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BackgroundYoung people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. ObjectiveThis review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. MethodsA systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. ResultsThe search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health–related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. ConclusionsThere is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender–attracted women, trans and gender-diverse people, and people with intersex variations. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164

Introduction Method Results Discussion and Conclusions There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6‐month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate‐adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open‐ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi‐levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction.While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self‐exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender‐affirming care. [ABSTRACT FROM AUTHOR]

Objectives: Non‐suicidal self‐injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk. Method: An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days. Results: Mental preoccupation in the form of NSSI mental imagery‐based flash‐forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross‐panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge. Conclusions: Mental imagery of NSSI is not simply an epiphenomenal by‐product of NSSI urge and may constitute a dynamic and proximal novel intervention target. [ABSTRACT FROM AUTHOR]

Objectives: Children and adolescents with chronic physical health conditions are also at elevated risk of poor mental health; the mechanisms to account for this relationship remain unclear. In this narrative review, we used the socio-ecological model to examine research on experiences of school for children with chronic health conditions and how socio-ecology might be involved in mental health problems. Design: We conducted a scoping review of the existing literature, focused on hearing loss, cystic fibrosis and type 1 diabetes, which examined child and/or adolescent mental health and aspects of the school social setting. Method: PubMed and ScienceDirect databases were searched for the three target conditions; from 353 abstracts, 38 articles were reviewed in detail. Results: Relevant articles that examined social aspects of the experience of school for students with chronic health conditions, including absenteeism due to illness or healthcare, self-perceived difference from peers, stigmatisation and discrimination, bullying and victimisation, and positive aspects of peer support at school were reviewed. Teacher-child aspects including teacher knowledge and/or attitudes about the condition and the possibility of overdependence in the relationship were examined. Each of these processes was considered for its impact on the young person's mental health. Conclusion: School-based social risk processes in the lives of young people with chronic health conditions, in particular in the peer microsystem, are likely to contribute to risk of psychological problems. These risks cannot be disentangled from mesosystemic, exosystemic and macrosystemic influences. Further research is required on the role of teachers and parents in the school social functioning of children with chronic health conditions.

Schools have an important role to play in supporting the psychosocial and physical health of students with Type 1 diabetes (T1D). Good school-based support for students with T1D is related to better diabetes management and quality of life. However, support for students with T1D appears inconsistent across schools in Western Australia. Strategic capacity-building for schools, including attention to policy and practice, is needed to support students with chronic and other health conditions. This project aimed to investigate how schools provide support for the psychosocial wellbeing and disease management of students with T1D. Ten schools, identified by a hospital-to-school transition team as being supportive of students with T1D, participated in this generic qualitative study. Semi-structured interviews were conducted with school staff, students with T1D and their parents at each school. Inductive and deductive thematic analysis identified three overarching themes to encapsulate the various ways schools provided support: (a) school characteristics; (b) interpersonal support; and (c) organisational support, and eleven sub-themes outlined this support. Based on these findings, a conceptual model of support is presented. This can be used as a foundation for a professional learning tool to enhance the capacity of schools to support the wellbeing of students with T1D.

Objective: The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia. Methods: We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14–25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines. Results: A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people. Conclusion: These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people. [ABSTRACT FROM AUTHOR]

Children and adolescents with type 1 diabetes (T1D) spend a significant portion of their day at school. It is therefore important that schools provide a safe and flexible environment for disease management and psychosocial support. Little is known of the school experiences of children and adolescents with T1D in Western Australia. The aim of this research was to describe the mental health and school experiences of children and adolescents with T1D attending mainstream schools in Western Australia. Using an online questionnaire, 92 parents of children and adolescents with T1D were surveyed. The results suggest elevated levels of emotional difficulties among school students with T1D and variable levels of support from school staff to assist these students to manage their diabetes at school. Increasing teacher knowledge to provide more individualised support and enhancing the quality of communication between parents and school staff may be useful strategies to support the physical and emotional needs of children and adolescents with T1D at school.

The existing literature exploring the experiences of parenting a trans child tends toward reporting the challenging aspects of the parental journey. Studies also reference positive experiences such as enhanced parent-child connectedness and affirmation of personal values. Limited dedicated research focused on the positive aspects of parenting a trans child exists. We aimed to better understand positive parental experiences accordingly. Using data from a large cross-sectional survey, we explored parental responses (N = 134) to a single open-text question asking what parents had experienced as positive about parenting their trans child. We used the general inductive approach (GIA) to analyze data and report on common themes. Almost all parents identified at least one positive aspect; most cited multiple benefits. Five major themes emerged from the data: 1) Personal growth; 2) experiencing the strengths of the child; 3) improved aspects of the parent-child relationship; 4) positive change in the child; 5) experiencing social connection and support. Findings provide a nuanced addition to the literature on parental experiences and have clinical implications for those working with parents of trans children. A better understanding of positive parental experiences can aid clinicians in increasing parental support and acceptance for young people within an affirmative framework. [ABSTRACT FROM AUTHOR]

Introduction: Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents' mental health is also unclear, as well as the role of teachers in conferring this benefit. Method: Using Wave 8 'B Cohort' data from the Longitudinal Study of Australian children (N = 3127, M age = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents' mental health. Results: Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%. Discussion: Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these. [ABSTRACT FROM AUTHOR]