scholarly journals Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People

2020 ◽  
Vol 17 (24) ◽  
pp. 9445
Author(s):  
Giuseppina Lo Moro ◽  
Emma Soneson ◽  
Peter B. Jones ◽  
Julieta Galante
Keyword(s):  
Mental Health ◽  
Young People ◽  
Randomised Trial ◽  
Intervention Group ◽  
Stakeholder Involvement ◽  
Population Based ◽  
Health Determinants ◽  
Local Stakeholder ◽  
Effective Interventions ◽  
Multi Level

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14–24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.

A multifaceted intervention to improve mental health literacy in employees of a multi-campus university: a cluster randomised trial

2014 ◽  
Vol 13 (1) ◽  
pp. 25-39 ◽  
Author(s):  
Nicola J. Reavley ◽  
Terence V. McCann ◽  
Stefan Cvetkovski ◽  
Anthony F. Jorm
Keyword(s):  
Mental Health ◽  
Health Literacy ◽  
Alcohol Use ◽  
Help Seeking ◽  
Mental Health Literacy ◽  
Randomised Trial ◽  
Intervention Group ◽  
Cluster Randomised Trial ◽  
Depression And Anxiety ◽  
Content Type

Purpose – The purpose of this study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in staff of a multi-campus university in Australia. Design/methodology/approach – In this cluster randomised trial (ACTRN12610001027000), nine campuses were paired, with one of each pair randomly assigned to either intervention or control. Interventions (which were whole-of-campus) included e-mails, posters, campus events, factsheets/booklets and mental health first aid training courses. A monitoring sample of staff were recruited from each campus. Participants had a 20-minute computer-assisted telephone interview at baseline, and at the end of academic years 1 and 2. The interview assessed mental health literacy, help seeking for mental health problems, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. Six campuses were randomised to intervention and three to control and all campuses were included in the analysis. Findings – There were no effects on depression and anxiety levels and alcohol use. Recall of intervention elements was greater in the intervention group at the end of the two-year assessment period. Staff in the intervention group showed better recognition of depression, greater knowledge of the National Health and Medical Research Council guidelines for safe levels of drinking and a greater intention to seek help for alcohol misuse from a general practitioner. Originality/value – Future interventions should involve more focused interventions that include consideration of working conditions and their influence on mental health, as well as addressing mental illness among employees, regardless of cause.

scholarly journals Pharmacist Led Homeless Outreach Engagement and Non-Medical Independent Prescribing (Rx) (PHOENIx) Intervention for People Experiencing Homelessness: A Non- Randomised Feasibility Study

2020 ◽  
Author(s):  
Richard Lowrie ◽  
Kate Stock ◽  
Sharon Lucey ◽  
Megan Knapp ◽  
Andrea Williamson ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Randomised Trial ◽  
Intervention Group ◽  
City Centre ◽  
Health Board ◽  
Independent Prescribing ◽  
Comparator Group ◽  
The Phoenix

Abstract BackgroundHomelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have failed to identify complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT).MethodsNon-randomised trial with comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, at the point of hospital discharge. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker). Patients who could not be reached by the PHOENIx team were allocated to the usual care (UC) group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date.Results Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0-14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3-3.8) and 2 repeat (1.3-7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) comparator group. Eight (67%) intervention group patients and 3(25%) comparator group patients attended scheduled out patient appointments. Conclusions Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.

Assisting Carers to Respond to the Mental Health Needs of Children

2017 ◽  
Vol 42 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Josh Fergeus ◽  
Cathy Humphreys ◽  
Carol Harvey ◽  
Helen Herrman
Keyword(s):  
Mental Health ◽  
Young People ◽  
Home Care ◽  
Mental Health Problems ◽  
Health Needs ◽  
Mental Health Needs ◽  
Children And Young People ◽  
Out Of Home Care ◽  
Effective Interventions ◽  
Developed World

Across the developed world, efforts are being made to identify and develop effective interventions that will reduce the prevalence and severity of mental health problems among children and young people in out-of-home care. Foster and kinship carers have been identified as critically important in this process. In order to develop an understanding of what interventions and/or supports assist carers in responding effectively to the mental health needs of the children and young people in their care, a scoping review was undertaken. Using the scoping study method, 1064 publications were identified, and 82 publications were selected for further analysis. The review shows that promising interventions that aim to improve the mental health of children and young people living in out-of-home care have been developed and trialled both in Australia and internationally. However, the review also highlights the lack of research specifically focused on the role of the carer.

Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study

2013 ◽  
Vol 203 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Willem Kuyken ◽  
Katherine Weare ◽  
Obioha C. Ukoumunne ◽  
Rachael Vicary ◽  
Nicola Motton ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Intervention Group ◽  
Well Being ◽  
School Curriculum ◽  
Lower Stress ◽  
Mindfulness Skills ◽  
Randomised Controlled ◽  
Health And Well Being

BackgroundMindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness among young people.AimsTo assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being.MethodA total of 522 young people aged 12–16 in 12 secondary schools either participated in the Mindfulness in Schools Programme (intervention) or took part in the usual school curriculum (control).ResultsRates of acceptability were high. Relative to the controls, and after adjusting for baseline imbalances, children who participated in the intervention reported fewer depressive symptoms post-treatment (P = 0.004) and at follow-up (P = 0.005) and lower stress (P = 0.05) and greater well-being (P = 0.05) at follow-up. The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being (P<0.001) and less stress (P = 0.03) at 3-month follow-up.ConclusionsThe findings provide promising evidence of the programme's acceptability and efficacy.

Supporting self-management amongst young people with acne vulgaris: feasibility randomised trial of a web-based behavioural intervention (Preprint)

2020 ◽  
Author(s):  
Athena Ip ◽  
Ingrid Muller ◽  
Adam Geraghty ◽  
Kate Rumsby ◽  
Beth Stuart ◽  
...  
Keyword(s):  
Young People ◽  
Usual Care ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Randomised Trial ◽  
Intervention Group ◽  
Primary Outcome Measure ◽  
Self Management ◽  
Web Based ◽  
Topical Treatments

BACKGROUND Acne is a common skin condition that is most prevalent in young people. It can have substantial impact on quality of life, which can be minimised with appropriate use of topical treatments. Nonadherence to topical treatments for acne is common often leading to treatment failure. OBJECTIVE The objective of this study was to develop a web-based behavioural intervention to support self-management of acne and to assess the feasibility of recruitment, retention and engagement in a parallel unblinded randomised trial of the intervention compared with usual care alone. METHODS The intervention was developed iteratively using LifeGuide software and following the Person-Based Approach (PBA) to intervention development. The target behaviour was ‘Appropriate use of topical treatments’ and barriers and facilitators identified from the qualitative research and evidence from the wider literature were used to identify techniques to improve and promote their use. Young people with acne aged 14-25 years who had received treatment for acne within the last 6 months were invited to participate through mail-out from primary care practices in the South of England. Participants were randomised to: (1) usual care, or (2) usual care plus access to web-based intervention. Usage data was collected and a series of questionnaires including the primary outcome measure for skin specific quality of life (Skindex-16) were collected at baseline, 4-weeks and 6-weeks follow-up. RESULTS A total of 1193 participants were invited and 53 young people with acne were randomised to usual care (n=27) or usual care plus intervention (n=26). The response rate for the primary outcome measure (Skindex-16) was 87% at 4-weeks, 6-weeks or both time points. The estimate of mean scores between groups (with 95% confidence) using linear regression showed a trend in the direction of benefit for the web-based intervention group in the primary outcome measure (Skindex-16), and secondary measures (Patient Health Questionnaire 4 and the Problematic Experiences of Therapy Scale). Intervention usage data showed a high uptake of the core module in the usual care plus web-based intervention group with 23 of 26 (88%) completing the module. Uptake of the optional modules were low with less than half visiting each (Myth-busting quiz: 27%; Living with spots or acne: 42%; Oral antibiotics: 19%; What are spots or acne: 27%; Other treatments: 27%; Talking to your GP: 12%). CONCLUSIONS This study demonstrated the feasibility of delivering a trial of a web-based intervention to support self-management for young people with acne. Additional work is needed prior to a full definitive trial including enhancing engagement with the intervention, recruitment and follow-up rates. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 78626638; https://doi.org/10.1186/ISRCTN78626638.

Punch injury self-harm in young people

2016 ◽  
Vol 22 (2) ◽  
pp. 318-325
Author(s):  
Cristal Oxley ◽  
Jane E Roberts ◽  
Sebastian Kraemer ◽  
Giles Armstrong
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
High Risk ◽  
Young People ◽  
Medical Records ◽  
Substance Misuse ◽  
Total Group ◽  
Effective Interventions ◽  
Male Preponderance ◽  
Self Harm

Punch injuries are a form of self-harm characterised by the intentional act of striking an object with a closed fist. We aimed to describe the characteristics and trends in young people presenting with injuries sustained via the punch mechanism. A comprehensive retrospective review of medical records was completed of all young people aged 10–18 years presenting to our Central London Emergency Department over a 12-month period. A subset of the total group was identified as the punch injury subgroup. A total of 78 punch injury presentations were identified. In this subgroup, the male:female ratio is 4.57:1; 37.18% of presentations were associated with a fracture ( n = 29) and 35.90% ( n = 28) of patients re-presented following another punch injury, as a victim of violence, or by other psychiatric presentation. In conclusion, a male preponderance was observed, with frequent re-presentations, often in high-risk circumstances. An opportunity for screening, including mental health, social and substance misuse, was identified. Further research is needed to enable targeted effective interventions in this group.

A randomised trial of skin photography as an aid to screening skin lesions in older males

2002 ◽  
Vol 9 (3) ◽  
pp. 128-132 ◽  
Author(s):  
P.F. Hanrahan ◽  
C.A. D’Este ◽  
S.W. Menzies ◽  
T. Plummer ◽  
P. Hersey
Keyword(s):  
Large Scale ◽  
Randomised Trial ◽  
Intervention Group ◽  
Cost Effective ◽  
Skin Lesions ◽  
Population Based ◽  
Control Group ◽  
Pigmented Lesions ◽  
South Wales ◽  
Non Melanoma Skin Cancer

OBJECTIVES: We have previously shown that photographs assist in detection of change in skin lesions and designed the present randomised population based trial to assess the feasibility of photographs as an aid to management of skin cancers in older men. SETTING: 1899 men over fifty, identified from the electoral roll in two regions in New South Wales (NSW), Australia, were invited by mail to participate. METHODS: A total of 973 of 1037 respondents were photographed and randomised into intervention (participants given their photographs) or control groups (photographs withheld by investigators). At one and two years from the time of photography, all participants were advised to see their primary care practitioner for a skin examination. Those in the intervention group were examined with their photographs and those in the control group without their photographs. RESULTS: The results indicated that the practitioners were more likely to leave suspicious lesions in place for follow up observation (37% v 29%) (p=0.006) and less likely to excise benign non pigmented lesions (20 v 32%). There was little difference in excision rates for benign pigmented lesions (21% v 23%). Lesions excised were more likely to be non-melanoma skin cancer (58% v 42%) from patients who had photographs compared to those without photographs (p=0.005). The use of skin photography resulted in a substantial savings due to the reduced excision of benign lesions. CONCLUSIONS: These results suggest that it would be feasible to conduct a large scale randomised trial to evaluate the value of photography in early detection of melanoma and that such a trial could be cost effective due to the reduced excision of benign skin lesions.

The association between economic inactivity and mental health among young people: a longitudinal study of young adults who are not in employment, education or training

2015 ◽  
Vol 32 (1) ◽  
pp. 155-160 ◽  
Author(s):  
E. Power ◽  
M. Clarke ◽  
I. Kelleher ◽  
H. Coughlan ◽  
F. Lynch ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Suicidal Ideation ◽  
Young People ◽  
Mental Disorder ◽  
Suicide Attempts ◽  
Mental Health Problems ◽  
Longitudinal Research ◽  
Population Based ◽  
Increased Risk

ObjectivesIncreasing rates of young people not in education, employment or training (NEETs) are a cause of concern both in Ireland and internationally, but little longitudinal research has examined the link between psychiatric disorder in young people and NEET status.MethodsThe Challenging Times (CT) Study is a longitudinal, population-based study of psychopathology among 212 young Irish people. Clinical interviews were performed at two time points: 12–15 years and 19–24 years.ResultsNEET status in young adulthood was associated with a sevenfold increased risk of current suicidal ideation. This result was independent of prior adolescent mental disorder. NEET young people had a fourfold increased odds of being diagnosed with a mental disorder in childhood or early adolescence compared with their economically active peers. NEET young people were at an almost threefold increased risk of any mental health disorder a twofold increased risk of anxiety disorder and threefold increased odds of suicide attempts over their lifetime compared with economically active peers.ConclusionsNEET young people are at increased risk for mental disorder and suicidal ideation. The association is bidirectional, as prior mental disorder in adolescence appeared to account for much of the association between NEET status and current mental health problems. However, economic inactivity conveys an increased risk for suicidal ideation over and above that due to prior disorder. Our findings provide a compelling economic and societal argument for early intervention and treatment of mental disorder and the importance of vocational interventions for reducing suicide risk in young adults.

scholarly journals Defining research priorities for youth public mental health: reflections on a co-production approach to transdisciplinary working

2021 ◽  
Author(s):  
Andrea Taylor ◽  
Christina McMellon ◽  
Tara French ◽  
Alice MacLachlan ◽  
Rhiannon Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Mental Health Problems ◽  
Research Priorities ◽  
Intervention Development ◽  
Public Mental Health ◽  
Community Settings ◽  
Transdisciplinary Approach ◽  
Effective Interventions ◽  
Production Approach

Abstract Background With most mental health problems established during childhood/adolescence, young people must be a key focus of public mental health (PMH) approaches. Despite the range of factors known to influence mental health, evidence for effective interventions is lacking for this age group. This study aimed to define priorities for future intervention-focussed research to support youth PMH by engaging with transdisciplinary stakeholder groups. Methods Our co-production approach involved priority-setting workshops with young people, researchers, practitioners and policymakers. Each workshop focussed on three thematic areas: social connections and relationships; schools and other education settings; key groups at greater risk of mental ill-health, specifically LGBTQ+ and care-experienced young people. Workshop outputs were synthesised to define research priorities. Results Ten priorities for youth PMH research were defined, covering the following areas: building supportive relationships; whole system approaches; social media; support at times of transition; improving links between different services; development and training for those who support young people; staff mental health; engaging with families; awareness of and access to services; out of school and community settings. Conclusions These research priorities can inform future intervention-development to support youth PMH. Our transdisciplinary approach means the identified research priorities are more likely to be relevant to young people’s experiences and needs, and to fit with the needs of those working in practice and policy to support young people.

scholarly journals Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033324 ◽  
Author(s):  
Paramala Santosh ◽  
Jatinder Singh ◽  
Laura Adams ◽  
Mathilde Mastroianni ◽  
Natalie Heaney ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Transition Readiness ◽  
Link Type ◽  
Cluster Randomised

ObjectiveYoung people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16–18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person’s readiness for transition, and their outcomes at the transfer boundary.DesignMILESTONE prospective study.SettingEight European Union (EU) countries participating in the EU-funded MILESTONE study.ParticipantsThe first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people.ResultsThe development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported.ConclusionThe TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person.Trial registration numberISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.

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