress, anxiety, and depressive symptoms were accurately detected with our classifiers. Female sex and prepandemic internalizing symptoms and sleep problems were strong predictors of psychological distress. Parent- and youth-reported pandemic-related psychosocial factors, including poorer quality and functioning of family relationships, more screen time, and witnessing discrimination in relation to the pandemic further predicted youth distress. However, better social support, regular physical activities, coping strategies, and healthy behaviors predicted better emotional well-being. DiscussionFindings highlight the importance of social connectedness and healthy behaviors, such as sleep and physical activity, as buffering factors against the deleterious effects of the pandemic on adolescents' mental health. They also point to the need for greater attention toward coping strategies that help the most vulnerable adolescents, particularly girls and those with prepandemic psychological problems.

The Association Between Bullying Victimization and Fighting in School Among US High School Students.

In-school fighting often results in severe punishment and compromised learning outcomes, without adequate consideration of contextual factors or student vulnerabilities. In this study, using a large, nationally representative data sample from the 2019 Youth Risk Behavior Survey (N = 13677), we assessed associations between a history of bullying victimization (at school and online) and past year fighting at school among U.S. high school students. Multiple regression models were used, adjusting first for demographics, and then for demographics and emotional-behavioral risks (depressive symptoms, alcohol consumption, and sexual violence victimization), for the total sample and then stratified by gender/sex. Both cyberbullying and in-school bullying were significantly associated with past year in-school fighting for the total sample, with associations retained, but marginally attenuated in fully adjusted models (cyberbullying: AOR: 1.30; 95% CI: 1.01-1.66 and in-school bullying: AOR: 1.96, 95% CI: 1.57-2.45). Gender/sex-stratified models demonstrated retained associations for males (cyberbullying: AOR: 1.93; 1.51-2.46 and in-school bullying: AOR: 2.70, 95% CI: 2.18-3.34) and females (cyberbullying: AOR: 1.89; 1.33-2.68 and in-school bullying: AOR: 1.66, 95% CI: 1.19-2.33) after adjusting for demographics, but only for males after adjusting for demographics and emotional-behavior risk factors (cyberbullying: AOR: 1.43; 95% CI: 1.07-1.93 and in-school bullying: AOR: 2.25; 95% CI: 1.73-2.92). These results demonstrate a significant association between bullying victimization and fighting, which was amplified for male students, and partially explained by social and emotional risks. This suggests that punitive approaches to fighting in school may be resulting in compounded harms for already vulnerable adolescents and that support-oriented approaches emphasizing conflict resolution, social-emotional well-being, positive gender identity development, and bullying prevention may be more appropriate.

Perceived Social Support and Symptom Loads of Psychiatric Disorders among Adolescents in Residential Youth Care

Abstract Adolescents in residential youth care (RYC) are at high risk for negative psychological and social development outcomes, as they have a high prevalence of mental health problems and perceive less social support than adolescents in the general population. Associations between perceived social support and mental health problems have been investigated, but no in-depth analyses have been published. Such knowledge is crucial to optimize vulnerable adolescents’ care while living in RYC. The present study, therefore, aims to investigate associations between the symptom load of four psychiatric disorders (the Child and Adolescent Psychiatric Assessment) and perceived social support (the Social Support Questionnaire) among 400 adolescents in Norwegian RYC facilities. The results reveal that a higher number of different types of support persons was associated with lower symptom loads for emotional disorders. In addition, girls reported lower emotional symptoms when perceiving support from their father, friends, and RYC staff, while boys reported more behavioral symptoms with father support and lower behavioral symptoms with staff support. Authors conclude that RYC staff and friends hold important roles in providing social support when parental support is absent. Authors recommend maintenance of social networks for adolescents in RYC and further development of staff members’ relational skills and competence.

Feasibility and relatability of cultural adaptation amongst conflict-affected populations

Cultural aspects, such as cultural values and specific stressors, need to be considered in intervention development of care.11Resnicow, K. (1999). Cultural sensitivity in public health: defined and demystified. Ethnicity & Disease. One study looked at the relevance and necessity of cultural adaptation in mental health interventions, and the results were conclusive. They found that for populations the intervention was not designed for, treatment was less effective than for the target population.22Benish, S.G. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta analysis. Journal of Counselling Psychology. Existing mental health programs well established in developed countries, with a low-threshold for quality care and a flexible delivery of the care, have shown to be less effective for marginalized populations and refugees, where linguistic and cultural barriers still exist. These barriers include limited understanding of treatment, a lack of knowledge on the healthcare systems in host countries, and the lack of interpreters or programs available in their native language.33Marrone, S. (2007). Understanding barriers to health care: a review of disparities in health care services among indigneous populations. International Journal of Circumpolar Health. A promising approach for culturally-informed treatment are short skills-training interventions, designed to help participants better cope with stress and build up resilience to successfully deal with new challenges. START NOW is an evidence-based integrative skills training program and an effective treatment for vulnerable adolescents in demanding situations. We designed a total of eleven characters and fifthteen storylines that reflect the negative experiences commonly experienced by the target beneficiaries, and then conducted content testing to identify the most relatable among them. By conducting content testing, we can culturally adapt the START NOW program to meet the needs of Persian and Afghans migrants, informed by the very community that the program seeks to help. The results identified the six most relatable characters and twelve most relatable storylines, which will go on to feature in START NOW intervention sessions, and improve outcomes in testing the adapted program's efficacy with participants in Switzerland. This study provided a greater understanding of the challenges and emotions experienced by Persian and Afghan migrants, and enables us to design an effective, culturally-relevant treatment to address symptoms of poor mental health amongst this population. We can now replicate this process when adapting evidence-based treatments for other populations in need.

Comparison of the Clinical Characteristics of Pediatric Poisoning Patients Who Visited Emergency Department Before and During the COVID-19 Pandemic.

We aimed to investigate changes in the clinical characteristics of pediatric poisoning patients who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Poisoning cases below age 18 who visited the ED from January 2018 to December 2021 were retrospectively analysed. The study period was then divided into pre-COVID-19 and COVID-19 pandemic to compare poisoning patterns. During the study period, 86,153 visits to the pediatric ED had been recorded, with 625 patients being included the final analysis. During the COVID-19 period, the proportion of poisoned patients increased from 0.62% to 0.98%. The average age of the patients was higher in the COVID-19 period, with 53.4% of the cases being intentional (pre-COVID-19, 32.5%; P < 0.001). Moreover, 70.4% of poisoning cases during the COVID-19 period were caused by drugs (pre-COVID-19, 60.6%; P = 0.038). More patients underwent decontamination and laboratory investigation during the COVID-19 period than during the previous period (P = 0.007 and P < 0.001, respectively). The length of ED stay and the proportion of hospitalisation were significantly greater during the COVID-19 period. After analysing accidental poisoning cases, we found that antipyretics/nonsteroidal anti-inflammatory drugs and respiratory drugs were more common in the pre-COVID-19 group, whereas iron/vitamins, cardiovascular drugs and hormones were more common in the COVID-19 group. After analysing intentional poisoning cases, we found that 73.6% and 76.4% of the patients in the pre-COVID-19 and COVID-19 group had a history of psychiatric disease, respectively. Although no difference was observed in the frequency of previous first suicide attempts, 19.0% of the patients in the COVID-19 group attempted suicide more than three times. During the COVID-19 pandemic, intentional poisoning cases, especially in adolescence, increased and were treated more. Many of the patients with intentional poisoning had a history of mental illness or suicide in the past. Therefore, it seems that policy consideration for mentally vulnerable adolescents during this new pandemic period is necessary.

Social Indicators with Serious Injury and School Bullying Victimization in Vulnerable Adolescents Aged 12-15: Data from the Global School-Based Student Survey

Social Indicators with Serious Injury and School Bullying Victimization in Vulnerable Adolescents Aged 12-15: Data from the Global School-Based Student Survey

Adolescent vulnerability to cocaine and mTOR signalling in the prefrontal cortex: effects on cognition

Adolescent vulnerability to cocaine and mTOR signalling in the prefrontal cortex: effects on cognition

Adolescent, Radicalism, and Terrorism in Indonesia: Experts’ View

Terrorism involving adolescents in Indonesia has been started since 2009. Currently, the number has reached about 16.5% of the total number of terrorism cases in Indonesia. Referring to this critical situation, we gathered experts in radicalism and terrorism issues in two focus group discussions (FGD) to examine the situation of adolescents and radicalism and terrorism in Indonesia, the vulnerability factors of adolescents, and the prevention strategies that can be done in the future. As a result, we find that radicalism has penetrated in young groups in Indonesia, even at an earlier age. This situation is supported by their vulnerability as an adolescent, including physical, psychological, and psychosocial vulnerabilities. Physical changes that happen in adolescence impact on psychological and psychosocial changes. In general, the need for self-existence becomes the source of all their vulnerabilities. Adolescent efforts to achieve their self-existence in society place them at risk of becoming the target of recruitment by radical and terror groups. Therefore, in the context of preventing radicalism and terrorism among adolescents in Indonesia, alternative identity is important to be pursued further.

Effects of mindfulness-based intervention on adolescents emotional disorders: A protocol for systematic review and meta-analysis.

Background:The vulnerability of adolescents to emotional disorders such as stress, anxiety, anger, depression, and emotional breakdown is a matter of great concern and urgent need. Studies in several countries and regions have reported higher prevalence of depression, stress, and anxiety in adolescents. Several studies have shown that mindfulness-based interventions have an ameliorative effect on both emotional disorders and psychological problems in adolescents. The purpose of this study is to systematically analyze the effects of mindfulness-based intervention on emotional disorders and psychological problems in adolescents, and to provide a reasonable mindfulness-based intervention program for adolescents with emotional disorders.Methods:Electronic databases including Google Scholar, EMBASE, Web of Science, PubMed, the CNKI, the Chinese Science and Technology Periodical Database, VIP, Wanfang, and Cochrane Library. These databases will be searched to identify randomized controlled trials (RCTs) published before October 2021. Only Chinese and English literature will be included. We will use the criteria provided in Cochrane Handbook 5.3.0 for quality assessment and risk assessment and Revman 5.3 software for meta-analysis. The primary outcome are mainly evaluated by PHCSS, SDS and SAS in adolescents.Conclusion:The results of this study may provide a strong basis for improving emotional disorders and psychological problems in adolescents.Systematic review registration: INPLASY2021110054.

Sex-Specific Predictors of Exposure to Hospital-Treated Assaults Among Former Adolescent Psychiatric Inpatients.

This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13-17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies.

Social inequalities and extreme vulnerability of children and adolescents affected by the COVID-19 pandemic.

Social inequalities and extreme vulnerability of children and adolescents affected by the COVID-19 pandemic.

Social inequalities and extreme vulnerability of children and adolescents impacted by the COVID-19 pandemic

Social inequalities and extreme vulnerability of children and adolescents impacted by the COVID-19 pandemic

Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents

BackgroundThere is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health.MethodsSchools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools.DiscussionThis is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India.Trial registrationClinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).