Youth Mental Health Interventions Research Articles

The use of technology and mobile health apps in child maltreatment interventions: Perspectives of TF-CBT therapists and SafeCare providers

BackgroundPrevious research has demonstrated positive effects of using technology as an augmentation to evidence-based youth mental health treatment and parenting programs, however, limited research has examined the use of technology in evidence-based child maltreatment (CM) prevention and treatment. ObjectivesThe purpose of this paper is twofold: 1) to understand the application of technology and mobile health apps in CM prevention and treatment programs and 2) examine the acceptability of CM programs with an evidence-informed app, JoyPop™, developed to promote resilience through emotion regulation. Participants and SettingTrauma-Focused Cognitive Behavioral Therapy (TF-CBT) therapists (N = 12) and SafeCare© providers (N = 12) were recruited and participated in virtual semi-structured interviews. MethodParticipants tested the JoyPop™ app over one week and were interviewed to assess their perspectives about and experiences using technology and mobile health apps in practice (aim 1) and the potential use of JoyPop™ as a program augmentation (aim 2). Data collection and analysis was guided by qualitative descriptive analysis. ResultsParticipants reported that technology and apps supporting positive coping strategies, including JoyPop™, are relevant to the goals of CM programs and can be used enhance client engagement and skill uptake. Participants noted that JoyPop™'s features more strongly align with the components of TF-CBT than Safecare. Limitations of technology use in practice are discussed. ConclusionsSupplementing CM programs with technology and mobile health apps may be used to bolster client engagement and positive outcomes. Future research is needed to address the efficacy and client acceptance of technology and app usage in practice.

An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.

This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health. Physical-Mental Multimorbidity in Ontario Youth.

Predicting recurrent chat contact in a psychological intervention for the youth using natural language processing.

Chat-based counseling hotlines emerged as a promising low-threshold intervention for youth mental health. However, despite the resulting availability of large text corpora, little work has investigated Natural Language Processing (NLP) applications within this setting. Therefore, this preregistered approach (OSF: XA4PN) utilizes a sample of approximately 19,000 children and young adults that received a chat consultation from a 24/7 crisis service in Germany. Around 800,000 messages were used to predict whether chatters would contact the service again, as this would allow the provision of or redirection to additional treatment. We trained an XGBoost Classifier on the words of the anonymized conversations, using repeated cross-validation and bayesian optimization for hyperparameter search. The best model was able to achieve an AUROC score of 0.68 (p < 0.01) on the previously unseen 3942 newest consultations. A shapely-based explainability approach revealed that words indicating younger age or female gender and terms related to self-harm and suicidal thoughts were associated with a higher chance of recontacting. We conclude that NLP-based predictions of recurrent contact are a promising path toward personalized care at chat hotlines.

Irritability across adolescence: Examining longitudinal trajectory, stability, and associations with psychopathology and functioning at age 18

BackgroundIrritability, marked by diminished frustration tolerance, holds significant implications for youth mental health treatment. Despite prior research on irritability trajectories, understanding of individual differences during adolescence remains limited. This study examines the stability and trajectory of irritability across ages 12–18, investigating associations with psychopathology and functioning at age 18. MethodsA community sample of families with 3-year-old children (N = 518) was recruited via commercial mailing lists. Irritability was assessed at ages 12, 15, and 18 using the Affective Reactivity Index. Psychopathology at age 18 was evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia, and functioning was assessed through the UCLA Life Stress Interview. Measurement invariance analyses and latent growth curve modeling were conducted within a structural equation modeling (SEM) framework. ResultsConfigural, metric, and scalar invariance models were supported. Elevated irritability at age 12 predicted adverse outcomes at age 18, including increased psychotropic medication use, mental health treatment, suicidal ideation, self-injury, and psychiatric disorders. Importantly, these associations persisted even after accounting for corresponding variables at age 12. The trajectory of irritability during early adolescence significantly predicted heightened risks for various outcomes at age 18, including suicidal ideation, depression, anxiety, disruptive behavior disorders, and impaired interpersonal functioning. DiscussionLimitations include using only youth-reported data at age 18, limited generalizability from a mostly White, middle-class sample, and insufficient exploration of the broader developmental trajectory of irritability. Nevertheless, the findings emphasize the crucial role of irritability's trajectory in influencing various psychopathological and functional outcomes in late adolescence.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12–25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia’s leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1–12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: Perspectives from Seattle, Washington.

In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This study aims to ascertain the kinds of support across the mental health care continuum recommended by young people and key stakeholders who could assist with implementation in Seattle. We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among youth. We complimented these data with a 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Qualitative informants attributed challenges to youth mental health to social isolation and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, and substance abuse prevention. Key informants and survey participants identified schools as the most important setting for mental health interventions. There were no significant differences among quantitative outcomes. Our findings highlight the need for interventions that reduce isolation and increase social connectedness to support youth mental health. As the city designs youth responsive interventions, schools and digital platforms should be prioritized. Engaging multiple stakeholders, particularly young people, tackling cultural stigma surrounding mental health, and improving access to safe community spaces are important considerations for youth mental health interventions.

Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination

Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination

In Mind and Spirit: The Psychosocial Impacts of Religiosity in Youth Mental Health Treatment

The rise in suicides among elementary- to high-school-aged youth has alarmed health professionals for years, only to be amplified by the long-lasting effects of the COVID-19 pandemic. Religion and spirituality offer many people significant psychosocial support in pandemic circumstances, often acting as platforms for hope and social connectedness. Yet, given the adultocentric world they inhabit, young people must often negotiate or reconsider the role of religion and spirituality in the context of their developmental trajectory. This research explores mental health professionals’ approaches to religiosity and spirituality in the delivery of therapeutic care to youth at risk of suicide. Qualitative analyses of interview transcripts conducted with youth mental health clinicians in the state of Texas underscore a myriad of contextual factors related to treating suicidal ideation and behaviors. We categorize our findings according to licensed mental health professionals’ (1) navigation of youth clients’ religious/spiritual preferences aligned with or opposed to familial preferences; (2) selective integration of youth-oriented religious/spiritual elements into treatment as warranted; and (3) reflections on the impacts of religion/spirituality on treatment efficacy for child and adolescent clients. This study adds to current research on religion and spirituality’s impact on mental health and its therapeutic integration into treatment practices tailored for youth.

Evaluation of a community-based intervention for youth mental health in rural Ireland.

This study aimed to provide information about pathways to care and clinical response to community-based brief interventions for improving youth mental health through evaluating the Mindspace Mayo service. Participants were 1,184 individuals aged 12-25 years (Mean = 17.92, SD = 2.66) who engaged with the Mindspace service. Demographic information included gender, age and living situation. The Clinical Outcome in Routine Evaluation (CORE) was used to measure psychological distress before and after attending the Mindspace service between February 2015 and 2022. On average, individuals received six sessions of therapeutic support. Analyses indicated that most referrals were made by either a parent (40%) or self-referral (38%). The most frequent reason for referral was mood and anxiety-related issues. Across the entire sample, reductions in CORE scores were both statistically and clinically significant. Neither the source of the referral nor living situation significantly predicted intervention response. Complexity of issues presented at referral significantly predicted a reduction in psychological distress post-intervention in young people aged over 17 years. This study highlighted the value of primary care mental health services for young people aged 12-25 years, and underlined the importance of recording electronic data to track referral pathways, reasons for referral and the intervention outcomes over time.

“It is like post-traumatic stress disorder, but in a positive sense!”: New territories of the self as inner therapeutic landscapes for youth experiencing mental ill-health

The manuscript reports on a study conducted on a youth mental health intervention, proposing a novel framework to look at the therapeutic potential of viticultural landscapes. Drawing on care studies applied to agricultural contexts, the work explores how the attention-based practice of manual grape harvest in a specific natural and social environment can produce a “therapeutic landscape of the mind”. Through ethnographic research, we investigate how the spatial and social context of the viticultural environment influences the experience of a group of young people with mental-ill health, eventually supporting their process of recovery. Findings describe how the lived experience of caring for the vines while interacting with professional winegrowers in a one-to-one relationship allows participants to explore new territories of the self. It is argued that this powerful experience is not only beneficial as it unfolds, but also at a later time. Its therapeutic potential resides in the fact that the “landscape of the mind” can be recalled by the person, while positive identities associated with it and newly discovered “ways of being” can be re-enacted. The paper furthers the reflection on place-making practices of public health services and the way they can support the identification and cultivation of enabling places, particularly for vulnerable populations (e.g. young people) that can benefit from interventions conducted in non-medical, non-stigmatizing environments. The work is the result of an interdisciplinary collaboration between a psychiatrist (designing and coordinating the intervention) and a sociologist (designing and conducting the ethnographic study).

Enhancing help-seeking efficacy in a sustainable and adaptive digital environment

Abstract Background Help-seeking efficacy is directly related to Mental Health Literacy (MHL) as one of its four important components and has been successfully addressed in digital mental health interventions for youth. However, these interventions are often not sustainable and not sufficiently diversity-sensitive. The 3-year Erasmus+ project me_HeLi-D (mental health literacy and diversity) aims to develop a digital, adaptable, diversity-sensitive tool to promote mental health and MHL among youth (12-15 years). Methods The tool-development is based on two pillars: thorough literature reviews and the voices of young people. Through a participatory research process, the design and content of the modules are co-created with the target group. The tool is implemented in Moodle to ensure high accessibility and flexibility and to allow updates and monitoring by the IT-department, which guarantees sustainability beyond the project duration. A total of 27 mental health interventions were systematically reviewed for the module addressing help-seeking efficacy, and three of them reported effective improvement in help-seeking behavior. Among these, an app using character vignettes resulted in greater increases in well-being and help-seeking intentions in the intervention group. Results Based on these findings and feedback from the participatory activities, an activity promoting help-seeking behavior was developed for the tool using a narrative format. The help-seeking activity, its content, and its goals are presented. In addition, the digital implementation is discussed, addressing issues of adaptability and sustainability in relation to the deployment plan in Moodle. Conclusions The importance of a participatory, evidence-based approach and consideration of diversity-sensitivity and digital sustainability in the development of a digital mental health tool was emphasized.

The adaptation of a youth mental health intervention to a peer-delivery model utilizing CBPR methods and the ADAPT-ITT framework in Sierra Leone.

Low- and middle-income countries (LMICs) carry a significant proportion of the global burden of untreated mental health disorders. Peer-delivered programs offer LMICs with limited mental health professionals an opportunity to increase mental health service access. This study describes the process of adapting a lay-worker-delivered evidence-based youth mental health intervention to a peer-delivery model in Sierra Leone using participatory methods. We convened Youth Community Advisory Boards (YCABs) as partners to develop a peer-delivery model for an evidence-based intervention. In collaboration with YCABs, the Assessment, Decision, Administration, Production, Topical experts, Integration, Training, Testing (ADAPT-ITT) framework was applied to guide the adaptation. The ADAPT-ITT framework is an eight-step process to adapt evidence-based interventions. The ADAPT-ITT framework facilitated the adaptation of the Youth Readiness Intervention (YRI), an evidence-based mental health program intervention that has been delivered by adult lay-workers to the youth peer-delivery platform in Sierra Leone. The YCABs identified program modifications, including the incorporation of storytelling, refinement of metaphors, and alterations to make delivery more accessible to low-literacy youth with particular attention to gender. YCABs also provided recommendations on how to support youth facilitators in providing psychosocial support, emphasizing self-care and boundary setting to ensure high-quality intervention delivery and do-no-harm principles. Study findings suggest that the ADAPT-ITT framework can be feasibly applied to guide the intervention adaptation process in LMICs. The use of participatory methods generated modifications that reflected youth experiences, needs, and concerns as facilitators and participants. Next steps include refinement and pilot testing of the adapted intervention.

Calling All Caregivers: Methods for Increasing Caregiver Involvement in Youth Mental Health Treatment

Calling All Caregivers: Methods for Increasing Caregiver Involvement in Youth Mental Health Treatment

How Do Youth Mental Health Interventions Change the Brain? Capturing the Malleability of Brain Development to Strengthen Brain Circuits in Young People

How Do Youth Mental Health Interventions Change the Brain? Capturing the Malleability of Brain Development to Strengthen Brain Circuits in Young People

52.1 Integrating Parents Within Outpatient Youth Mental Health Treatment

52.1 Integrating Parents Within Outpatient Youth Mental Health Treatment

Prevalence of Mental Health Problems among School-going Adolescents in Melmaruvathur: An Observational Study

Introduction: Around 2.2 billion of the world's population are children and adolescents. Ninety percentage live in low-and middle-income countries, where they make up 30%–50% of the population. This study examines mental health issues and their association with gender in Melmaruvathur, teenage school children. Materials and Methods: After receiving approval from the Ethics Committee, a descriptive cross-sectional questionnaire-based study was carried out on adolescents who were attending school in Melmaruvathur. The participants in the study filled out the questionnaires. The power of the study was set at 80%, and the significance level was set at 0.05. The estimated size of the sample was 500. The duration of the study was approximately 1 ½ years, beginning on June 1, 2021, and ending on December 30, 2022. The age range was anywhere between 11 and 17 years, participants had to be adolescents who attended school. Those who had participated in mental health training programs in the past were not allowed to participate. Results: There were about 43.4% of females and 56.6% of males among the study participants. About 3.0% had very high conduct problems, 5.80% had high conduct problems, 1.4% had very high hyperactivity, around 1.80% had very high emotional problems, around 7.40% had very high peer problems, and 6.80% had very low prosocial. There was no statistically significant difference between the genders regarding conduct problems, hyperactivity problems, emotional problems, peer problems, and prosocial. In the case of females, 77.52% had a total difficulty score that was quite close to the average and in males, 81.53% received a total difficulty score that was quite close to the average. Conclusion: The findings are significant for several reasons, including the understanding of gender-specific vulnerabilities, the creation of youth mental health interventions that are more specifically focused on youth, and the peculiarities of the home setting.

​​Nested Ethics: The Management of Young People’s Goals in Alternative UK Mental Health Services

Youth mental health interventions in the UK increasingly use goal-setting procedures to shape services and measure outcomes in ways that are intended to be meaningful to service users. This research article questions this premise, departing with the ethnographic observation that many young people do not seem to welcome the invitation or requirement to direct their therapeutic aims and set the terms for service evaluation in the form of goals. I will show that goal-setting procedures are examples of a broader field of complex ethico-political dilemmas navigated by mental health service staff. While wanting to enable young people to be healthy agents, staff are simultaneously critically aware of the risk of imposing normative, unrealistic and unfair expectations onto young people. I propose that these staff are engaged in a specific form of ethico-political practice, which I call ‘nested ethics’. I use this term to describe instances where staff ethically evaluate their own conduct in line with the capacity to enable the ethical life of another person (youth, in this case). Viewing goal-setting processes as an example of an uneasy politics of nested ethics enables a new perspective from which to advance debates about the enablement of service user choice within care provisions.

The Effectiveness of Equine-Assisted Mental Health Interventions for Youth: A Meta-Analysis of Controlled Studies

The Effectiveness of Equine-Assisted Mental Health Interventions for Youth: A Meta-Analysis of Controlled Studies

Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis

BackgroundPrior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed.MethodsQuantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants’ ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians’ responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III).ResultsWe identified two classes of clinicians: “Higher MFS” and “Lower MFS,” and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts.ConclusionThis study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.

RESEARCH ARTICLE: Ethical challenges faced by community mental health workers in urban Chennai.

Delivery of mental health interventions to youth in schools requires a cadre of community mental health workers (CMHWs) in addition to psychiatrists. Literature is sparse in the India context on the ethical and professional challenges faced by CMHWs, especially those working with youth. Hence, the aim of the study was to understand these challenges faced by CMHWs working in schools in urban Chennai and explore ways to overcome them. A qualitative study was done with CMHWs involved in the delivery of youth mental health (YMH) interventions, including mental health literacy, screening for mental disorders and mental health support to youth in schools in urban Chennai. Focus group discussions (FGDs) were conducted with the study participants and audio recorded. Transcription of the recording was done verbatim and coded for themes using a thematic analysis approach. Two FGDs were conducted with a total of eight participants. The mean (± standard deviation) age of the participants was 27 ± 3.7 years; all having a master's degree in either psychology, social work, or public health. The major themes that emerged were the meaning of ethics and professionalism, confidentiality, dilemma in decision making, incongruence between the requirements of student and school administration, and personal and professional challenges faced by CMHWs. Recommendations to overcome these challenges were also explored. The results indicate CMHWs face significant ethical challenges with confidentiality, and decision making while delivering YMH interventions in schools, highlighting the need for designing and implementing a framework to address these challenges.