Worse Mental Health Research Articles

Financial strain and the health and well-being of college students during the COVID-19 pandemic

Objective: This study examined the associations between COVID-19-related financial strain and the stress, mental health, physical health symptoms, and health behaviors of American university students. Participants: Online data were collected from 485 participants between May 2020 and March 2021. Participants were majority female and majority white. Methods: Participants reported on stress (COVID-19 health stress and work stress), mental health (depression, anxiety, loneliness, social support, and subjective well-being), physical health symptoms, and health behaviors (sleep latency, alcohol consumption, alcohol coping, other substance use, exercise, COVID-19 health behaviors). Results: Both Pearson’s correlations and Bayesian correlation indicated more stress and worse mental health, health symptoms, and health behaviors for students who experienced more financial strain. Conclusion: Pandemic-related financial strain could have enduring negative effects for students, many of whom already experience financial challenges. This work highlights a need to allocate resources to promote college student health during and after the COVID-19 pandemic.

Study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems among university students: the SUN cohort study

ObjectiveTo determine the association between different aspects of study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems.Design, setting and participantsWe recruited a cohort of 4262 Swedish...

Associations between type and timing of sedentary behaviour and affect in adolescents: An ecological momentary assessment study

BackgroundThere is limited evidence on the associations between type and timing of different sedentary behaviour with affect in adolescents. This study aimed to investigate within-person associations between different types of sedentary behaviour with core affect among a sample of Australian adolescents and explore if the association differs across different times of the day. MethodsUsing ecological momentary assessment, 119 participants (Mage = 14.7 years, 54% male) self-reported engagement in different types of sedentary behaviour, as well as providing information on their affective states multiple times each day, over a four-day period. Data were analysed using multi-level and time-varying effects models. ResultsPlaying video games and having a meal on the weekend was favourably associated with valence and tense arousal. Watching TV or a movie on the weekend was associated with lower tense arousal but also lower energetic arousal. Using social media and reading or doing homework on the weekend were also negatively associated with energetic arousal. Reading or doing homework and using social media on a weekday afternoon were inversely associated with valence. Playing video games using social media and reading or doing homework were inversely associated with energetic arousal on weekdays. Results from the time-varying effects models demonstrated that the magnitude of these effects may differ depending upon the time of the day that the sedentary behaviour occurs. ConclusionsThe type, and to a lesser extent, the timing of sedentary behaviours are differently associated with affect in adolescents. These results may provide unique insights into why some types of sedentary behaviours are related to worse mental health and wellbeing and others are not.

Psychological Resilience of Chinese College Students: A Cross-Sectional Study after the Deblocking of China's COVID-19 Pandemic Strategy.

Psychological resilience (PR) plays an important role in fortifying mental health during pandemics. This study aimed to examine the PR and its related factors of college students in China after the deblocking of the China's COVID-19 pandemic strategy. A total of 1100 college students from 15 universities participated in this cross-sectional survey by multi-stage stratified sampling. Data were collected by self-designed socio-demographic information, the family function assessment scale (APGAR), a general health questionnaire (GHQ-12), the general self-efficacy scale (GSES), and a psychological resilience scale. The average score of PR was 135.65 ± 18.54. Cluster analysis of PR scores showed that 24.9% of the college students had weak PR. The higher PR, the higher mental health status (r = 0.352, p < 0.05). Females had higher PR than males (OR = 0.550, 95% CI: 0.367-0.827). High self-efficacy was an independent protective factor of high PR (OR = 0.093, 95% CI: 0.059-0.145). Low family contact frequency, poor family function, and bad mental health status were the independent risk factors of high PR. In conclusion, the PR of Chinese college students were insufficient after the deblocking of China's COVID-19 pandemic strategy, indicating an improvement of PR should be put into practice immediately. Frequent monthly contact with family, family function, self-efficacy, mental health status, and gender were the influencing factors of PR, which provides an intervention strategy for the future.

Trends in mental health inequalities for people with disability, Australia 2003 to 2020.

Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities. We use annual data (2003-2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened. This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations.

Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women.

Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.

Patients with chronic myeloid leukemia and coronavirus disease 2019 in the Omicron era.

To explore the prevalence and severity of COVID-19 and the mental health during the Omicron pandemic in patients with chronic myeloid leukemia (CML), a cross-sectional survey from 2609 respondents with CML was performed. A total of 1725 (66%) reported that they had COVID-19 during this period. Among them, 1621 (94%) were mild; 97 (6%), moderate; 7 (0.4%), severe; and 0, critical or death. Four hundred three (15%), 199 (8%), and 532 (20%) had moderate to severe depression, anxiety, and distress, respectively. Eight hundred ninety (34%), 667 (26%), and 573 (22%), avoidance, intrusion, and hyper-arousal, respectively. In multivariate analyses, longer TKI-therapy duration was significantly associated with a lower prevalence of COVID-19 (odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.95, 0.99; p = 0.043); however, living in urban areas (OR = 1.6 [1.3, 2.0]; p < 0.001) and having family members with COVID-19 (OR = 18.6 [15.1, 22.8]; p < 0.001), a higher prevalence of COVID-19. Increasing age (OR = 1.2 [1.1, 1.4]; p = 0.009), comorbidity(ies) (OR = 1.7 [1.1, 2.7]; p = 0.010), and multi-TKI-resistant patients receiving 3rd-generation TKIs or investigational agents (OR = 2.2 [1.2, 4.2]; p = 0.010) were significantly associated with moderate or severe COVID-19. Female, comorbidity(ies), unvaccinated, and moderate or severe COVID-19 were significantly associated with almost all adverse mental health consequences; increasing age or forced TKI dose reduction because of various restriction during the pandemic, moderate to severe distress, avoidance, or intrusion; however, mild COVID-19, none or mild anxiety, distress, avoidance, or intrusion. In conclusion, shorter TKI-therapy duration, increasing age, comorbidity(ies), or multi-TKI-resistant patients receiving 3rd-generation TKIs or investigational agents had a higher prevalence of COVID-19 or higher risk of moderate or severe disease in patients with CML; increasing age, female, comorbidity(ies), forced TKI dose reduction due to the pandemic, moderate or severe COVID-19, unvaccinated, a higher likelihood of worse mental health.

Quality of life of inpatients in the mental health ward of Herat Regional Hospital: a cross-sectional study

Background: Quality of life is a vital parameter for assessing the impact of severe psychiatric conditions on patients, significantly influencing their overall well-being. This study aims to comprehensively examine and evaluate the quality of life among inpatients in the Mental Health Ward of Herat Regional Hospital. Methods: A cross-sectional study was conducted from September 23, 2022, to October 12, 2022, involving 147 inpatients from the Mental Health Ward of Herat Regional Hospital. Results: The study included 147 participants, with the majority (59.9%) falling within the 15-28 age range, and 20.4% were male. Among the respondents, 79.6% reported poor physical health, while 20.4% of hospitalized patients reported good mental health. Regarding gender, females (84.6%) exhibited worse physical health compared to males. Moreover, individuals with limited literacy (unable to read and write) had a lower physical health score (82.3%). Among unemployed participants, only 37.5% reported good physical health. Females (82.9%) also showed worse mental health compared to males, with a statistically significant correlation observed between gender and mental health. Conclusion: The quality of life of inpatients in the Mental Health Ward of Herat Regional Hospital was found to be lower in both physical and mental dimensions compared to hospitalized patients in other countries. Identifying factors contributing to the poor quality of life among patients is of paramount importance. Targeted interventions are needed to prevent morbidity and mitigate factors impacting the quality of life of these patients.

I feel addicted to watching TV series: association between binge-watching and mental health.

Binge-watching (BW) is the consecutive viewing of three or more episodes of the same series in one sitting. Although some negative effects on mental health were evidenced, the continuum of BW from leisure activity to problematic behavior is still unclear. This study aimed to analyze mental health (depression, trait anxiety, social anxiety, impulsivity, alexithymia) of people involved in different expressions of BW. A cross-sectional survey collected data from 482 respondents. According to a validated BW questionnaire, participants were divided into Problematic BW, Moderate BW, Non-BW, and No-viewer, and differences between groups were tested on psychological dimensions assessed via standardized questionnaires evaluating: trait and social anxiety, depression, impulsivity, and emotional dysregulation. An association between problematic BW and worse mental health conditions was evidenced, and a positive effect of non-problematic BW was supported. A negative linear trend from the BW as a leisure activity to problematic BW was marked, indicating how a possible maladaptive behavior orientation of BW in specific mental health conditions could be figured out as a behavioral addiction.

Working time variation and mental health during the Covid-19 pandemic in China

The Covid-19 pandemic has brought about a significant shift in labor market dynamics, leading to a notable increase in labor market flexibilization. One prominent aspect of this transformation is the growing variation in working time patterns. The irregular and unpredictable nature of working time may contribute to increased stress levels, difficulty in establishing routines, and challenges in maintaining work-life boundaries. Drawing on China General Social survey 2021, this study aims to examine (1) the relationship between working time variation and mental health during the Covid-19 pandemic in China; (2) whether the relationship can be mediated by work-family conflict; (3) to what extent the relationship varies across occupations. We find that working time variation is associated with significantly worse mental health during the Covid-19 pandemic in China, and around half of the negative effect can be mediated by increased work-family conflict. Moreover, the negative association is more pronounced among non-professional occupations than professional occupations. Overall, these findings shed light on the detrimental impact of working time variation on mental health and its potential mechanism, highlighting how novel work paradigm may interact with existing labor market inequalities to shape workers’ mental health.

Changes in mental health symptoms and sociocultural factors across the COVID-19 pandemic in mothers of Mexican descent.

Latinos have been disproportionately affected by the COVID-19 pandemic in the US. Little is known about the lasting effects on mental health, particularly among mothers of young children, who historically report high levels of depression and anxiety. We examined if anxiety and depression symptoms worsened for mothers of Mexican descent across the pandemic and identified the role of sociocultural risk and protective factors on these changes. Mothers of Mexican descent (n = 141) with young children (ages 0-7) were administered surveys on mental health symptoms (anxiety and depression), stress-related sociocultural factors (perceived discrimination) before (pre-pandemic), within 3 months (early pandemic), and 18 months after the COVID-19 stay-at-home order (late pandemic). Another sociocultural factor, acculturative stress, was only measured pre-pandemic while during the later phase of the pandemic mothers reported their levels of loneliness, optimism, and coping styles. Repeated measures (RM) ANOVA demonstrated that depressive and anxiety symptoms as well as perceived discrimination increased from pre to early months of the COVID-19 pandemic and slightly lowered in late-COVID but did not return to pre-COVID levels. Two-way RM ANOVA showed that acculturative stress and perceived discrimination predicted worse mental health trajectories across the pandemic while moderations revealed that optimism buffered against, and avoidant coping increased the adverse effects of sociocultural factors on mental health. The effects of the COVID pandemic on mental health are lingering in mothers of young children; however, optimism may be a protective factor. The results also highlight the damaging effects of external factors, such as discrimination, on maternal mental health during times of crisis.

Residence in segregated settlements (colonies) rather than Roma identity increases the risk of unfavourable mental health in Hungarian adults.

Roma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary. A cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3). Residents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity. The study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Hostile sexism is related to worse mental health outcomes among fathers.

Transition to parenthood is a life-changing yet stressful event for both men and women. The present study aims to: (1) establish the incidence of prenatal paternal depression and anxiety in a sample of expectant fathers and (2) assess the relationship between sexist beliefs and mental health outcomes. We recruited expectant fathers (n = 100) who attended the Gynecology and Obstetrics Outpatient Clinic of Eskişehir Osmangazi University Hospital with their pregnant partners. Fathers completed the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and the Ambivalent Sexism Scale. 36% of expectant fathers reported depression, and 12% reported anxiety. Hostile sexism was correlated with depression (r = 0.303, p < 0.01), and anxiety (r = 0.228, p < 0.05). Benevolent sexism was not related to anxiety or depression (each, p > 0.05). Family social support (p = 0.004) and perceived financial satisfaction (p = 0.027) predicted anxiety, while family social support (p < 0.001) and perceived financial satisfaction (p = 0.036) predicted depression. Hostile sexism predicted both anxiety (B = 0.28, p = 0.004) and depression (B = 0.32, p < 0.001). Results may not show a causal relationship due to the study's cross-sectional design. We recruited participants in only one center. Our measures of anxiety and depression were purely psychometric. Sexist beliefs may serve as environmental stressors among men in the perinatal period by increasing the masculine role stress. Future interventions to treat prenatal paternal depression may target sexism.

Anxiety and Depression Symptoms During the COVID-19 Pandemic: A Cluster Analysis of Individuals Living in Portugal.

The COVID-19 pandemic is an illustration of how a physical illness can damage people's minds. In this regard, the goal of this study was to see how different sociodemographic and behavioral factors were linked to anxiety and depression symptoms in a group of individuals living in Portugal. Between November 2020 and February 2021, a cross-sectional, snowball online study was conducted. The study's target population was adults over the age of 18, residents of the country. For the statistical analysis, the clustering technique - K-means algorithm was applied. The chi-squared test was used to determine the relationships between clusters and sociodemographic and behavioral characteristics. Statistical analyses were conducted in R language, with a significance level of 0.05. A total of 453 participants were included. The majority were female (69.8%), under the age of 40 (60.8%), with a higher education degree (75.3%), and not married (54.4%). Furthermore, the majority were from the country's north region (66%). Cluster 1 (n = 194) was characterized by low or nonexistent levels of anxiety and depression symptoms, which means normal; cluster 2 by severe symptoms (n = 82), meaning case; and cluster 3 by mild symptoms (n = 177), which means borderline. Younger participants (p-value 0.024), female (p-value 0.041), with drinking habits (p-value 0.002), food insecurity (p-value < 0.001), food affordability exacerbation (p-value < 0.001), comorbidity (p-value < 0.001), use of anxiolytics (p-value < 0.001), insufficient household income (p-value 0.017) and income change (p-value < 0.001) were significantly associated with the anxiety-depression clusters. From the three clusters, cluster 2 was mainly represented by younger participants, with more persons stating that their household income was insufficient and that their income has changed as a result of COVID-19 and that they had the highest probability of food insecurity. The impacts of a crisis on mental health extend longer than the event itself. We were able to observe that younger women with insufficient household income who suffered a change in income due to COVID-19 and were classified as food insecure presented higher levels of anxiety and depression symptoms. These results highlight the presence of a social gradient where we saw that people who were less advantaged in terms of socioeconomic position presented worse mental health outcomes, stressing, in this sense, the need to bring the best public health responses for these specific groups of the population.

Mental and Emotional Health of Caregivers of Youth with Sickle Cell Disease: A Systematic Review

Abstract: People of African descent and those identifying as Black and/or Latino experience a disproportionate burden of sickle cell disease (SCD), a chronic, serious blood condition. Caregivers of children with chronic medical conditions report worse mental health than others. Disease-associated stressors can affect caregivers of children with SCD. We conducted a systematic review to summarize the prevalence of mental health symptoms in caregivers of children with SCD and to see if symptoms were associated with the child's SCD. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, PsycINFO, and Embase, identifying 1,322 records of which 40 met criteria for inclusion in this review. Findings suggest caregivers experience mental health problems, and poorer mental health was associated with worse child SCD-related outcomes and treatment adherence. Efforts should be made to routinely screen SCD caregiver mental health and to refer accordingly.

HUBUNGAN TINGKAT PENGETAHUAN DAN PERILAKU PERAWATAN DIRI KESEHATAN JIWA GENERASI Z SUKU LANI PAPUA

Introduction: Mental health problems in Generation Z are currently increasing. The level of knowledge of Generation Z plays an important role in dealing with mental health problems. So this study aims to determine the relationship between the level of knowledge and mental health self-care behavior in generation Z of the Papuan Lani tribe. Method: This study uses a descriptive design and the approach is a survey. The sampling technique used was purposive sampling with a total sample of 171 respondents. Measuring tools used in this study are the Knowledge Level questionnaire and The Mindful Self-Care Scale Questionnaire. This study was carried out in Malang City from October 2022-March 2023. Data processing used the IBM SPSS program. Results: a study of 171 respondents, 97 (56.7%) respondents had good mental health self-care behavior, 47 (27.5%) respondents had moderate mental health self-care behavior and 27 (15.8%) respondents had bad mental health self-care behavior. Conclusion: This study shows that generation Z has a pattern of good mental health self-care behavior, followed by moderate mental health self-care behavior and bad mental health self-care behavior.

Exploring the relationship between mental health and dialect use among Chinese older adults: a moderated mediation estimation.

Mental health, conceptualized as psychological status that includes rational cognition, emotional stability, and interpersonal harmony, is highly relevant to the expected health and well-being of all humans. China is facing the dual risk of increased aging and mental health disorders in older adults, while the established studies have rarely focused on the influence of dialect on the mental health of Chinese older adults. The present study aims to capture the relationship between dialect and mental health in Chinese older adults. We use cross-sectional data from the nationally representative China Family Panel Studies, which encompasses the dialect use, mental health, and other socioeconomic features of 4,420 respondents. We construct a moderated mediation model that uses dialects and mental health as the independent and dependent variables and income inequality and subjective well-being as the mediator and moderator to reveal the relationship between dialect and mental health in Chinese older adults. (1) Dialects are shown to have a negative influence on the mental health of older adults in the current study (coefficient = -0.354, 95% CI = [-0.608, -0.097]). (2) Income inequality positively mediates the correlation between dialects and mental health (coefficient = 0.019, 95% CI = [0.010, 0.045]). (3) Subjective well-being negatively moderates the potential mechanism between dialects and mental health (coefficient = -0.126, 95% CI = [-0.284, -0.010]). The use of dialects is associated with worse mental health outcomes in Chinese older adults, while this negative influence is positively mediated by income inequality and negatively moderated by subjective well-being, simultaneously. This study contributes to the knowledge enrichment of government workers, older adults with mental disorders, medical staff, and other stakeholders.

Daily Cannabidiol Administration for 10 Weeks Modulates Hippocampal and Amygdalar Resting-State Functional Connectivity in Cannabis Users: A Functional Magnetic Resonance Imaging Open-Label Clinical Trial.

Introduction: Cannabis use is associated with brain functional changes in regions implicated in prominent neuroscientific theories of addiction. Emerging evidence suggests that cannabidiol (CBD) is neuroprotective and may reverse structural brain changes associated with prolonged heavy cannabis use. In this study, we examine how an ∼10-week exposure of CBD in cannabis users affected resting-state functional connectivity in brain regions functionally altered by cannabis use. Materials and Methods: Eighteen people who use cannabis took part in a ∼10 weeks open-label pragmatic trial of self-administered daily 200 mg CBD in capsules. They were not required to change their cannabis exposure patterns. Participants were assessed at baseline and post-CBD exposure with structural magnetic resonance imaging (MRI) and a functional MRI resting-state task (eyes closed). Seed-based connectivity analyses were run to examine changes in the functional connectivity of a priori regions-the hippocampus and the amygdala. We explored if connectivity changes were associated with cannabinoid exposure (i.e., cumulative cannabis dosage over trial, and plasma CBD concentrations and Δ9-tetrahydrocannabinol (THC) plasma metabolites postexposure), and mental health (i.e., severity of anxiety, depression, and positive psychotic symptom scores), accounting for cigarette exposure in the past month, alcohol standard drinks in the past month and cumulative CBD dose during the trial. Results: Functional connectivity significantly decreased pre-to-post the CBD trial between the anterior hippocampus and precentral gyrus, with a strong effect size (d=1.73). Functional connectivity increased between the amygdala and the lingual gyrus pre-to-post the CBD trial, with a strong effect size (d=1.19). There were no correlations with cannabinoids or mental health symptom scores. Discussion: Prolonged CBD exposure may restore/reduce functional connectivity differences reported in cannabis users. These new findings warrant replication in a larger sample, using robust methodologies-double-blind and placebo-controlled-and in the most vulnerable people who use cannabis, including those with more severe forms of Cannabis Use Disorder and experiencing worse mental health outcomes (e.g., psychosis, depression).

Exploring mechanisms andcontexts ina Peer Education Project to improve mental health literacy inschools inEngland: a qualitative realist evaluation.

Poor adolescent mental health calls for universal prevention. The Mental Health Foundation's 'Peer Education Project' equips older students ('peer educators') to teach younger students ('peer learners') about mental health. The peer-led lessons cover defining good and bad mental health, risk and protective factors, self-care, help-seeking and looking after one another. While previous pre-post evaluations have suggested effectiveness, the mechanisms through which the intervention improves mental health literacy remain unclear. We purposively recruited seven secondary schools across England from 2020 to 2022 and collected data through five observations, 12 staff interviews and 15 student focus groups (totalling 134 students; 46 peer educators aged 14-18 years and 88 peer learners aged 11-13 years). Our realist analysis adopted retroductive logic, intertwining deductive and inductive approaches to test the initial programme theory against insights arising from the data. We developed Context-Mechanisms-Outcome configurations related to four themes: (i) modelling behaviours and forming supportive relationships, (ii) relevant and appropriate content, (iii) peer educators feeling empowered and (iV) a school culture that prioritises mental health support. Our refined programme theory highlights key mechanisms, contexts conducive to achieving the outcomes and ways to improve training, recruitment and delivery to maximise effectiveness for similar peer-led initiatives.

Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescents.

Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way. A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups. The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference. It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed.