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This study investigated vocational students' mental health by identifying the prevalence of depression, stress, anxiety, eating disorders and associated risk and protective factors among 16- to 18-year-old students attending a vocational college in Malta. Health Related Quality of Life (HRQOL) was also investigated. A sample of 422 students completed standardised self-report mental health tools and a demographic and personal variables' questionnaire. A total of 64.4% of students were found to be struggling with at least one of the mental health conditions assessed while 36.7% reported a suspected eating disorder. The prevalence rates of depression, anxiety and stress (moderate, severe or extremely severe) were 43.3%, 48.8% and 29.3% respectively. Students had a lower HRQOL than the reference population as indicated by European norm data. Only 13.5% of participants sought help from mental health services. Risk factors include female gender, poverty, being LGBTQ, not living with both parents, past negative school experiences, poor relationships and presence of suspected or diagnosed conditions or disabilities, amongst others. Having supportive relationships with family, peers and school personnel emerged as protective factors.

In the past several decades, the number of college students who experience mental health concerns has increased astronomically. During that time, acts of campus violence have increased as well. Unfortunately, many colleges have been unable to effectively meet the needs of students with mental disorders. This article explores the challenges surrounding the mental health and wellness of college students. It also analyzes the impact of such challenges on students and the institution. Additionally, this paper examines best practices that colleges may implement to assist students in distress and discusses implications for higher education leaders.

Existing research evidence pertaining to the occupational therapy (OT) role with adventure-based outdoor activities for military veterans and the authors' positive experience serving members of a non-profit veteran-run organization that promotes rehabilitation archeology suggest that outdoor rehabilitation for this client population is a promising avenue for the profession. Moreover, students' exposure to outdoor experiences designed for military veterans as well as other populations presenting with physical and mental health conditions has the potential to significantly augment OT curriculum by impacting both the learning trajectory and personal transformation of the students. This paper describes a unique service-learning experience involving graduate OT students who engaged with and provided services to veterans participating in archeological fieldwork, as well as the impact of this experience on the students.

This study examines the association between the boarding protection/care service models offered by the General Directorate of Social Services and Child Protection Agency and the behavioral and emotional problems children and adolescents under protection or care. The relational scanning model guided the preparation of the study sample. The study's scope included an analysis of 296 children and adolescents aged 4 to 18 who needed protection or care. Various service models benefit the kids, including children's homes, orphanages, and nursery schools. Data collection tools included the Personal Information form, the Scale of Child Behavior Checklist for Ages 4-18, and the Scale of Child Behavior Checklist for Ages 6-18. The software program used Mann Whitney and Kruskall Wallis test procedures to examine the study data. It has been noted that the behavioral and emotional disorders of children and adolescents receiving protection or care exhibit notable variations in the number of children in the family (p<0.05), the reasons for placement under protection or care (p<0.05), the kind of service model received (p<0.05), and the length of time the current service model has been assisting (p<0.05). Furthermore, it is noted that the kind of service model used has correlations with age (p<0.05), gender (p<0.05), the reason (p<0.05) for being placed under protection or care, and the length of time (p<0.05) that the person has benefitted from the present service model. The results are evaluated in light of the relevant literature covered.

The mental health of students in higher education is an increasing concern. Research indicates that university students are at a higher risk of poor mental health and wellbeing compared to the general population, which negatively impacts their studies. The main issue addressed in this study is the evident gap in mental health research dedicated to university students in sub-Saharan Africa (SSA). The purpose of this article is to review the literature on mental health of university students in SSA and to provide an overview of student mental health policy in educational institutions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendation was followed to objectively select and retain articles within the topic of interest for this systematic review. Findings indicate a significant gap in mental health research for university students in SSA. There is a need for higher education institutions to establish mental health empowerment policies and strategies. International examples, such as the University Mental Health Framework in Australia and the United Kingdom Universities Student Wellbeing Good Practice Guide, exist for benchmarking. Contribution: The higher education sector and policymakers can use the results to inform current policy decisions and identify priorities for future directions. It is crucial to translate international guidelines into the African context to address the specific mental health issues of students in the region.

Worldwide trends suggest we are witnessing a global "campus mental health crisis" (Andersen, Holm, & Côté, 2021). According to the most recent US National College Health Assessment, over the course of a typical month, 29% of students chronically experience high levels of stress, 42% experience stress that negatively impacts their performance or progress towards their degree, and 66% feel hopeless (National College Health Assessment, 2022a). Study reviews in various countries indicate that the prevalence of students meeting criteria for a mental health disorder is alarmingly high (e.g., 25% depressive disorder, Sheldon et al., 2021). Accordingly, students' demand for mental health services has reached new heights (Xiao et al., 2017). While this rise in psychological distress and help-seeking behavior is likely in part due to decreased mental health stigma (Lipson, Lattie, & Eisenberg, 2019), postsecondary students are also believed to be facing unprecedented challenges. Ensuring that colleges and universities procure learning environments that prioritize emerging adults' wellbeing has thus become necessary.

Little is known about OCD in people with learning disabilities (LD) in general and in terms of current and professional support. In this study, we examined caregivers' perceived challenges and strategies practiced in institutionalized settings in managing OCD in people with LD and derived implications for research and practice. We studied individual cases of people with LD (n = 7). Each case included group discussions (n = 28) and semistructured interviews with caregivers (n = 20). We used qualitative content analysis to analyze the data. Our findings reveal the following challenges for caregivers: recognizing and classifying ambiguous behaviors, recognizing emotional well-being and needs through nonverbal signals, finding and applying effective strategies, being unqualified regarding additional needs, managing inappropriate institutionalized conditions, and lacking external specialization. We identified five strategies for dealing with compulsive behavior: tolerating and allowing, accepting and supporting, involving, limiting the compulsive act, and stopping the act. Collaboration among psychiatric, therapeutic, and caregivers in institutionalized settings is critical for early identification and support of OCD. Challenges arise from caregivers' lack of training on the additional needs of people with LD and OCD, highlighting the urgent need for disorder-specific guidelines for identification and support.

Understanding the overlap of symptoms between oppositional defiant disorder (ODD) and obsessivecompulsive disorder (OCD) experienced by youth is pertinent for accurate diagnosis. A quantitative, retrospective, cross-sectional design format was used to assess the relationship between ODD and OCD in addition to evaluating the difference in ODD severity and symptoms based on OCD severity. Symptoms and severity ratings of ODD and OCD were collected from youth diagnosed with ODD (N = 179). Fisher's exact test and a Wilcoxon signed-rank test were performed. There were significant relationships between frustration related to obsessions and compulsions and the ODD symptoms of annoyance and anger. Results suggested that OCD severity predicted an increase in scores for ODD severity and symptoms.

Sense of coherence (SOC) is a relevant contributor and predictor of the individuals' mental and physical health. There are a number of studies about SOC, but only two validation articles of the sense of coherence scale (SOCS) were found on adolescents and none on children. The aim of this research was to validate the SOC scale in youth under 18. We hypothesized that younger children and children without psychiatric problems will have higher SOC than older ones, and children with psychiatric symptoms. We also wanted to examine the factor structure of both the 13 and the 29 item versions of the scale to study which is more valid in child and adolescent population. 199 children and 198 adolescents were included in the study; the mean age was 14.3 (SD 2.1) years. The sample included average youth from schools and youth under psychiatric treatment. Strength and Difficulties Questionnaire (SDQ) and Inventory of Life Quality (ILK) were used for validation of the SOCS. SOCS-13 was applied to compare SOC of children and adolescents. Children had higher SOC than adolescents in both samples. Males had higher SOC than females in children but not in adolescents. Psychiatric and behavioral symptoms were associated with a lower SOC regardless

Mental health conditions such as anxiety, depression, aggression, and inattention are common in autistic youth and are challenging to treat by community providers. We aim to parse the heterogeneity of autism based on dimensions of executive function and determine whether specific executive function profiles are differentially related to psychiatric symptoms. Parents of 397 well-characterized 8-14-year-old autistic children without an intellectual disability reported on their child's executive function skills and psychiatric symptoms. We applied a data-driven, graph theory-based, community-detection approach to a common executive function measure, revealing three distinct executive function profile subgroups. Despite having similar social challenges, the executive function subgroups differed on anxiety, aggression, affect, and inattention symptoms. Results support the need for more intensive subtyping with autistic youth to develop appropriate, individualized mental health treatments and supports. Characterizing youth through neurocognitive strengths and challenges can guide the development of precision medicine, allowing for more meaningful, specialized treatment.

Autism spectrum disorder is a neurodevelopmental disorder characterized by a wide range of behavioral alterations, including impaired social interaction and repetitive behaviors. Numerous pharmacological interventions have been developed for autism spectrum disorder, often proving ineffective and accompanied by a multitude of side effects. The gut microbial alterations observed in individuals with autism spectrum disorder, including elevated levels of "Bacteroidetes," "Firmicutes," and "Proteobacteria," as well as reduced levels of "Bifidobacterium," provide a basis for further investigation. Recent preclinical studies have shown favorable outcomes with probiotic therapy, including improvements in oxidative stress, anti-inflammatory effects, regulation of neurotransmitters, and restoration of microbial balance. The aim of this review is to explore the potential of probiotics for the management and treatment of autism spectrum disorder, by investigating insights from recent studies in animals.

Suicide is a complex, multifaceted crisis affecting children and adolescents, and has become a major public health concern. While there is a plethora of research on this topic among neurotypically developing youth, much less is known about the nature of suicidality in autistic individuals. Autistic youth show an increased vulnerability for suicidal tendencies that are poorly understood among school mental health (SMH) professionals, who report a range of competency and self-efficacy to address suicidality in school settings (Debski et al., 2007; O'Neill et al., 2020). Co-occurring mental health difficulties pose significant challenges in the early detection of suicide risk in autistic youth. Given that suicide is the leading cause of death among autistic individuals, the incidence of suicidality among autistic youth is of particular concern. This article provides a practice-friendly review of the research outlining innate vulnerabilities that present risk factors for suicide among autistic youth, along with assessment considerations that help inform the management of suicide risk in autistic youth. We conclude with recommendations for integrating a multi-tiered neurodiverse-affirming approach with sensitivity for student intersecting identities and system-level influences on student mental health that enables SMH professionals to create supportive school environments for autistic youth that prevent further harm.

Autistic adults experience disproportionate rates of co-occurring mental health problems. Psychotherapy has been recognized as an appropriate treatment approach, but evidence is limited. Researchers used a qualitative research paradigm to explore the experiences of mental health providers who provide psychotherapy to autistic adults. The Enhanced Critical Incident Technique was used to interview 13 mental health providers regarding perceptions of facilitating therapy with autistic adults. This research highlights challenges to providing psychotherapy to autistic adults while also illuminating ways that mental health providers have worked to ameliorate such challenges and create positive experiences in therapy. This research also contrasts therapy for autistic adults relative to the general population. Practice recommendations and suggestions for future research are offered.

The COVID-19 pandemic has strained the resources of the world's healthcare systems. Most individuals with neurodevelopmental disabilities (NDDs) experience significant mental health issues and face substantial barriers in accessing appropriate supports which have been exacerbated during the pandemic. It is unknown the extent to which COVID-19 impacted the demand for and effectiveness of inpatient care for those with NDDs. The impact of COVID-19 on the number of admissions of youth with NDDs to pediatric inpatient psychiatry units, as well as their functioning and length of stay during the first two years of the pandemic was analyzed using Bayesian structural time series models. Admission data of youth with NDDs from four pediatric inpatient units in Alberta, Canada (n = 2144) was examined. Inpatient admissions of youth with NDDs significantly increased following the onset of the pandemic. Compared to the period prior to the pandemic, patients with NDDs had significantly worse overall functioning and received fewer days of treatment. These findings highlight the need for increased resources to support the mental health needs of this vulnerable population and are consistent with other studies in the general population examining the utilization of inpatient psychiatric units during the pandemic.

Purpose: To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD). Method: 40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits. Results: The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group. Conclusion: Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities.

Mental health problems are increasing among children and adolescents. School-based mindfulness interventions are gaining popularity worldwide and may be a way to decrease depression and anxiety symptoms in students. However, before introducing large-scale mindfulness interventions in school settings, more research is needed on feasible, easily applicable practices that are possible to fit in the school schedule. In this controlled intervention study, a total of 1399 students aged 9-16 were included. The 10-week classroom-based mindfulness intervention comprised daily, brief mindfulness sessions led by school-teachers or via audio files. Symptoms of depression and anxiety were evaluated with Beck scales prior to and after the intervention. In addition to whole group analyses, subgroup analyses on age, sex as well as mode of delivery were performed. ClinicalTrials.gov ID: NCT03327714. No significant differences between the intervention and control group in change of depression or anxiety symptoms after the intervention were detected. However, the subgroup of students who received teacher-led mindfulness sessions (16%) had a significant decrease of depression and anxiety symptoms after 10 weeks compared to those who received the sessions via audio files. Brief mindfulness sessions on daily basis did not have any detectable overall effect on depression and anxiety symptoms among schoolchildren. Our findings do not support an introduction of large-scale mindfulness interventions in schools although the potential influence of mode of delivery needs to be further examined.

In the past 40 years, accumulating evidence suggested that autistic individuals are at an increased risk of suicidal thoughts and behaviors. This study examined the occurrence of various potential risk factors for lifetime suicidal behavior and suicidal thoughts in the past month in a Dutch cohort (Netherlands Autism Register) of autistic individuals using the Suicidal Behaviors Questionnaire (SBQ-R) and the Suicidal Ideation Attributes Scale (SIDAS). Our results show that the majority (80%) of the initial sample (N = 1164) had thought about or attempted suicide in their lifetime, of which 15% had attempted suicide. In the final sample (n = 421), backward linear regression analyses identified the following predictors for suicidal behavior: psychiatric comorbidity, loneliness, and higher number of autistic traits, F(3, 240) = 21.22, p < 0.001, with R[superscript 2] of 0.21. For suicidal thoughts in the past month, psychiatric comorbidity and a higher number of autistic traits were significant predictors, F(2, 241) = 20.34, p < 0.001, with R[superscript 2] of 0.14. In sum, additional risk markers for suicidal thoughts and behaviors in autistic individuals (e.g. number of autistic traits) should be considered when assessing the suicide risk in autistic individuals. Future research should focus on adapting suicide prevention interventions for autistic individuals, such as addressing loneliness as one of the intervention strategies.

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

The mental health treatment gap remains wide across the world despite mental illness being a significant cause of disability globally. Both end-user and healthcare provider perspectives are critical to understanding barriers to mental healthcare and developing interventions. However, the views of providers are relatively understudied. In this review, we synthesized findings from current literature regarding providers' perspectives on barriers to mental healthcare in Canada. We searched Medline, PsycINFO, Embase, and CINAHL for eligible Canadian studies published since 2000. Analysis and quality assessment were conducted on the included studies. Of 4,773 reports screened, 29 moderate-high quality studies were reviewed. Five themes of barriers emerged: health systems availability and complexity (reported in 72% of the studies), work conditions (55%), training/education (52%), patient accessibility (41%), and identity-based sensitivity (17%). Common barriers included lack of resources, fragmented services, and gaps in continuing education. Interestingly, clinicians often cited confusion in determining the ideal service for patients due to an overwhelming number of potential services without clear descriptions. These five domains of barriers present a synthesized review of areas of improvement for mental healthcare spanning both patients and clinicians. Canadian mental health systems face a need to improve capacity, clinician training, and in particular service navigability and collaboration.

Purpose: This study examined predictors of sexual victimization among autistic and non-autistic college students. Specifically, we aimed to determine whether autistic students are more likely than non-autistic students to experience unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. We also aimed to determine whether students with other disabilities, specifically ADHD, learning disability (LD), and psychological disorders, are more likely than students without these disabilities to experience unwanted sexual contact and sexual assault. Methods: Autistic students (n = 270) and non-autistic students (n = 270) who had participated in a nationwide survey were matched on demographic characteristics and co-occurring diagnoses. Logistic regression analyses were conducted to address the research questions and evaluate predictors of unwanted sexual contact and sexual assault. Results: Autistic students were as likely as non-autistic students to have experienced unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. Regardless of autism diagnostic status, students with ADHD were more likely than students without ADHD to have experienced unwanted sexual contact and sexual assault. Conclusions: Although autism diagnostic status was not a significant predictor of unwanted sexual contact or sexual assault, other factors associated with increased risk of sexual victimization, such as co-occurring ADHD, are likely to be found in autistic populations. This study highlights the importance of educational, social, and institutional supports to decrease sexual victimization among college students with neurodevelopmental disabilities.

The aim of this study was to assess the pattern of mutual relations within the Problematic Smartphone Use (PSU) (first network) and between adolescent mental health problems and PSU (second network). The invariance of both networks was investigated across age, gender, and severity of symptoms. The participants were 708 Romanian adolescents (M[subscript age] = 16). Analyses were performed in RStudio. The results indicated that the most central node in the PSU network was a preoccupation symptom. The strongest bridge path laid between a reckless symptom and PSU. The networks were invariant with respect to the gender of the adolescents but were different--both in structure and strength--between the adolescents with low vs. high total difficulties. Furthermore, the networks were significantly different in terms of structure between middle and late adolescents. These findings are further discussed.

Poor mental health in childhood and adolescence has a significant impact on both physical and mental health throughout life. However, growing evidence suggests that current levels of child and adolescent mental health (CAMH) care are insufficient to meet the needs of many children and adolescents in the United States as evidenced by increasing rates of mental health problems, inequities in diagnosis, and inaccessibility of services. This article provides a discussion of current problems in CAMH and school mental health services and emphasizes a developmental perspective of CAMH, including the co-occurrence of school difficulties and mental health concerns. A universal design for learning framework for school-wide mental health programs is suggested as a means of addressing barriers to care and promoting prevention and early intervention in CAMH.

Objective: Our study examined the impact of sex, ADHD subtype, and comorbid illnesses (depression/anxiety) on the timing of diagnosis and treatment for ADHD. Method: To analyze ADHD patients, four health databases were used to assess subtype, comorbid mood, and antidepressant or anxiolytic drug exposure. Analyses were stratified by sex and age. Standardized mean differences measured intergroup differences. Results: Females with ADHD were identified at older ages and had higher rates of depression and anxiety diagnoses and treatments before and after their initial ADHD diagnosis. Predominantly inattentive ADHD patients were diagnosed later and more likely to receive mood disorder diagnosis and treatment than hyperactive impulsive ADHD patients. Conclusions: Results suggest a more complex ADHD presentation in females, potentially causing late diagnosis and delayed treatment.

This study examined the clinical utility of the Massachusetts Youth Screening Instrument--Second Version (MAYSI-2) among African American (AA) incarcerated youth and used White incarcerated youth as a comparison group. Data were analyzed for 314 incarcerated youth (193 AA offenders and 121 White offenders) of ages 13-17 years who were adjudicated delinquent from a southeastern United States medium security residential facility. Seven logistic regression and receiver operating characteristic curve (ROC) models were built to determine whether the MAYSI-2 subscales accurately identify committed AA male incarcerated youth who have a mental illness diagnosis on file. Analyses also examined how well the MAYSI-2 subscales identify specific mental illnesses among AA-committed male incarcerated youth. Results demonstrated that no MAYSI-2 subscales accurately identified and categorized AA-committed male incarcerated youth who have mental disorders, and only two subscales (Alcohol/Drug Use, Depressed/Anxious) identified and categorized White committed male incarcerated youth who have a mental disorder. Additional results and implications for research and practice are provided.

It can be tough to talk about disabilities. However, when we avoid talking about it, we ignore a huge piece of someone's personal identity. This identity is complex, multifaceted, and requires a unique set of needs. It is important that students with disabilities are heard. When living with a disability, society can often have lower expectations of what we can do in comparison to our non-disabled counterparts. In this article, the author describes a few of the stories and assumptions people with disabilities experience every day on college campuses due to their unique characteristics. In telling these stories, the author demonstrates how students with disabilities are constantly trying to prove that they are more than just their disability.

English language learning students in China often feel challenged to learn English due to lack of motivation and confidence, pronunciation and grammar difference, lack of practice and people to communicate with etc., which affects students mental health. Adopting Big data and AI will help in overcoming these limitations as it provides personalized guidance to the students in all aspects. The paper has established an automatic early warning system to monitor the students' psychological state at any time period. The data is collected from 650 respondents from four different public universities in China. The data analysis has been done with the help of powerful SPSS software and the methodology which we used for determining sample size is, Random sampling. The study involves a qualitative assessment to identify participants' characteristics and categorize them to appropriate clusters. The findings of the research showed that the most obvious differences in mental health between students who used automatic warning and those who did not use automatic warning were: depression, anxiety, hostility, terror, and psychosis. The proportion of students who use early warning was less than those who did not use early warning. Research contributes to policymakers to emphasize the importance of incorporating mental health support and resources into educational policies. The novelty of the study seeks to provide a deeper understanding of how AI and big data can optimize mental health education for English students. With the support of AI and Big data there is a constant monitoring and improvement effect on English education students' mental health.

At the 2020 American String Teachers Association (ASTA) Conference held in Orlando Florida, an attendee of the Wellness Committee Listening Session recommended that a study be conducted to determine the prevalence and awareness of mental health concerns among students and teachers within the organization. Members agreed that there is more needed to be understood so that ASTA could provide professional development webinars, resources, as well as local, state, and national conference sessions. In response to this request and the clear need for more information, a survey was developed and deployed to the ASTA membership in the fall of 2020. Follow-up interviews with members who volunteered in response to an invitation on the survey were conducted in the spring and early summer of 2021. Teachers reported a high prevalence of student mental health issues prior to and during the pandemic and reported concerning levels of work overload, compassion fatigue/burnout, and mental health issues. Generational differences in mental health perceptions were noted, as were opportunities to provide targeted professional development and community-level services.

Increased reactivity to daily stressors is associated with mental health difficulties, which are common in autistic individuals. We investigated affective reactivity to daily-life stress, cognitive emotion regulation, and their link with co-occurring mental health symptoms in adolescents and young adults with autism. A 6-day ecological momentary assessment protocol was used to assess perceived daily-life stress (event-related, activity-related, and social stress) as well as negative affects in autistic (n = 39, age = 18.4) and non-autistic (n = 55, age = 18.1) participants. Co-occurring mental health difficulties, social functioning, and cognitive emotion regulation were assessed with questionnaires and clinical evaluations. Youth with autism showed higher levels of perceived stress related to their daily social context and activities, as well as an increased affective reactivity to activity-related stressors compared with non-autistic youth. Moreover, they reported using less adaptive and more non-adaptive emotion regulation, the latter increasing their affective response to daily stressors and possibly contributing to the severity of co-occurring mental health symptoms. Our findings demonstrate high perceived daily-life stress in autistic adolescents and young adults. To minimize the negative effects of stress and the development of mental health symptoms, interventions could focus on effective stress management and strategies that autistic young people use to manage their emotions.

Neurodivergent students exhibit an inclination towards Science, Technology, Engineering and Mathematics (STEM) fields, yet their learning experiences in STEM courses remain underexamined. Utilizing an online survey of neurodivergent (n = 60) and neurotypical (n = 83) US college students, this study identified various factors influencing their self-perceived learning experiences, including interest in the course content, instruction quality and performance outcomes. Compared to their neurotypical peers, neurodivergent students attributed negative experiences in STEM courses less frequently to performance-related factors and more often to a mismatch between their interests and the course content. Both groups also articulated a variety of strengths and challenges encountered in their STEM studies. Neurodivergent students were more likely to report having interest and passion for STEM and less likely to report having peer support and effective study skills and habits as their primary strength for studying STEM. Conversely, while neurotypical students cited difficult content as their central challenge, neurodivergent students more commonly faced challenges with focus and attention. Despite the study's limited sample size, it revealed emerging patterns that emphasize the importance of developing inclusive teaching methods and specific support mechanisms to cater to the unique strengths and challenges of neurodivergent students in higher education.

Objectives: WhatMakesUs is a digital media campaign aimed at reducing mental health stigma in the Greater Omaha-Council Bluffs metropolitan area. This study evaluated the campaign's impact at the end of the second year of the campaign by examining different aspects of mental health stigma, including social distance, attitudes, behaviours and self-efficacy, among campaign-aware (CA) individuals and non-campaign-aware (NCA) individuals. The study also explored the campaign's feasibility and potential for adaptation to other parts of the USA. Design, Setting, and Method: A cross-sectional online survey was conducted in the campaign's implementation area. Respondents were recruited through a panel recruiting company using non-probabilistic methods. Digital metrics from the campaign's social media accounts and website were collected and analysed using Google Analytics. Results: CA respondents exhibited lower social distance and stigmatising attitudes and beliefs, and more positive behaviours and self-efficacy towards people with mental health conditions (MHCs) compared to NCA respondents. A significantly higher proportion of CA respondents reported living with (p = 0.001), working with (p = 0.005), and having close friendships with individuals with MHCs (p = 0.043). CA respondents found therapy and counselling effective treatments for MHCs (p = 0.005), greater comfort in providing support to individuals with MHCs (p < 0.001), pursued steps to improve their own mental health (p = 0.032) and perceived their workplaces taking an active role in their mental health (p = 0.029), when compared to NCA respondents. Digital metrics indicated successful engagement with the campaign's intended audience. Conclusion: Findings highlight the impact of digital campaigns in addressing the stigmatisation of MHCs and provide valuable insights for future campaigns.

This study builds on existing literature on autism spectrum disorder (autism) and sexual and gender minority (SGM) identities and is the first to examine self-declared frequency rates, associated functional impairments, and treatment engagement levels for sexual minority (SM) and non-SM populations with and without autism cross-sectionally via a large nationwide college-student sample across 3 years. Using data from the American College Health Association-National College Health Assessment (ACHA-NCHA) III, we analyzed data from 81,286 college students (ages 18-25 years old) randomly selected from 75 U.S. colleges and universities. Included ACHA-NCHA-III measures consisted of self-reported demographics, SM and gender minority (GM) identities, autism diagnosis, stress, academic impairment, mental health symptoms, and treatment engagement. We found a 2.8% self-declared frequency of autism in the SM group, compared with 0.9% self-declared frequency among the non-SM sample. Autistic college students with both SM and GM identities had the greatest levels of reported adverse stress and the most negative academic and mental health outcomes (i.e., suicidality), followed by college students with two minority identities (i.e., Autism and SM, SM and GM), across all groups. These findings emphasize the need for mental healthcare providers to consider SM and GM identities in non-autistic and, especially, in autistic college students to assess suicide risk and inform treatment.

Numerous studies show that children and young people in out-of-home care (OOHC) face significant disadvantage in completing high school and accessing post-secondary education. The current research involved a two-round Delphi survey which aimed to identify educational challenges and school reforms to improve the educational experiences of children and young people in OOHC. A total of 45 participants from three OOHC stakeholder groups (carers of children in OOHC, professionals/educators, and young people with lived experience of OOHC) completed the round one survey which consisted of open-ended questions analysed using thematic analysis. In the second survey round, 19 participants completed a Likert scale questionnaire which drew on themes from the round one thematic analysis. Using a consensus threshold of 70% for the round two survey, participants agreed that students in OOHC face a myriad of educational challenges, such as dealing with a history of trauma, frequent home and school transitions, mental health issues and stigma as a result of being in OOHC. It was agreed that teachers lack knowledge and experience, and schools lack support for students in OOHC. Stakeholders recommended provision of greater mental health support, coordination of services and more autonomy for OOHC students regarding their education.

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

In recent years, some models for binary and graded format responses have been proposed to assess unipolar variables or "quasi-traits." These studies have mainly focused on clinical variables that have traditionally been treated as bipolar traits. In the present study, we have made a proposal for unipolar traits measured with continuous response items. The proposed log-logistic continuous unipolar model (LL-C) is remarkably simple and is more similar to the original binary formulation than the graded extensions, which is an advantage. Furthermore, considering that irrational, extreme, or polarizing beliefs could be another domain of unipolar variables, we have applied this proposal to an empirical example of superstitious beliefs. The results suggest that, in certain cases, the standard linear model can be a good approximation to the LL-C model in terms of parameter estimation and goodness of fit, but not trait estimates and their accuracy. The results also show the importance of considering the unipolar nature of this kind of trait when predicting criterion variables, since the validity results were clearly different.

School nurses have reported stress and worry caring for young people experiencing mental health problems, but why this occurs and how they respond has not been well-explored. In this study researchers generated a substantive theory of the experiences of secondary school nurses who encountered young people with mental health problems using the original method of grounded theory. Thirty-one Western Australian school nurse participants reported that students presented with complex mental and social health needs that were not easily resolved. This was conceptualized as an "untenable burden". Participants countered this by engaging in the three-stage process of "tactical prioritizing". During an initial period of "strategic assimilation" into the school and broader community, participants referred students to external service providers. This was frequently inadequate, and participants found themselves grappling with unmet student mental health needs. Participants responded by implementing nursing strategies for "optimizing outcomes" in the lives of young people, while simultaneously engaging in "managing self" to support their own well-being.

Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary.

Background: Integrated primary care (IPC) can address prevalent behavioral health concerns identified in pediatric office visits, but research on IPC consultation patterns is limited. Objective: This study investigated variation in consultation rates across presenting problems, patient sociodemographic factors, and IPC treatment duration. Method: Retrospective electronic health record data were extracted for 970 patients seen in 12 pediatric primary care sites and for whom behavioral health consultation was requested between June 2018 and December 2019. Logistic regressions were used to examine associations between sociodemographic variables, consultation reasons, and IPC visit type. We used multiple linear regression to assess the association between consultation reason and treatment duration. Results: Anxiety (36.2%) and disruptive behavior (29.7%) were the most common consultation reasons. Consultation requests for internalizing (anxiety, mood) problems were more prevalent in school-aged children and adolescents, whereas consultations for disruptive behavior (tantrums) and health-related issues (toileting, sleep concerns) were common in early childhood. Girls were less likely to receive consultation requests for attention deficit/hyperactivity disorder (ADHD) and autism/developmental concerns compared to boys, but more likely to receive consultation for internalizing problems. Consultation requests varied by patient race, ethnicity, visit type, and insurance type. Treatment duration after consultation was longer among patients with consultation requests for ADHD and for depression/mood concerns. Conclusions: Age-related behavioral health consultation patterns in IPC conform with expected developmental trends; however, sociodemographic findings suggest opportunities for enhancing care. Additional research is needed on IPC consultation given its promise for early identification, prevention, and treatment of pediatric mental health concerns.

The purpose of this provincial cross-sectional survey (N = 254) was to explore the mental health literacy (MHL) of educators, and particularly, if training and experience explains differences in MHL. There were meaningful differences based on MHL training and between educators of different division levels. Those who completed graduate degrees or took Learn or Teach MHL training modules clearly had stronger MHL knowledge and abilities to accurately discriminate mental health needs on a vignette measure. Pre-primary educators had the lowest MHL knowledge and ability to discriminate mental health needs on a vignette measure. Our findings evidence current disparities in, as well pathways towards, improving MHL training for pre- and in-service educators, including pre-primary educators. Significant relationships observed between measures of MHL, and vignette discrimination accuracy suggest MHL training for educators may strengthen help-seeking pathways through the timely identification of students experiencing mental disorders and the judicious provision of mental health resources for these students.

The Positive Outcomes With Emotion Regulation (POWER) Program is a transdiagnostic intervention for adolescents at risk of developing emotional disorders. The POWER Program was designed to be implemented in secondary schools, by school personnel with or without specialized mental health training, as a Tier 2 intervention. In this pilot study, the POWER Program was implemented by school psychologists and school psychologists-in-training and evaluated across four focal student participants using a multiple-baseline-across-participants single-case design. Program efficacy was assessed using systematic direct classroom observations of student negative affect and social engagement as well as student and caregiver ratings of emotional and behavioral symptoms. Program usability was assessed through rating scales completed by intervention facilitators and student participants. Overall, results provide evidence of the POWER Program's small- to large-sized effects on students' emotional and behavioral functioning as observed in the classroom and self-reported by students. In addition, results suggest implementation facilitators' and students' positive impressions of the program, evident in ratings of high understanding, feasibility, and acceptability across groups. Study limitations are highlighted with attention to opportunities to further refine and evaluate the POWER Program.

School absenteeism among children and adolescents has been associated with a myriad of adverse outcomes. Despite a substantial amount of research on school attendance, our understanding of absenteeism in elementary-aged children with mental health difficulties is limited. The current study used a mixed-method sequential explanatory design to gain a better understanding of the links between children's mental health symptoms, age, gender and school absenteeism. The study included two phases: Phase I presented a quantitative investigation of the links between absenteeism and mental health symptoms in a large sample (N = 750) of primarily White (74%) clinic-referred children aged 5-12 years. Phase II used a participant selection model and chart review design to garner a deeper understanding of how school absenteeism presents in children with mental health problems in the elementary years. Results suggested that internalizing symptoms were significantly related to school attendance problems, and this association worsens as children age and as internalizing symptoms increase in severity. Externalizing symptoms were associated with absenteeism as well, but these findings showed that school attendance problems were worse for younger children with low to moderate levels of externalizing symptoms. The qualitative chart review illustrates the complex interplay of school absenteeism and child mental health, particularly for children experiencing co-occurring internalizing and externalizing problems. Children often struggled academically and socially, with some exhibiting increasing levels of school refusal and truancy and others displaying aggressive behaviors resulting in suspensions. Future studies that examine additional contextual factors, such as school and family variables, with longitudinal cross-lagged models and diverse families are needed to develop a comprehensive understanding of causal associations and their impact on children's school attendance across children's development.

Autistic youth engage in higher levels of screen time and are more likely to experience mental health problems than their typically developing peers; however, few studies have investigated a potential relationship between daily screen time hours and mental health in autistic youth. This study examined the relations among daily screen time hours and commonly co-occurring psychopathology (i.e., anxiety, depression, conduct/behavioral problems, and attention-deficit/hyperactivity disorder [ADHD]) in autistic youth utilizing data from the 2018-2019 National Survey of Children's Health. Results indicated screen time was significantly related to conduct problems; however, contrary to findings from studies with neurotypical samples, screen time was not significantly related to anxiety, depression, or ADHD diagnoses in autistic children and adolescents.

To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.

Young people struggle to seek help for their mental health, despite having different resources available. As the coping process is very complex, and elements such as trust and availability of resources have been said to influence it, this study aimed to understand how young people cope with their own or a friend's symptoms of poor mental health. Eleven young people (13-15 years old) were interviewed. Thematic Analysis of the interviews showed that participants reported different coping strategies for dealing with their own hypothetical symptoms and those of a friend. Participants identified the social impact of experiencing symptoms of poor mental health and choice of resources as the main factors influencing their coping strategies. For their own symptoms, young people expressed concern about being judged and that they would only disclose to someone they trust. Participants would not disclose a friend's symptoms because they did not want to break their trust. Finally, choice of resources was mainly influenced by the severity of symptoms being experienced, especially when it comes to asking for professional help. This study contributes to a better understanding of the different ways in which young people cope with their own symptoms and symptoms experienced by a friend.

Autistic people appear to be at increased risk of post-traumatic stress disorder, and experiences involving violence or sexual abuse appear to be common in this population. However, knowledge concerning trauma in autistic people with co-occurring intellectual disabilities is limited. In this cross-sectional study, we explored the prevalence of post-traumatic stress disorder, as well as the prevalence and clinical correlates of reported experiences of violence and sexual abuse, in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only three participants (3.4%) were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of 'challenging' behaviours (Aberrant Behaviour Checklist). These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.

Background: Studies have found that presence of challenging behaviours and mental health problems limits employment for people with intellectual disabilities. This study investigates the associations between age, gender, living condition, level of intellectual disability, diagnoses, behaviour, mental health, and employment in adults with intellectual disabilities in Norway. Method: A cross-sectional community-based survey including 214 adult participants (56% men) with intellectual disabilities. Results: In our sample, 25% had no organised day activity, 27% attended non-work day care, 19% attended sheltered employment, or day care with production, without pay and 29% worked in paid sheltered employment. One participant attended mainstream employment. Moderate and severe/profound level of intellectual disability, possible organic condition and irritability significantly reduced the odds of employment (paid and unpaid). Conclusion: Findings suggest unequal access to the sheltered employment that was meant to be inclusive. More individualised evaluation of prerequisites is suggested to further facilitate employment for this group.

The issue of educational work with trauma in juvenile detention centres (JDC) is a less explored area in the Czech Republic, even though the literature points to a higher incidence of trauma among children at risk in this target group. The aim of our research was to determine the extent of adverse childhood experiences among young people in detention centres in the Czech Republic. A quantitative research strategy was applied in the research. The results show that more than 90% of the surveyed adolescents living in JDC had more than one adverse childhood experience (captured in the ACE-Q). In light of the findings, it seems important to pay attention to traumatic experience of youth in JDC and to design comprehensive holistic interventions based on the individual needs of the at-risk youth with traumatic experiences.