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The aim of this study is to translate, cross-culturally adapt, and validate the Croatian Athlete Psychological Strain Questionnaire (APSQ-Cro) as part of the Sport Mental Health Assessment Tool 1 (SMHAT-1) validation. We assessed the reliability and applicability of the APSQ-Cro among Croatian athletes. The international sports community is increasingly focused on mental health issues in athletes, highlighting the need for early detection tools like the Athlete Psychological Strain Questionnaire (APSQ) and SMHAT-1. We included 869 Croatian competing athletes across 54 sports who received a link to access the WEB-based questionnaire. The Croatian Olympic Board helped in distributing the questionnaires, aiming to reach as many and as diverse a group of registered competing athletes in Croatia as possible. Results showed a Cronbach's alpha of 0.75 for the entire questionnaire, indicating acceptable reliability. An exploratory strategy of factor analysis was used to determine the underlying structure of the APSQ-Cro. For this purpose, the Kaiser–Meyer–Olkin (KMO) test and Bartlett's test for sphericity were performed to ensure the suitability of the data. The KMO test ensured sampling adequacy, with a measure of 0.77 indicating suitability for factor analysis, while Bartlett's test confirmed significant correlations among variables (χ2 = 2779.155, df = 45, p < 0.001), validating the dataset's appropriateness for data reduction techniques. The factor analysis, together with the Cattell scree test and varimax rotation, resulted in a two-factor structure for the APSQ-Cro. Factor 1 included items related to internal psychological struggles, while Factor 2 included items related to external pressures from the athletic environment. These two factors explained 53% of the variability, with Cronbach's alphas of 0.75 and 0.88 for the respective factors. The APSQ-Cro is a valid and reliable tool for assessing distress in Croatian athletes. Croatian athletes' sporting experience will be improved with the broad adoption of the APSQ-Cro, which can help detect early signs of psychological distress and subsequently improve mental health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore how young people in child and adolescent mental health services (CAMHS) in the UK, Ireland, The Netherlands and Croatia, experienced leaving CAMHS and identified a range of factors impeding optimal discharge or transition to adult mental health services (AMHS). Design/methodology/approach: Interviews about discharge or transition planning, including what information was provided about their ongoing mental health needs, undertaken with 34 young people aged 17–24, all previous or current attendees of CAMHS. Some interviews included accounts by parents or carers. Data were thematically analysed. Findings: A number of previously well-documented barriers to a well-delivered discharge or transition were noted. Two issues less frequently reported on were identified and further discussed; they are the provision of an adequately explained, timely and appropriately used diagnosis and post-CAMHS medication management. Overall, planning processes for discharging or transitioning young people from CAMHS are often sub-optimal. Practice with regard to how and when young people are given a diagnosis and arrangements for the continuation of prescribed medication appear to be areas requiring improvement. Originality/value: Study participants came from a large cohort involving a wide range of different services and health systems in the first pan-European study exploring the CAMHS to adult service interface. Two novel and infrequently discussed issues in the literature about young people's mental health transitions, diagnosis and medication management were identified in this cohort and worthy of further study. [ABSTRACT FROM AUTHOR]

Background: In mental health, transition refers to the pathway of young people from child and adolescent to adult services. Training of mental health psychiatrists on transition-related topics offers the opportunity to improve clinical practice and experiences of young people reaching the upper age limit of child and adolescent care. Methods: National psychiatrist's organizations or experts from 21 European countries were surveyed 1/ to describe the status of transition in adult psychiatry (AP) and child and adolescent psychiatry (CAP) postgraduate training in Europe; 2/ to explore the amount of cross-training between both specialties. This survey was a part of the MILESTONE project aiming to study and improve the transition process of young people at the service boundary. Results: Transition was a mandatory topic in the AP curriculum of 1/19 countries (5%) and in the CAP curriculum of 4/17 countries (24%). Most topics relevant for transition planning were addressed during AP training in 7/17 countries (41%) to 10/17 countries (59%), and during CAP training in 9/11 countries (82%) to 13/13 countries (100%). Depending on the training models, theoretical education in CAP was mandatory during AP training in 94% (15/16) to 100% of the countries (3/3); and in AP during CAP training in 81% (13/16) to 100% of the countries (3/3). Placements were mandatory in CAP during AP training in 67% (2/3) to 71% of the countries (12/17); and in AP during CAP training in 87% (13/15) to 100% of the countries (3/3). Discussion and Conclusion: Specific training about transition is limited during CAP and AP postgraduate training in Europe. Cross-training between both specialties offers a basis for improved communication between child and adult services but efforts should be sustained in practical training. Recommendations are provided to foster further development and meet the specific needs of young people transitioning to adult services. [ABSTRACT FROM AUTHOR]

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background. Cross-sectional study. LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist. Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R2 =.24; F2,3823 = 619.01; p <.01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß =.14; 95% BC CI [.10,.20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families. The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents. [ABSTRACT FROM AUTHOR]

Background: Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods: Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results: The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions: Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs. [ABSTRACT FROM AUTHOR]

Purpose: Young people transitioning from child to adult mental health services are frequently also known to social services, but the role of such services in this study and their interplay with mental healthcare system lacks evidence in the European panorama. This study aims to gather information on the characteristics and the involvement of social services supporting young people approaching transition. Design/methodology/approach: A survey of 16 European Union countries was conducted. Country respondents, representing social services' point of view, completed an ad hoc questionnaire. Information sought included details on social service availability and the characteristics of their interplay with mental health services. Findings: Service availability ranges from a low of 3/100,000 social workers working with young people of transition age in Spain to a high 500/100,000 social workers in Poland, with heterogeneous involvement in youth health care. Community-based residential facilities and services for youth under custodial measures were the most commonly type of social service involved. In 80% of the surveyed countries, youth protection from abuse/neglect is overall regulated by national protocols or written agreements between mental health and social services, with the exception of Czech Republic and Greece, where poor or no protocols apply. Lack of connection between child and adult mental health services has been identified as the major obstacles to transition (93.8%), together with insufficient involvement of stakeholders throughout the process. Research limitations/implications: Marked heterogeneity across countries may suggest weaknesses in youth mental health policy-making at the European level. Greater inclusion of relevant stakeholders is needed to inform the development and implementation of person-centered health-care models. Disconnection between child and adult mental health services is widely recognized in the social services arena as the major barrier faced by young service users in transition; this "outside" perspective provides further support for an urgent re-configuration of services and the need to address unaligned working practices and service cultures. Originality/value: This is the first survey gathering information on social service provision at the time of mental health services transition at a European level; its findings may help to inform services to offer a better coordinated social health care for young people with mental health disorders. [ABSTRACT FROM AUTHOR]

Background: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) raises novel ethical aspects for healthcare professionals, as well as for young people, their parents and carers. Method: Focus groups were conducted in Croatia, Ireland and the United Kingdom with youth mental health groups and youth representatives with no mental health (MH) remit. One hundred and eleven participants, aged from 16 to 60 years, contributed to discussions. Results: Perpetuation of stigma, autonomy and decision‐making were central themes as both enablers and deterrents of successful transition. The tension between professional (and at times parental) paternalism and young persons' growing autonomy was well captured in the themes; (a) desired practice, (b) who should decide, (c) the process of decision‐making and (d) potential harm(s). Conclusions: This study provides insight into the ethical values, particularly autonomy and collaboratively working, which people expect to underpin the transition between CAMHS and AMHS. Key Practitioner Message: Engaging young people early in making decisions about their future care can enhance trust between practitioner and the young person.In addition to diagnosis, a number of factors (such as moving home; waiting lists and stigma) may need to be taken into account when considering the direction of future health care.When possible, alternatives to AMHS should be considered if considered by the young person to be a less‐stigmatising treatment option. [ABSTRACT FROM AUTHOR]

The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16–26 years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project. [ABSTRACT FROM AUTHOR]

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Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20-30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care. [ABSTRACT FROM AUTHOR]

In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Children's Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

This study evaluated the cross-cultural measurement invariance of the Pediatric Quality of Life Inventory version 4.0 (Peds QL™) among adolescents sampled from Bulgaria, Croatia, India, Indonesia, Nigeria, Serbia, and Turkey. The multiple-indicator multiple-cause ( MIMIC) model was used, which allowed controlling of demographic variables (i.e., age, gender, and socioeconomic status). Significant effects of country on scores within the Peds QL™ domains were observed, with up to 17 items showing differential item functioning ( DIF) across the countries. We did not find support for cross-cultural measurement invariance hypotheses for scores on the Peds QL™ adolescent self-report in this study. Researchers should use caution in making cross-cultural quality of life comparisons while using the Peds QL. [ABSTRACT FROM AUTHOR]

The original version of this article contained an error in Table 1. The correct table is presented below: [ABSTRACT FROM AUTHOR]