Youth Mental Health Research Articles

Coping with ethnic-racial discrimination: Protective-reactive effects of shift-and-persist coping on internalizing symptoms among Black American adolescents.

Ethnic-racial discrimination has pervasive negative effects on Black youth's mental health; therefore, it is crucial to identify factors that provide resilience against discrimination. Two promising factors to help youth cope are ethnic-racial identity (how one feels about their ethnicity/race) and shift-and-persist coping (reappraising and accepting an uncontrollable stressor while remaining optimistic about the future). While there is existing scholarship on ethnic-racial identity among Black youth, this work has not yet assessed the impacts of shift-and-persist in this population. Using a sample of 155 Black youth (ages 13-17), the current study examined the interplay between discrimination, ethnic-racial identity, shift-and-persist coping, and internalizing symptoms. Symptoms of depression and anxiety were positively associated with discrimination and negatively associated with shift-and-persist. Significant interactions between discrimination and shift-and-persist predicting both depressive and anxiety symptoms revealed significant negative associations between shift-and-persist and internalizing symptoms at low and average, but not high discrimination levels. Effects are, thus, protective-reactive; the protective effects of shift-and-persist are not significant for youth facing high levels of discrimination. Ethnic-racial identity, surprisingly, was not significantly associated with either depressive or anxiety symptoms, nor did it interact with shift-and-persist as it has in studies of Latinx youth. By understanding the protective benefits of shift-and-persist and ethnic-racial identity in Black youth, during a pivotal period for mental health, we can provide this growing population with tools to lessen the maladaptive outcomes associated with discrimination.

Depressive Symptoms in Adolescence and Young Adulthood

Depressive symptoms have increased among US adolescents since 2010. It remains unclear as to what extent this increase will persist into young adulthood, potentially turning the youth mental health crisis into a young adult mental health crisis. To test the association between birth cohort and adolescent depressive symptoms at ages 18, 19 to 20, and 21 to 22 years and changes in these symptoms by cohort. This panel cohort study analyzed data from the Monitoring the Future longitudinal survey from 1990 to 2019, including birth cohorts from 1972 to 2001. Survey respondents were recruited from US high schools in 12th grade and were approximately aged 18 years (at baseline) through age 21 to 22 years (during mail and web follow-up). Data analysis was conducted from April to October 2023. Depressive symptoms score (>12 vs ≤12, with >12 representing top-decile scores) on a scale examining affective items (eg, "Life often seems meaningless"). High (vs lower) depressive symptoms at ages 19 to 20 years and 21 to 22 years. The 36 552 respondents included 18 597 females (50.5%), and most reported having a parent who graduated from college (44.8%). Among females, 19.1% (95% CI, 16.7%-21.4%) of the most recent birth cohort (born: 1997-2001) had high depressive symptoms at age 18 years, higher than any previous birth cohort. While prevalence declined by age 21 to 22 years, it remained higher than previous cohorts at that age. Among males, 13.4% (95% CI, 11.2%-15.6%) of the most recent birth cohort had high depressive symptoms at age 18 years, and prevalence increased through young adulthood. Males with high baseline depressive symptoms had 10.24 (95% CI, 7.01-14.97) times the odds of symptoms at age 19 to 20 years and 6.20 (95% CI, 3.93-9.78) times the odds of symptoms at age 21 to 22 years. Females with high baseline depressive symptoms had 9.16 (95% CI, 6.57-12.76) times the odds of symptoms at age 19 to 20 years and 7.28 (95% CI, 4.92-10.78) times the odds of symptoms at age 21 to 22 years. The magnitude of the associations did not vary over time. Population attributable fractions indicated that the total proportion of young adult symptoms associated with depressive symptoms at age 18 years among females has increased; in the most recent birth cohort, 55.25% (95% CI, 38.11%-65.13%) of depressive symptoms at age 21 to 22 years were associated with symptoms at age 18 years. This panel cohort study found that increases in depressive symptoms in adolescence persisted into young adulthood, suggesting the need for primary prevention and mental health resources during the adolescent years.

The Interrater Reliability of a Coding System for Measuring Mental Health Professionals’ Decisions and Actions

ABSTRACT Objective The clinical decisions and actions of evidence-based practice in psychology (EBPP) are largely underspecified and poorly understood, in part due to the lack of measurement methods. We tested the reliability of a behavioral coding system that characterizes a flow of interrelated activities that includes problem detection and prioritization, intervention selection and implementation, and review of intervention integrity and impact. Method The context included two publicly funded youth mental health service organizations located in geographically distinct and underresourced communities in the U.S. where service inequities are common. We sampled 84 digitally recorded and transcribed supervision events that included a sample of professionals who were mostly women (93.02%) and BIPOC (86.04%) whose self-reported race/ethnicity matched the youth populations they served. We coded these events for activities (e.g., considering) and their predicate content (i.e., problems or practices) and examined reliability of these codes applied to excerpts (i.e., small contiguous units of dialogue) as well as to complete events. Results Interrater reliability estimates showed that, overall, coders reliably rated the occurrence and extensiveness of activities and content. Excerpt coding was generally more reliable than event coding. However, mathematical aggregation of excerpt coding offered a superior method for estimating event codes reliably, reducing individual subjectivity while providing event level synthesis of activities that are grounded in excerpt level details. Conclusions The assessment of clinical decisions and actions has the potential to unpack the black box of EBPP, with different methods best suited to different research questions and resource considerations.

Youth mental health care use during the COVID-19 pandemic in Alberta, Canada: an interrupted time series, population-based study

BackgroundDuring the COVID-19 pandemic, youth had rising mental health needs and changes in service accessibility. Our study investigated changes in use of mental health care services for Canadian youth in Alberta before and during the COVID-19 pandemic. We also investigated how youth utilization patterns differed for subgroups based on social factors (i.e., age, gender, socioeconomic status, and geography) previously associated with health care access.MethodsWe used cross-sectional population-based data from Alberta, Canada to understand youth (15–24 year) mental health care use from 2018/19 to 2021/22. We performed interrupted time series design, segmented regression modeling on type of mental health care use (i.e., general physician, psychiatrist, emergency room, and hospitalization) and diagnosis-related use. We also investigated the characteristics of youth who utilized mental health care services and stratified diagnosis-related use patterns by youth subgroups.ResultsThe proportion of youth using mental health care significantly increased from 15.6% in 2018/19 to 18.8% in 2021/22. Mental health care use showed an immediate drop in April 2020 when the COVID-19 pandemic was declared and public health protections were instituted, followed by a steady rise during the next 2 years. An increase was significant for general physician and psychiatrist visits. Most individual diagnoses included in this study showed significant increasing trends during the pandemic (i.e., anxiety, adjustment, ADHD, schizophrenia, and self-harm), with substance use showing an overall decrease. Mortality rates greatly increased for youth being seen for mental health reasons from 71 per 100,000 youth in 2018/19 to 163 per 100,000 in 2021/22. In addition, there were clear shifts over time in the characteristics of youth using mental health care services. Specifically, there was increased utilization for women/girls compared to men/boys and for youth from wealthier neighborhoods. Increases over time in the utilization of services for self-harm were limited to younger youth (15–16 year).ConclusionsThe study provides evidence of shifts in mental health care use during the COVID-19 pandemic. Findings can be used to plan for ongoing mental health needs of youth, future pandemic responses, and other public health emergencies.

Understanding Community Perceptions on the Role of Schools in Youth Mental Health.

Youth mental health rates of depression and anxiety continue to climb. Schools have a role to play to support youth mental health but often struggle to navigate community expectations. Focus groups (n = 17) were conducted with over 100 participants to understand community perceptions on the role of schools. Three themes emerged around what schools should be doing: (1) provide accurate education about mental health, (2) create mental health promoting environments that positively supports young people, and (3) act as a common space to bring community members and organizations together for their young people. School professionals and systems should be equipped to adequately address youth mental health. The current US institutional response to this crisis is underdeveloped and exacerbates equity issues and health outcome disparities. Schools need institutional support for addressing mental health in ways that incorporate building a shared understanding with families and providing efforts to prevent and detect rather than just treat mental health. Schools should work with their communities to promote shared understanding and accountability for all to engage in building rich protective environments that promote mental well-being for kids in their care.

Untangling purpose: examining the nuanced influence of personal meaning and beyond-the-self orientation on youth mental health in unprecedented times

ABSTRACT This modified sequential explanatory mixed methods study explores how the components of purpose (personal meaningfulness and a beyond-the-self orientation) impact youth mental health outcomes (depressive and anxiety symptoms) in the context of COVID-19. We hypothesized that youth with higher scores on the components of purpose (goal-directedness, personal meaningfulness, and beyond-the-self orientation) would be less likely to experience anxiety and depressive symptoms during COVID-19. We also explored in what ways youths’ descriptions of their own prosocial behavior align with the relation between purpose and mental health. Data are from two waves of the Boy Scouts of America (BSA) Building Evidence in Scouting Together study. Quantitative data are from 4,896 youth and a subsample of 94 youth completed qualitative personal communication Results indicate the personal meaning component of purpose is protective against depressive and anxiety symptoms. However, the beyond-the-self orientation of purpose is associated with higher levels of depressive and anxiety symptoms. In addition, differences were found between youth who reported higher and lower levels of depressive and anxiety symptoms, and personal meaning and a beyond-the-self orientation for the following themes: 1) Empathy for others, 2) Desire to change the situation, 3) Solutions to change the situation, 4) Helping at home, 5) Following health advice, and 6) Scouting-specific examples. Taken together, this study provides useful insights into how each component of purpose can uniquely promote or provide a buffer for depression and anxiety among youth.

Contextual determinants of family-driven care implementation in juvenile justice settings

IntroductionEngaging families in behavioral health services is a high priority for juvenile justice (JJ) systems and family advocacy groups. Family-driven care (FDC) enhances family engagement and decision-making power in youth behavioral health services, ultimately, improving youth and family mental health and substance abuse outcomes. Despite the benefits, there is limited guidance on how to integrate FDC into behavioral health care within the JJ system. Therefore, the goal of this study is to understand factors that promoted adoption of FDC the JJ context.MethodsJJ staff and leadership across the state of Georgia participated in surveys and interviews to understand contextual implementation determinants related to the adoption of FDC. Between November 2021- July 2022, 140 JJ staff participated in the survey from 61 unique JJ organizations. In addition, 16 staff participated in follow-up key informant interviews to explain quantitative findings.ResultsBased on a mixed methods analysis, JJ agencies were more likely to implement FDC if they had the following characteristics: (1) presence of site leaders that were strongly committed to family engagement, (2) a shared understanding that family engagement was a top priority, (3) staff training related to family engagement, (4) external partnerships with organizations that serve families, (5) a workplace culture that was supportive of innovation, and (6) presence of family engagement programs that were easier (or more feasible) for staff to implement.DiscussionThis mixed methods study underscores the importance of strengthening these 6 inner and outer setting implementation determinants when preparing to integrate FDC into JJ systems. Findings are used to promote the adoption and delivery of this high priority intervention in a state-level JJ system.

Is There a Place for Cognitive Restructuring in Brief, Self-Guided Interventions? Randomized Controlled Trial of a Single-Session, Digital Program for Adolescents

ABSTRACT Objective Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). Method We conducted the first-ever RCT testing a CR DMHI (“Project Think”) against an active control (supportive therapy; “Project Share”) in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. Results Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. Conclusion Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths’ CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.

The beliefs and practices used to promote physical and mental health in youth who identify as lesbian, gay, bisexual, transgender, intersex, or queer plus (LGBTIQ+) experiencing housing insecurity: An integrative review.

The purpose of this integrative review was to explore the beliefs and practices used to promote physical and mental health among youth ages 18-25 years, identifying as LGBTIQ+ experiencing housing insecurity. The approach used strategies described by Whittemore and Knafl. Peer-reviewed, published research articles in English were identified using eight electronic databases. Eighteen research reports using qualitative, quantitative, and mixed methods were identified. Articles were evaluated for quality using the American Association of Critical Care Nurses Evidenced-Level Hierarchy evaluation tool. Data were analyzed and synthesized using Braun and Clarke's method. Four themes related to the purpose were extracted: pervasive experiences of stigma and discrimination, constantly attuned to navigating risks, inconsistent engagement in health information and care, and inner strength developed through personal and community experiences. There are strong implications for future research, public health nursing practice, and health policy. Public health nurses should incorporate social determinants of health (addressing harmful social processes such as homophobia and racism) as well as a strength-based upstream approach in research, education, and health care practices. More research must also be done to assess engagement in physical and mental health information and care.

Scale-up of Global Child and Youth Mental Health Services: A Scoping Review

Numerous influential policy and scientific bodies are calling for more rapid advances in the scale-up of child and youth mental health services (CYMHS). A number of CYMHS innovations hold promise for advancing scale-up but little is known about how real-world efforts are progressing. We conducted a scoping review to identify promising approaches to CYMHS scale-up across the globe. Searches were completed in six databases (Academic Search Complete, CINAHL, MEDLINE, PsychInfo, PubMed, and Web of Science). Article selection and synthesis were conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A second search focused on low-and-middle-income countries (LMIC) was conducted based on the Cochrane Library recommended search filters of the World Bank listed LMIC countries. Authors used a double coding strategy during the title/abstract and full-text review. Twenty-eight articles meeting the eligibility criteria were identified that described 22 initiatives (in 11 different countries). Our review found the majority of published scale-up studies in CYMHS were not informed by scale-up frameworks in design or reporting. The methods and outcomes used in the identified articles were highly variable and limited our ability to draw conclusions about comparative effectiveness although promising approaches emerged. Successes and failures identified in our review largely reflect consensus in the broader literature regarding the need for strategies to better navigate the complexities of system and policy implementation while ensuring CYMHS interventions fit local contexts.

A Test of the Growth Mindset Compensatory Message in the Context of Youth Mental Health

A Test of the Growth Mindset Compensatory Message in the Context of Youth Mental Health

Mental Health Agency Officials' Perceived Priorities for Youth Mental Health and Factors That Influence Priorities.

This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities. Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities. Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities. These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems.

MHA report finds youth mental health distress, service access concerning

MHA report finds youth mental health distress, service access concerning

Youth Mental Health First Aid Training: Impact on the Ability to Recognize and Support Youth Needs

Youth Mental Health First Aid (YMHFA) trains individuals who regularly interact with youth to identify youth experiencing mental health challenges. Several studies demonstrate positive training impacts, but few assess whether the training equally impacts participants of different demographic and professional backgrounds or those who participate in different training modalities. Using a pre-post follow-up design with a comparison group, this study examined changes in participants’ confidence in their ability to recognize and support youth mental health needs 1 to 2 months after training. Data were collected over two years (2021–2023) from training participants (n = 480) and comparable non-participants (n = 51). The authors examined whether changes in confidence varied by participant race/ethnicity, professional role in the education or mental health fields, and training modality (online versus hybrid). Training participants’ confidence in supporting youth mental health increased significantly compared to non-participants. Although the training was effective for all participants, those with less mental health experience benefited more, consistent with previous research. While both in-person and hybrid training were effective, in-person training participants reported slightly higher confidence scores than virtual at follow-up. Study findings suggest that educational and social service organizations should offer this training to their staff and community members who interact with youth, prioritizing participants with less prior mental health training and delivering training through an in-person training modality when possible. However, additional research is needed to explore how aspects of in-person training, such as trainer characteristics and group dynamics, impact outcomes.

Longitudinal Changes in Youth Mental Health From Before to During the COVID-19 Pandemic

Robust longitudinal studies of within-child changes in mental health associated with the COVID-19 pandemic are lacking, as are studies examining sources of heterogeneity in such changes. To investigate within-child changes, overall and between subgroups, in youth mental health from prepandemic to midpandemic. This cohort study used longitudinal prepandemic and midpandemic data from the Environmental influences on Child Health Outcomes (ECHO) Program, collected between January 1, 2015, and March 12, 2020 (prepandemic), and between March 13, 2020, and August 31, 2022 (midpandemic). Data were analyzed between December 1, 2022, and June 1, 2024. The sample included 9 US-based observational longitudinal pediatric ECHO cohorts. Cohorts were included if they collected the Child Behavior Checklist (CBCL) School Age version before and during the pandemic on more than 20 participants of normal birth weight aged 6 to 17 years. The COVID-19 pandemic. Prepandemic to midpandemic changes in CBCL internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores were estimated, and differences in outcome trajectories by child sociodemographic characteristics (age, sex, race, ethnicity, and poverty level) and prepandemic mental health problems were examined using established CBCL clinical score thresholds. A total of 1229 participants (mean [SD] age during the pandemic, 10.68 [2.29] years; 625 girls [50.9%]) were included. The sample was socioeconomically diverse (197 of 1056 children [18.7%] lived at ≤130% of the Federal Poverty Level; 635 (51.7%) identified as White, 388 (31.6%) as Black, 147 (12.0%) as multiracial, 40 (3.3%) as another race, and 118 (9.6%) as Hispanic). Generalized linear mixed-effects models revealed minor decreases in externalizing problems (β = -0.88; 95% CI, -1.16 to -0.60), anxiety (β = -0.18; 95% CI, -0.31 to -0.05), and ADHD (β = -0.36; 95% CI, -0.50 to -0.22), but a minor increase in depression (β = 0.22; 95% CI, 0.10 to 0.35). Youth with borderline or clinically meaningful prepandemic scores experienced decreases across all outcomes, particularly externalizing problems (borderline, β = -2.85; 95% CI, -3.92 to -1.78; clinical, β = -4.88; 95% CI, -5.84 to -3.92). Low-income (β = -0.76; 95% CI, -1.14 to -0.37) and Black (β = -0.52; 95% CI, -0.83 to -0.20) youth experienced small decreases in ADHD compared with higher income and White youth, respectively. In this longitudinal cohort study of economically and racially diverse US youth, there was evidence of differential susceptibility and resilience for mental health problems during the pandemic that was associated with prepandemic mental health and sociodemographic characteristics.

Bridging the gap: a call for inclusive policy making in youth mental health care

Bridging the gap: a call for inclusive policy making in youth mental health care

Amplifying Youth Voice to Promote Black Youth Mental Health Through Policy in Georgia

Summary: There is an unmet need for mental health policies that are culturally competent, engaging, and equitable for Black youth. This paper describes a youth-adult partnership advisory council approach to identify, assess, and measure the effectiveness of innovative policy solutions to promote Black youth mental health in Georgia.

Youth Suicide, Mental Health, and Firearm Access—Time to Focus on Upstream Prevention

Youth Suicide, Mental Health, and Firearm Access—Time to Focus on Upstream Prevention

Young people's participation in their own mental health care: Session-by-session feedback in youth mental health services (headspace).

Young people's participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future and feeling that things are improving in their lives. This study reports on young people's session experiences over time and by key demographics for headspace youth mental health services. The sample comprised 16 484 young people aged 12-25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

"When one has no REAL illness"-analysis of the knowledge component of mental health literacy in children and adolescents of parents with a mental illness.

Mental Health Literacy (MHL) is important in promoting youth mental health. One key aspect of MHL is knowledge about mental disorders, which is particularly relevant for populations at risk for developing mental disorders, such as children of parents with a mental illness (COPMI), representing a mechanism within the transgenerational transmission. Currently, COPMI's level of disorder knowledge in general, and about the specific parental disorder has not been comprehensively researched. We, therefore, aimed to assess COPMI's disorder knowledge and clarify its association with COPMI's age and sex exploratively. To assess both general and disorder-specific knowledge, we took a novel approach that makes disorder knowledge comparable across samples and over time. A mixed method analysis of N = 181 semi-structured MHL interviews with COPMI (aged 5 to 17 years) was carried out in the COMPARE-family study in Germany. We conducted a DSM-oriented deductive qualitative content analysis to assess COPMI's general and specific disorder knowledge. Chi-square tests served to identify age and sex differences. Children revealed limited knowledge of mental disorders in general, whereas adolescents displayed more knowledge that was also partly consistent with descriptions of classification systems like the DSM-5. The level of specific knowledge about the parent's disorder depended on the disorder group. More children displayed adequate knowledge of somatic and anxiety disorders compared to trauma and depressive disorders, and more adolescents displayed adequate knowledge of depressive and anxiety disorders. COPMI's age and sex were found to be significantly associated with disorder knowledge: adolescents exhibited higher levels of adequate general and specific disorder knowledge, and males exhibited higher levels of adequate general disorder knowledge. Assessing COPMI's disorder knowledge and identifying associated age and sex differences yield valuable insights into the knowledge component of the MHL theory. Our findings can help to improve psychoeducational interventions for COPMI by orienting them to their prevailing levels of disorder knowledge. We recommend employing and extending the DSM-oriented deductive approach to assess knowledge within MHL. Analyses involving additional assessments within the COMPARE-family study are in preparation to identify potential knowledge gains over time, and associations to COPMI's own well-being and mental health symptoms.