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Background: Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. Methods: A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. Results: Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. Conclusions: The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821. [ABSTRACT FROM AUTHOR]

Background: The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. Aim: The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. Methods: A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. Conclusion: This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. Study Registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606. [ABSTRACT FROM AUTHOR]

Background: Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. Methods: We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. Results: Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d =.41) and 14 weeks (95% CI: −3.34 to −0.19, d =.39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d =.28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. Conclusions: An app‐delivered program for insomnia could be a practical, non‐stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep. [ABSTRACT FROM AUTHOR]

Objectives: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. Methods: The FPS is an Australian school‐based prospective cohort study with an embedded cluster‐randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self‐report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years. Results: The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05). Conclusions: This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the impact of a web-based positive psychology program delivered universally to secondary school students during school closures caused by the COVID-19 pandemic in New South Wales, Australia. Methods: Using a quasi-experimental design conducted in 2020, 438 students aged 12–15 years (73% male) from 4 secondary schools were invited to complete the 'Bite Back Mental Fitness Challenge'. This web-based program consisted of 7 self-directed modules that targeted 5 key domains of positive psychology. Self-reported symptoms of anxiety and depression and help-seeking intentions for mental health were assessed at baseline prior to school closures (February to March 2020) and at post-test after the return to school (July to August 2020). At post-test, students also reported on their perceived changes in mental health and help-seeking behavior for mental health during the pandemic. Completion of the program modules was recorded. Results: A total of 445 students consented and 336 (75.5%) completed both assessments. On average, participants completed 2.31 modules (SD: 2.38, range: 0 to 7). There was no change in symptoms of anxiety and depression or help-seeking intentions between baseline and post-test, with no significant effects for gender and history of mental illness. Students who were symptomatic for anxiety and depression at baseline reported lower symptoms at post-test, but this change was not significant. Ninety-seven students (27.5%) reported that their mental health had worsened during the pandemic, and a significant increase in anxiety and depressive symptoms was found in this subsample at post-test. Only 7.7% of students reported a change in their help-seeking behavior, with increased mental health support sought from the Internet, parents, and friends. Conclusions: The universal delivery of a web-based positive psychology program during school closures did not appear to be associated with improved mental health symptoms; however, completion of the modules was low. Different effects may emerge when selectively delivered to students with mild or greater symptoms. The findings also suggest that broader measures of mental health and wellbeing, including perceived change, are key to the mental health surveillance of students during periods of remote learning. [ABSTRACT FROM AUTHOR]

Background: Traditional face-to-face cognitive behavioural therapy (CBT) has been successful at reducing fear of falling (FOF) in older people but can be labour-intensive and costly. Online CBT has been suggested as a cost-effective alternative but has not yet been tested in the context of FOF. This study evaluates the effectiveness of a readily available, self-guided and generalised online CBT program (myCompass) on reducing FOF in older people. Methods: Fifty community-dwelling older people with FOF received a paper-based health education program, and half were randomly assigned to receive three selected modules from myCompass for 6 weeks. The primary outcome was feared consequences of falling at 6 weeks. Secondary outcomes were concern about falling, balance confidence, activity avoidance, physical activity, exercise self-efficacy, health literacy and mental health at 6/26/52 weeks and falls incidence at 12 months. Results: All intervention participants completed at least 2-out-of-3 myCompass modules. There was a significant main effect of time on feared consequences of falling (Cohen's f = 0.55). The group by time interactions for concern about falling (f = 0.28), stress (f = 0.26) and social support for health (health literacy) (f = 0.26) was also significant, favouring the control group. The overall attrition rate at 12 months was 24% (n = 12). Conclusion: The high program compliance and low attrition rate suggest that online CBT is feasible among older people. However, the myCompass program had no effect at reducing FOF in older people. A more targeted CBT program with a well-integrated psychoeducation module on FOF might be the solution to boost the therapeutic effects of a generalised CBT program at reducing FOF for older people. [ABSTRACT FROM AUTHOR]

This paper outlines a systematic review and meta-analyses to identify, describe, and evaluate randomised and non-randomised controlled trials of psychological programs targeting the mental health, professional burnout, and/or wellbeing of school classroom teachers. Eighty-eight unique studies were identified for inclusion in the review, and of those 46 were included in the meta-analyses (23 randomised controlled trials). In randomised controlled trials, the programs examined had large effects on stress (g=0.93), and moderate effects on anxiety (g=0.65), depression (g=0.51), professional burnout (g=0.57), and wellbeing (g=0.56) at post. In non-randomised controlled trials, programs had moderate effects on stress (g=0.50), and small effects on anxiety (g=0.38) and wellbeing (g=0.38) at post. Studies were heterogeneous in design and methodological quality was generally poor, particularly in non-randomised controlled trials. There was an inadequate number of comparisons to perform sub-group analyses, meta-regression, or publication bias analyses. Most of the programs examined required significant time, effort, and resources to deliver and complete. These programs may not translate well outside of research trials to real-world contexts due to teachers being time-poor. Priorities for research include using methodologically rigorous designs, developing programs for teachers with teachers (i.e. co-design), and considering implementation factors to ensure feasibility, acceptability, and uptake. Systematic Review Registration Number: PROPSERO - CRD42020159805. [ABSTRACT FROM AUTHOR]

Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. [ABSTRACT FROM AUTHOR]

Background: Suicidal ideation is a major risk for a suicide attempt in younger people, such that reducing severity of ideation is an important target for suicide prevention. Smartphone applications present a new opportunity for managing ideation in young adults; however, confirmatory evidence for efficacy from randomized trials is lacking. The objective of this study was to assess whether a therapeutic smartphone application ("LifeBuoy") was superior to an attention-matched control application at reducing the severity of suicidal ideation.Methods and Findings: In this 2-arm parallel, double-blind, randomized controlled trial, 455 young adults from Australia experiencing recent suicidal ideation and aged 18 to 25 years were randomly assigned in a 2:2 ratio to use a smartphone application for 6 weeks in May 2020, with the final follow-up in October 2020. The primary outcome was change in suicidal ideation symptom severity scores from baseline (T0) to postintervention (T1) and 3-month postintervention follow-up (T2), measured using the Suicidal Ideation Attributes Scale (SIDAS). Secondary outcomes were symptom changes in depression (Patient Health Questionnaire-9, PHQ-9), generalized anxiety (Generalized Anxiety Disorder-7, GAD-7), distress (Distress Questionnaire-5, DQ5), and well-being (Short Warwick-Edinburgh Mental Well-Being Scale, SWEMWBS). This trial was conducted online, using a targeted social media recruitment strategy. The intervention groups were provided with a self-guided smartphone application based on dialectical behavior therapy (DBT; "LifeBuoy") to improve emotion regulation and distress tolerance. The control group were provided a smartphone application that looked like LifeBuoy ("LifeBuoy-C"), but delivered general (nontherapeutic) information on a range of health and lifestyle topics. Among 228 participants randomized to LifeBuoy, 110 did not complete the final survey; among 227 participants randomized to the control condition, 91 did not complete the final survey. All randomized participants were included in the intent-to-treat analysis for the primary and secondary outcomes. There was a significant time × condition effect for suicidal ideation scores in favor of LifeBuoy at T1 (p < 0.001, d = 0.45) and T2 (p = 0.007, d = 0.34). There were no superior intervention effects for LifeBuoy on any secondary mental health outcomes from baseline to T1 or T2 [p-values: 0.069 to 0.896]. No serious adverse events (suicide attempts requiring medical care) were reported. The main limitations of the study are the lack of sample size calculations supporting the study to be powered to detect changes in secondary outcomes and a high attrition rate at T2, which may lead efficacy to be overestimated.Conclusions: LifeBuoy was associated with superior improvements in suicidal ideation severity, but not secondary mental health outcomes, compared to the control application, LifeBuoy-C. Digital therapeutics may need to be purposefully designed to target a specific health outcome to have efficacy.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156. [ABSTRACT FROM AUTHOR]

Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants' social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. [ABSTRACT FROM AUTHOR]

The feasibility of addressing the mental health needs of young people at school is influenced by how staff perceive their role, and the role of schools, in mental health care. Using qualitative methodology, this study investigated the roles of Australian school teachers and counselors. The aims were two-fold: (i) to explore how teachers and counselors perceive the role of the school in student mental health; and (ii) to explore their views about what is being practically done in schools to provide this support. Ninety-one secondary school teachers and 83 counselors (Mage = 39.45) across New South Wales responded to open-ended questions between November 2017 and July 2018. Key themes included support, being on the frontline, collaboration, and education, although there were some discrepancies between staff. Further, counselors endorsed evidence-based programs in schools that directly targeted student mental health. Results indicated that clear professional roles and a coordinated effort are needed to appropriately address student mental health. [ABSTRACT FROM AUTHOR]

Data generated within social media platforms may present a new way to identify individuals who are experiencing mental illness. This study aimed to investigate the associations between linguistic features in individuals' blog data and their symptoms of depression, generalised anxiety, and suicidal ideation. Individuals who blogged were invited to participate in a longitudinal study in which they completed fortnightly symptom scales for depression and anxiety (PHQ-9, GAD-7) for a period of 36 weeks. Blog data published in the same period was also collected, and linguistic features were analysed using the LIWC tool. Bivariate and multivariate analyses were performed to investigate the correlations between the linguistic features and symptoms between subjects. Multivariate regression models were used to predict longitudinal changes in symptoms within subjects. A total of 153 participants consented to the study. The final sample consisted of the 38 participants who completed the required number of symptom scales and generated blog data during the study period. Between-subject analysis revealed that the linguistic features "tentativeness" and "non-fluencies" were significantly correlated with symptoms of depression and anxiety, but not suicidal thoughts. Within-subject analysis showed no robust correlations between linguistic features and changes in symptoms. The findings may provide evidence of a relationship between some linguistic features in social media data and mental health; however, the study was limited by missing data and other important considerations. The findings also suggest that linguistic features observed at the group level may not generalise to, or be useful for, detecting individual symptom change over time. [ABSTRACT FROM AUTHOR]

This study examined school counsellors' and parents' experiences of a school-based digital mental health service (Smooth Sailing) that screened students' mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child's participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools. Trial registration: This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12617000977370). [ABSTRACT FROM AUTHOR]

This study examined school counsellors' and parents' experiences of a school-based digital mental health service (Smooth Sailing) that screened students' mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child's participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools. Trial registration: This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12617000977370). [ABSTRACT FROM AUTHOR]

Background: This study evaluated the acceptability and effectiveness of a relationship‐focussed mobile phone application (WeClick) for improving depressive symptoms and other mental health outcomes in adolescents. Methods: A randomised controlled trial involving 193 youth (M age: 14.82, SD: 0.94, 86.5% female) from Australia was conducted. Youth were recruited via the Internet and randomly allocated to the intervention or a 4‐week wait list control condition, stratified for age and gender. The primary outcome was change in depressive symptom scores measured using the Patient Health Questionnaire for Adolescents (PHQ‐A) at baseline, 4‐week post‐test and 12‐week follow‐up. Secondary outcomes included anxiety, psychological distress, wellbeing, help‐seeking intentions for mental health, social self‐efficacy and social support. Participants in the intervention condition received access to the intervention for four weeks. Thematic analysis was utilised to identify and examine acceptability. Results: The change in PHQ‐A scores from baseline to 4‐week post‐test did not differ significantly (d = 0.26, p =.138) between the intervention (Mchange = −2.9, SD = 5.3) and wait list control conditions (Mchange = −1.7, SD = 4.3). However, significant between‐group improvements were observed in wellbeing (d = 0.37, p =.023), help‐seeking intentions (d = 0.36, p =.016) and professional help‐seeking intentions for mental health problems (d = 0.36, p =.008). Increases in help‐seeking intentions were sustained at follow‐up in the intervention condition. No differential effects were found for generalised anxiety, separation anxiety, social self‐efficacy or for any social support outcomes. Over 90% of participants indicated the app was enjoyable, interesting and easy to use. The app provided 'advice and direction' (n = 42; 46.15%), an 'opportunity for self‐reflection' (n = 33; 36.3%) and 'normalised experiences' (n = 21; 23.1%). Conclusions: The WeClick app was found to be effective for improving wellbeing and help‐seeking intentions for mental health in adolescents. A larger, adequately powered trial is now required to establish differential effects on depressive symptoms. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001982202. [ABSTRACT FROM AUTHOR]

Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14 to 17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented, and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people's symptom reduction. [ABSTRACT FROM AUTHOR]

Background: Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.Methods: A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.Discussion: This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019. [ABSTRACT FROM AUTHOR]

Childhood emotional and behavioural problems can indicate a higher risk of developing mental illness in adolescence and beyond. Schools provide an appropriate setting in which to deliver universal preventions to improve well-being and protect against early risks for mental health disorder. However, interventions can often be difficult to implement in schools due to their perceived or actual burdensomeness and implementation challenges can affect effectiveness. Teacher-delivered well-being interventions that can be integrated into usual classroom teaching practices provide a potential solution. This study examines the efficacy of a teacher-delivered programme, the Good Behaviour Game, in Australian primary schools. The programme significantly reduced emotional and behavioural problems as measured by the Strengths and Difficulties Questionnaire from baseline to post-intervention, suggesting that it may be an effective teaching practice for managing students in the classroom and for promoting well-being and development. [ABSTRACT FROM AUTHOR]

Objective: Parents are important facilitators of mental healthcare for their adolescent children. An online, school-based, mental health service may assist parents in gaining access to care. This study explored parental attitudes towards this new type of service provision. Method: The study was undertaken in July and August 2016. Semi-structured interviews were used to understand parents' attitudes towards a proposed online, school-based service called Smooth Sailing. Themes were identified through thematic analysis. Fourteen parents were interviewed. Results: Seven key themes emerged. Parents' own experiences seeking help and awareness of mental health services, their perceived prevalence of mental health issues in youth and the appropriateness of online and school-delivered care, the desire to be involved in their child's care, alongside concerns about stigma, service trust and credibility, and the availability of face-to-face support, were all found to influence parents' attitudes to the proposed service. Discussion: This study confirmed that parents have both positive and negative attitudes towards online, school-based mental health service provision. By understanding these attitudes, service providers are better equipped to develop strategies to mitigate concerns and promote engagement. In doing so, parents are likely to be more supportive of their child seeking help for mental health in the school setting. [ABSTRACT FROM AUTHOR]

This review aimed to examine the effectiveness of mental health training programs designed to improve the knowledge, attitudes, or helping behaviour of secondary school teachers for adolescent depression, anxiety, and related mental health problems. A systematic search strategy was conducted using electronic databases and hand search procedures. Eight studies met inclusion criteria, representing six unique training programs. All eight studies reported an improvement in mental health knowledge (d = 0.57–3.1) and attitudes (d = 0.36–1.18) at post-intervention. There was little evidence that the included training programs improved teachers' helping behaviour or students' mental health. There was no evidence to suggest that these training programs alleviated mental health problems among teachers themselves. Only two studies were conducted as randomised controlled trials. The findings suggest there may be value in providing mental health training to teachers; however, there is an urgent need for more rigorous research to determine which, if any, programs can alter teacher behaviour or improve student outcomes for mental health. [ABSTRACT FROM AUTHOR]

Background : Schools play an important role in supporting young people's mental health, but face challenges identifying and responding to students in need of care. To assist secondary schools, the Black Dog Institute has developed an online, school-based, mental health service (Smooth Sailing). Delivered in the classroom, Smooth Sailing uses a website to screen, assess, allocate, and deliver care for depression and anxiety. The service is based on the principles of stepped care, offering treatments with varied intensity and follow-up by a school counselor when necessary. The current study aimed to evaluate the feasibility, acceptability, and safety of this new type of service among secondary school students. Methods : Between February and June 2017, a single-arm, pre-post, pilot study was conducted among students from four NSW secondary schools. Schools were given access to the service for 6 weeks. Feasibility measures (consent rates and step allocations), acceptability measures (service use and satisfaction) and safety measures (deterioration in help-seeking intention scores and mental health symptoms) were assessed at baseline and completion of the 6-week trial period. Results : A total of 59 students took part in the service pilot (mean age, 14.57 years; SD, 0.89 years; range, 13-16 years). At baseline, 18.64% of students were found to require follow-up from the school counselor, and 80% of these were new cases. Although completion of the online modules was low, service satisfaction was high. At 6 weeks, the mean scores for help-seeking, depression, and anxiety remained relatively stable or improved. Conclusions : The current study presents important findings for the development and implementation of an online mental health service that screens students' mental health and allocates care accordingly, all within the school setting. Although the findings provide some support for the feasibility, acceptability, and safety, service improvements are needed. The modifications outlined are likely to improve the quality of the service and its effectiveness. Trial Registration : Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000977370 [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to test the feasibility, acceptability and preliminary effects of a recently developed smartphone application, Sleep Ninja, for adolescent sleep difficulties. Setting The study was conducted online with Australian individuals recruited through the community. Participants Participants were 50 young people aged 12-16 years with sleep difficulties. Design A single-arm pre-post design was used to evaluate feasibility, acceptability and sleep and mental health variables at baseline and postintervention. Intervention Cognitive-behavioural therapy for insomnia informed the development of the Sleep Ninja. The core strategies covered by the app are psychoeducation, stimulus control, sleep hygiene and sleep-related cognitive therapy. It includes six training sessions (lessons), a sleep tracking function, recommended bedtimes based on sleep guidelines, reminders to start a wind-down routine each night, a series of sleep tips and general information about sleep. Users progress through each training session and conclude the 6-week programme with a black belt in sleep. Outcome measures Feasibility was evaluated based on consent rates, adherence and attrition, acceptability was assessed using questionnaires and a poststudy interview, and sleep, depression and anxiety variables were assessed at baseline and postintervention. Results Data indicated that the Sleep Ninja is a feasible intervention and is acceptable to young people. Findings showed that there were significant improvements on sleep variables including insomnia (within-group effect size d=-0.90), sleep quality (d=-0.46), depression (d=-0.36) and anxiety (d=-0.41). Conclusions The Sleep Ninja is a promising intervention that could assist adolescents who experience sleep difficulties. A follow-up randomised controlled trial is now warranted. [ABSTRACT FROM AUTHOR]

Background The Australian Government's Fifth National Mental Health and Suicide Prevention Plan recommends a stepped care model of mental healthcare that focuses on matching the intensity of care to the severity of illness. General practitioners (GPs) need to learn more about low-intensity online interventions to better meet the needs of patients of lower severity. Objective This article provides GPs with information about low-intensity, evidence-based online resources developed in Australia and available for integration into the care of patients with mild-to-moderate mental health conditions. This article has an emphasis on new developments since 2015. Discussion The internet provides an opportunity to deliver effective mental health treatment to people who would otherwise not seek, or be able to reach, skilled help for their mental health conditions. High-quality, evidence-based cognitive behavioural therapy treatment programs are available to all Australians, at no or low cost. These options can be integrated into a stepped care model of mental healthcare, and provide GPs with an opportunity to help patients access treatment that suits their needs. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Broadcasting a suicide attempt on social media has become a public concern in China. Stigmatizing attitudes around such broadcast can limit help‐seeking and increase the likelihood of death. To reduce stigmatizing attitudes, this paper aims to detect stigma expressions in social media posts through language use patterns and then identify suicide literacy in responses to such broadcast. Methods: Firstly, to examine linguistic patterns of stigma expressions, 6632 Weibo posts with keywords were collected and analyzed. Using 102 linguistic features, 2 classification models were built: one for differentiating between stigmatizing and nonstigmatizing attitudes, and one for differentiating between specific types of stigmatizing attitudes. Secondly, to identify the levels of suicide literacy, a content analysis was conducted on 4969 Weibo posts related to social media suicide. Results: Firstly, the model accuracy ranged from 66.15% to 72.79%. Secondly, a total of 11.67% of the Weibo posts (n = 580) contained misinformation about suicide. In the category of knowledge of signs, 27.93% and 18.10% of posts endorsed the stigmatizing views that “suicide happens without warning” and “people who want to attempt suicide cannot change their mind quickly,” both of which were related to a stigmatizing belief that a suicide attempt on social media is not genuine. In the category of knowledge of treatments, 35.17% of posts endorsed the stigmatizing view that “people who have thoughts about suicide should not tell others about it.” Discussion: This paper presents an opportunity for the dissemination of targeted online campaigns to increase mental health literacy and help‐seeking. [ABSTRACT FROM AUTHOR]

Depression is a highly prevalent mental health problem and is a co-morbidity of other mental, physical, and behavioural disorders. The internet allows individuals who are depressed or caring for those who are depressed, to connect with others via online communities; however, the characteristics of these discussions have not yet been fully explored. This work aims to explore the textual cues of online communities interested in depression. A total of 5,000 posts were randomly selected from 24 online communities. Five subgroups of online communities were identified: Depression, Bipolar Disorder, Self-Harm, Grief/Bereavement, and Suicide. Psycholinguistic features and content topics were extracted from the posts and analysed. Machine learning techniques were used to discriminate the online conversations in the depression communities from the other subgroups. Topics and psycholinguistic features were found to be highly valid predictors of community subgroup. Clear discrimination between linguistic features and topics, alongside good predictive power is an important step in understanding social media and its use in mental health. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations between depression course, functional disability, and Not in Education or Training (NEET) status in a clinical sample of young adults with mental health problems.Methods: Young adults aged 15-25 years seeking help from four primary mental health services were invited to participate in a prospective cohort study evaluating the course of psychiatric disorders in youth. Demographic and clinical characteristics, including depressive symptomatology and functioning, were evaluated through clinical interview and self-report at baseline and 12 month follow-up.Results: A total of 448 young adults participated (70 % female; M: 20.05 years, SD = 2.85). A significant interaction effect for time and depression course was found, such that those who became depressed reported an increase in functional disability and those whose depression remitted reported a significant reduction in functional disability. Developing depression was not a significant predictor of becoming NEET and vice versa: remitted depression did not make a person more likely to reengage in employment or education.Conclusions: This is the first study to examine the course of depression, functional disability, and NEET rates among help-seeking young adults. This study confirms the importance of symptom reduction for improved functioning; however, functional disability remained greater than that seen in young people in the community and there was no association between a change in depression and a change in NEET status. These results argue that services need to address functional outcomes and reengagement with education and employment in addition to symptom reduction. [ABSTRACT FROM AUTHOR]

This study explored the importance of cognitive, intrapersonal, and interpersonal attributes to student success among a large sample of university students and staff. This study also explored student and staff views of the role of the University in developing such skills. A list of 38 attributes was developed by the authors, with 30 items derived from the self-authorship model. Delivered via an online survey, including demographics and student characteristics, a total of 3065 students and staff participated. Results indicated that both students and staff viewed almost all of the attributes as important to student success, and only three attributes elicited a meaningful diversity of opinion. Differences in views were found to be associated with different student characteristics. The University was considered to be the most responsible for the development of cognitive skills (Students = 80%, Academics = 96%, Professionals = 91%), with less responsibility for intrapersonal and interpersonal skills. Overall, this study endorses student success as a multidimensional concept and provides support for the University's role in developing such skills and attributes. [ABSTRACT FROM AUTHOR]

Objective To investigate the associations between demographic factors, binge drinking, psychological distress, psychological flexibility, and self-reported Days Out of Role ( DOR) among students attending a large metropolitan university in Sydney, Australia. This study aimed to determine whether psychological flexibility moderated the association between psychological distress and DOR. Method All enrolled students were invited to participate in an online survey titled ' The Mental Health Census' which contained standardised measures of binge drinking, psychological distress, and psychological flexibility. Students received an email, which outlined the purpose of the study, including the link to the anonymous survey. Results A total of 3950 students participated in the survey. A higher number of DOR was significantly associated with a Non- English Speaking Language ( NESL) background, binge drinking and economic hardship. Greater DOR was also associated with increased psychological distress and lower levels of psychological flexibility. Psychological flexibility was found to moderate the association between psychological distress and DOR: students experiencing high distress were less likely to report greater DOR if they possessed higher levels of psychological flexibility. Conclusions Overall, this study confirmed that university students experiencing psychological distress are at a greater risk of experiencing DOR, which may be counteracted by improving psychological flexibility. [ABSTRACT FROM AUTHOR]

Objective: Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Design: Cross-sectional data from a longitudinal cohort study. Setting: Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Participants: Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Measures: Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning were assessed using clinical interview and self-report. Results: A total of 19% (n=130/696) were NEET. NEETs were more likely to be male, older, have a history of criminal charges, risky cannabis use, higher level of depression, poorer social functioning, greater disability and economic hardship, and a more advanced stage of mental illness than those engaged in education, training or work. Demographics such as postsecondary education, immigrant background and indigenous background, were not significantly associated with NEET status in this sample. Conclusions: One in five young people seeking help for mental health problems were not in any form of education, employment and training. The commonly observed risk factors did not appear to influence this association, instead, behavioural factors such as criminal offending and cannabis use appeared to require targeted intervention. [ABSTRACT FROM AUTHOR]

The article presents research on the effects of delayed sleep onset in depressed young people, with information on the circadian abnormalities in depressed young adults. Topics include risk factors, such as substance use, in delayed sleep phases; the cohort of help-seeking young adults with mental health problems; and the correlation between mental illness and delayed sleep phase.

Online social networking sites (SNS) are popular social tools used amongst adolescents and account for much of their daily internet activity. Recently, these sites have presented opportunities for youth to experience cyber-bullying. Often resulting in psychological distress, cyber-bullying is a common experience for many young people. Continual use of SNS signifies the importance of examining its links to cyber-bullying. This study examined the relationship between online social networking and the experience of cyber-bullying. A total of 400 participants (Mage=14.31 years) completed an online survey which examined the perceived definitions and frequency of cyber-bullying. Users of SNS reported significantly higher frequencies of stranger contact compared to non-users. Spearman's rho correlations determined no significant relationship between daily time on SNS and the frequency of stranger contact. This suggests that ownership of a SNS profile may be a stronger predictor of some cyber-bullying experiences compared to time spent on these sites. Findings encourage continued research on the nature of internet activities used by young adolescents and the possible exposure to online victimization. [ABSTRACT FROM AUTHOR]

This study examined the effects of an online cognitive behavior therapy (CBT) program (moodgym) compared with an online support group (moodgarden) in decreasing symptoms of depression and anxiety, and improving dysfunctional thoughts, online social support, and CBT literacy in young adults. Thirty-nine university students (aged 18-25) with elevated scores on the kessler psychological distress scale were allocated to either the moodgym, moodgarden or control condition. Relative to the control condition, participation in the moodgym group significantly improved anxiety symptoms and CBT literacy. Similarly, participation in the moodgarden group significantly improved anxiety symptoms and online social support relative to the control condition. although it appears that these online resources are beneficial, further research is needed to determine their long-term efficacy. Furthermore, qualitative participant evaluations indicated that improvements may need to be made to moodgym to ensure that young adults remain engaged with the program. [ABSTRACT FROM AUTHOR]

Social and professional support for mental health is lacking in many rural areas - highlighting the need for innovative ways to improve access to services. This study explores the potential of online social networking as an avenue for peer support. Using a cross sectional survey, 74 secondary students answered questions relating to internet use, online social network use and perceptions of mental health support. Over half of the sample had experienced a need for mental health support with 53% of participants turning to the internet. Results indicate that online social networking sites were used regularly by 82% of the sample and 47% believed these sites could help with mental health problems. The study concluded that online social networking sites may be able to link young people together with others in similar situations. The popularity and frequency of use may allow these sites to provide information, advice and direction for those seeking help. [ABSTRACT FROM AUTHOR]

The impact of Internet communication on adolescent social development is of considerable importance to health professionals, parents and teachers. Online social networking and instant messaging programs are popular utilities amongst a generation of techno-savvy youth. Although these utilities provide varied methods of communication, their social benefits are still in question. This study examined the relationship between online social interaction, perceived social support, self-esteem and psychological distress amongst teens. A total of 400 participants (Mage = 14.31 years) completed an online survey consisting of parametric and non-parametric measures. No significant relationship was found between online interaction and social support. Time spent interacting online was negatively correlated with self-esteem and psychological distress. While previous research has focused on young adults, this study examines the impact of online social networking on emerging teens. It highlights the need for continued caution in the acceptance of these utilities. [ABSTRACT FROM AUTHOR]