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This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4–5, 8–9, 16–17, and 26–27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4–5, 8–9, and 16–17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26–27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. Maternal and child measures were based on maternal reports only. The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children. • We present maternal depressive symptom trajectories over 27 years (1989–2017) • The maternal symptom trajectories were Very Low, Low Stable and High Stable • Low Stable trajectory predicted the best and High Stable the least optimal outcome • Child's problems predicted mother's problems but not her adaptive functioning [ABSTRACT FROM AUTHOR]

Objective: Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income. Methods: A descriptive cross-sectional analysis was performed among youths ages 5–17 years in the 2018–2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists. Results: Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income. Conclusions: The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families. [ABSTRACT FROM AUTHOR]

Purpose: Patient-reported experiences are a key source of information on quality in mental health care. Most patient experience surveys are limited to assessments from adults, including those conducted by parents or proxies on behalf of others. The aim of this study was to produce findings to inform development of modules on patient and parent experiences with medication in outpatient CAMHS in Norway, for use in previously validated instruments applied in national surveys. Patients and methods: We developed survey questions based on a systematic literature review, expert-group consultations, interviews with adolescents and parents, and pretesting of the modules in a pilot study. This study included adolescents aged 12–17 years and parents with experiences from outpatient CAMHS and we present findings from semi-structured interviews. Results: Adolescents with ADHD emphasized the following aspects as important concerning medication use in CAMHS: positive effects of medication like better function and concentration in school and change of behaviour. They also stressed the importance of side effects such as eating problems, nausea, loss of appetite, insomnia, and changes in thoughts and feelings. In addition, adolescents highlighted the significance of aspects as support in daily routines for taking medications, while parents highlighted needs for a professional follow-up care. Parents emphasized aspects regarding their children's medication included both positive effects and change in behaviour, as well as their identification of negative side effects. Conclusion: Our findings from semi-structured interviews identified important aspects reported by both patients and parents on functions, side effects and follow-up care related to medication. The results indicated that both groups emphasized corresponding aspects of what was important regarding medication. However, when it came to follow-up care, the two groups highlighted distinct aspects, indicating differing priorities or concerns in this area. [ABSTRACT FROM AUTHOR]

Background: Children and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population. Objective: This project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services. Participants and setting: We recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4). Methods: This project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops. Results: We identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change. Conclusions: We found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services. [ABSTRACT FROM AUTHOR]

AbstractHigh numbers of children face mental health difficulties in the UK, leading to increased referrals to Child and Adolescent Mental Health Services (CAMHS) which face reduced capacity and increased waiting times. Children’s mental health can deteriorate significantly during this wait for treatment. Safety Nets is an 8-week group intervention for children on CAMHS waiting lists, involving psychoeducation and physical activity co-delivered by clinicians and coaches at local sports clubs. A mixed-methods feasibility study was conducted exploring the impact of Safety Nets. A fully powered trial is now needed to further test for clinical and cost-effectiveness and to support future implementation. [ABSTRACT FROM AUTHOR]

Background: When creating resources, such as psychoeducational materials, for children and families, it is essential to consult all stakeholders. By asking service users what they would find helpful, we can ensure that psychoeducational materials developed are directly addressing a need. This report summarises the process of co-developing a psychoeducational video with young people for the adults in their lives. Methods and results: The idea for a psychoeducational video originated from discussions within a Youth Advisory Group in a South London Child and Adolescent Mental Health Service. The group shared that they wanted a way of letting the adults in their lives know what is and is not helpful to hear when they are experiencing mental health distress. A workshop was held with young people to gather ideas for the content and style of a psychoeducational video resource. Through co-design methods, themes were identified including prioritising the young person's lived experience, the importance of listening, respecting and validating, adults not making assumptions about a diagnosis, and actively involving young people in care planning. A script and accompanying video were produced over several co-design sessions and shared via multiple online mass communication channels. Conclusions: This project was co-produced at all stages by young people with lived experience of mental health difficulties to develop a digital resource that they considered necessary and meaningful. Centring the voices of young people when producing materials concerning their mental health results in valuable resources and can bring autonomy to those involved. [ABSTRACT FROM AUTHOR]

PRACTICE IMPACT STATEMENTUnsupervised technology use by children is increasing rapidly and with it, a common area of crime is emerging: Technology Assisted-Harmful Sexual Behaviour (TA-HSB). Previous research has demonstrated that there are significant differences between adult offenders displaying TA-HSB, offline Harmful Sexual Behaviour (offline HSB) and those displaying both (dual HSB). This study aimed to investigate these differences further within a community adolescent forensic population over a period of four years (1 April 2018 to 31 March 2022). The demographic characteristics and TA-HSB typologies of an adolescent forensic population who were displaying TA-HSB (n = 43), offline HSB (n = 116) and dual HSB (n = 130) were examined. The implications for future research are discussed.This evaluation promotes a greater sense of awareness and knowledge of the characteristics of young people engaging in TA-HSB in a community adolescent forensic service and the incidence and types of TA-HSB they engage in. Findings help develop an understanding of risk formulation, differential needs and support of young people presenting with TA-HSB. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) of mothers have been shown to be associated with children's mental health and behavior problems. It is important to identify effective intervention points to prevent negative consequences among children. This study aimed to investigate whether mothers' education is protective against children's depressive symptoms in families with mothers who experienced parental divorce in childhood. Data from a cross-sectional study of 5th and 8th grade children and their caregivers in a prefecture in Japan were used. Final analytic sample consisted of 9666 child-caregiver pairs. Mediation analyses using inverse odds weighting were performed where the exposure was maternal experience of parental divorce in childhood, outcome was child depressive symptoms, and potential mediators were maternal education beyond high school, maternal mental health, and household income. Maternal experience of parental divorce was associated with an elevated risk of child depressive symptoms (risk ratio: 1.22, 95 % confidence interval (CI): 1.07–1.39). Mediation analyses indicated that the combination of maternal education, maternal depression and household income mediated about half of the total effect. In the model where maternal education was the sole mediator, maternal education mediated nearly half of the total effect (risk ratio: 1.10, 95 % CI: 1.01–1.20). Results should be cautiously interpreted given observational and cross-sectional nature of the data. Maternal education beyond high school may be protective against negative mental health consequences among children due to mothers' experience of parental divorce. Further studies are needed regarding potential mechanisms and the roles of other potential mediators. • Maternal experience of parental divorce was associated with an elevated risk of their children's depressive symptoms. • Maternal education mediated the link between maternal experience of parental divorce and their children's mental health. • Maternal education may be protective against children's depressive symptoms due to mothers' experience of parental divorce. [ABSTRACT FROM AUTHOR]

Purpose: Almost 20% of children and adolescents who attend in mental health centres are witnesses of domestic violence (WDVs). It would therefore be clinically useful to have an appropriate screening instrument for this population, such as the PTSD-CBCL. Our aim here was thus to assess the psychometric properties of relevant tools by determining their internal consistency, sensitivity/specificity, and positive/negative predictive values in our centre's population. Methods: We recruited 194 parents of children aged 4–16 at the Child and Adolescent Mental Health Service of the Hospital Sant Joan de Déu and Els Pins primary school. This sample was divided into: (1) a WDV group (n = 104); (2) an ADHD diagnosis group (n = 28); and (3) a general population (GP) primary school group (n = 62). Results: The PTSD-CBCL total reliability score was high (Cronbach's alpha = 0.87). We found significant mean difference for WDV vs. GP (MD = 8.57; p < 0.001) with significantly higher mean scores in WDV than in GP. We also found significant differences for ADHD vs. GP (MD = 6.91; p < 0.001) with higher mean scores in ADHD than in GP. We observed good discriminatory power indices in the following group comparisons: WDV vs. GP, ADHD vs. GP, WDV vs. ADHD + GP, and GP vs. WDV + ADHD. Nevertheless, the PTSD-CBCL did not discriminate WDV vs. ADHD. Conclusions: Thus, we conclude that the PTSD-CBCL instrument has good discriminatory power in general and clinical populations, and could be implemented in the context of prevention and early intervention after trauma. [ABSTRACT FROM AUTHOR]

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health. [ABSTRACT FROM AUTHOR]

The way parents report their child's emotional and behavioral difficulties is important both for identifying the child's needs, diagnosis, and prevention. This study examined to what extent parents' internal processes predict the way in which parents report their child's emotional and behavioral difficulties on the SDQ, as mediated by parental feelings. Parents of children who were referred to a community mental health clinic completed a self-report questionnaire including the following scales: adulthood attachment style, self-regulation difficulty, personal well-being, self-compassion parental feelings, and their child's emotional-behavioral difficulties. Study findings indicated that parents' internal processes do not directly predict parents' report of their children's mental difficulties on the SDQ, only when mediated by parental feelings. These findings highlight the significance of parental feelings in reporting children's behavioral and emotional difficulties. It also contributes to the body of knowledge concerning the importance of caring for parents' needs and feelings and overall parenthood. [ABSTRACT FROM AUTHOR]

Background: While assisted reproductive technologies (ART) have helped many people experiencing infertility become pregnant, the ART process can take a psychological toll. This study examined whether and how perceived stress- and depression-related symptoms vary among individuals at different stages of the infertility and ART process, and whether ART-specific stressors and emotional support are associated with mental health symptomatology. Methods: Data were collected using an online REDCap survey administered between July 2021 and March 2022. The survey was administered to 240 participants who had experienced infertility, including those who had not yet accessed ART, those undergoing ART but who were not yet pregnant, those currently pregnant through ART, and those who had given birth in the last year through ART. Each participant completed the Cohen Perceived Stress Scale (range 0–40) and the Edinburgh Depression Scale (range 0–30). Participants who had undergone ART were asked about their experience of ART-specific stressors and how helpful partner and provider support had been during the ART process. Survey data were analyzed using ANOVA and multivariate linear regressions. Results: 88% of participants reported medium or high levels of perceived stress, and 43.8% of respondents showed probable indications of depression. Perceived stress and depression symptoms were significantly higher for individuals currently undergoing, but not yet pregnant from, ART treatments. These effect sizes were substantial; for example, depression scores in this group were five points higher than among currently pregnant individuals and nine points higher than among postpartum individuals. For the subset of participants who had used or were currently undergoing ART (N = 221), perceived social stigma and the physical and time demands of ART were significantly associated with higher stress and depression symptoms, while partner emotional support was associated with lower perceived stress. Conclusions: The ART process exacerbates perceived stress and depression symptoms among individuals experiencing infertility. Given the potential long-term impacts on both parent and child wellbeing, clinicians and policymaking groups, including the American Society for Reproductive Medicine (ASRM), should consider making access to mental health services a standard of care during infertility treatment. [ABSTRACT FROM AUTHOR]

This study explored facilitators of and barriers to mental health services for children in foster care in a Southeastern state. We thematically analyzed 10 interviews with foster parents. Throughout the interviews, a wide range of facilitators and barriers that promote the use of mental health services among children in foster care at the child welfare system, children in foster care, foster parents, biological parents, and mental health provider levels, were identified. Findings suggest that all stakeholders must collaborate to address both systemic and individual barriers to improve the use of mental health services among children in foster care. [ABSTRACT FROM AUTHOR]

An art competition was recently organized in Pakistani schools by various mental health organizations and institutions. The competition aimed to raise awareness about mental health among children and adolescents. Art was seen as a transformative medium for promoting mental health awareness, reducing stigma, and fostering understanding and empathy. The competition had two age categories, and participants submitted artwork based on different mental health themes. Winners received certificates and shields, and all contestants received e-certificates. The competition highlighted the power of art in empowering young minds and promoting mental well-being in schools and communities globally. [Extracted from the article]

Background: Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. Methods: This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre's services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals' experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre's operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres' population. Discussion: The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings. [ABSTRACT FROM AUTHOR]

Objective: This study investigated changes in the emotional availability of the parent and the child in the dyadic relationship, parental reflective functioning, and parental perception of the relationship with their child following treatment with an integrated family approach in adult and child mental health care services. The aim of the study was to investigate if an integrated family approach in treatment contributes to good practice in mental health care. Background: Children of parents with a mental disorder are at increased risk for developing mental health problems themselves during lifetime. Infants are extremely vulnerable for environmental influences. Parents with mental disorders are at risk for mis-attuned behavior and non-optimal emotional availability. This increases the risk of adverse cascading effects on the parentchild relationship and child development. A secure parent-child relationship is an important protective factor against the intergenerational transmission of mental disorders. Although treatment of the parental mental disorder is important, it does not automatically change undesirable patterns in the parent-child relationship. Therefore, an integrated family approach to mental health treatment is recommended. Methods: This study involved a mixed methods design using questionnaires, an observation instrument and semi-structured interviews. The variables examined were the quality of the parent-child interaction, the parental perspective on their relationship with the child, their problems with child upbringing, and on their parental reflective functioning. The clinical sample consisted of 50 patients with a variety of mental disorders and their young children. Results: After finishing the integrated treatment the quality of the parent-child interaction had improved significantly. Likewise, we found a significant improvement in parental perception regarding the relationship with the child and the parental role. The majority of the parents interviewed showed that they were better able to mentalize about themselves, their child and their relationship with the child, but the data from the questionnaire showed mixed results regarding parents' reflective functioning. Conclusion: Treatment with an integrated family approach to mental health care in which the parental role of the patient, the young child, and the parent-child relationship are integrated in treatment, can be a valuable addition to the current practice of mental health care in which patients are commonly perceived as individuals. [ABSTRACT FROM AUTHOR]

This article examines the complexities of mourning from a psychodynamic perspective, drawing on the author's clinical experience. It explores how developments in psychoanalytic and psychodynamic thinking, particularly projective identification, can enhance our understanding of Freud's ideas on mourning and bereavement. The concept of destructive superego and persecuting guilt in depression is also discussed. Through real-life examples, the author illustrates the difficulties individuals face in the mourning process and the role of therapy in facilitating healing. The text highlights the impact of unresolved losses on mental health and the challenges therapists encounter when working with patients who are confronting their own mortality. It emphasizes the significance of mourning in therapy and the importance of recognizing the limitations of therapy for both therapist and client. [Extracted from the article]

Dr. June Tuma is a pioneer in clinical child and adolescent psychology and pediatric psychology. She made significant contributions to establishing training standards and professional competencies for clinical child psychologists. Dr. Tuma served as the President of the Section on Clinical Child Psychology of the American Psychological Association and was one of the early leaders of the Society of Pediatric Psychology. She played a crucial role in organizing the Hilton Head Conference in 1985, which defined training standards and competencies in clinical child psychology. Her research and advocacy efforts have had a lasting impact on the field, shaping the training, practice, and professional identity of clinical child psychologists. [Extracted from the article]

Conflict-affected youth are at risk for poor psychological and social outcomes, yet few receive mental health services. Strategies to expand access and sustain evidence-based interventions (EBIs) across novel delivery platforms must be tested. The present study was a hybrid type II implementation-effectiveness trial using a cluster randomized design. The primary goal was to evaluate feasibility and impact of using the collaborative team approach to deliver the Youth Readiness Intervention (YRI), an EBI, integrated into a youth entrepreneurship program (ENTR) with quality control in post-conflict Sierra Leone. Youth were screened and randomly assigned to control, ENTR, or combined YRI and ENTR (YRI+ENTR). Implementation outcomes were dissemination and implementation indicators, competence, and fidelity. Effectiveness outcomes were emotion regulation, psychological distress, and interpersonal functioning. Secondary outcomes were third-party reporter assessments of youth functioning and behavior. Data were collected and analyzed from 1,151 youth participants and 528 third-party reporters. Scores on implementation constructs, competence, and fidelity demonstrated acceptable intervention response and quality. YRI+ENTR participants showed overall improvements in depression (β = −.081, 95% CI −0.124 to −0.038, d = −0.154) and anxiety (β = −.043, 95% CI −0.091 to −0.005, d = 0.082) symptoms compared with control participants. Community leaders indicated that YRI+ENTR participants demonstrated improvements in overall work or training performance compared with control participants (β = −.114, 95% CI 0.004 to 0.232, d = 0.374). Integration of EBIs such as the YRI into youth employment programs has the potential to address limited reach of EBIs in conflict and post-conflict settings. A collaborative team implementation approach can facilitate integration and fidelity. In a Hybrid Type-II Implementation-Effectiveness trial conducted in Sierra Leone, researchers tested a Collaborative Team Approach (CTA) for delivering an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), within a youth entrepreneurship program. A total of 1,151 youth participated in the study, with outcomes measured on youth mental health indicators of emotional regulation, psychological distress, and interpersonal functioning, as well as implementation indicators, competence, and fidelity. Results demonstrated that the integrated YRI and entrepreneurship program led to significant improvements in depression and anxiety symptoms compared to the control group. Community leaders also noted enhanced overall performance in YRI participants, suggesting that integrating evidence-based interventions into youth employment programs can effectively address mental health challenges in low-resource regions. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science. Youth FORWARD Phase 2 YRI and EPP Study; https://clinicaltrials.gov/ ; NCT03542500. Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD): Study Protocol; https://doi.org/10.1176/appi.ps.202000009. [ABSTRACT FROM AUTHOR]

Aim: Remethylation disorders such as 5,10-methylenetetrahydrofolate reductase (MTHFR) deficiency reduce the remethylation of homocysteine to methionine. The resulting hyperhomocysteinemia can lead to serious neurological consequences and multisystem toxicity. The role of MTHFR genotypes has not been investigated in patients with Rett Syndrome (RTT). In this study, we sought to assess the impact of co-occurring MTHFR genotypes on symptom profiles in RTT. Method: Using pharmacogenomic (PGx) testing, the MTHFR genetic polymorphisms rs1801133 (c.665C>T mutation) and rs1801131 (c.1286A>C mutation) were determined in 65 patients (18.7 years ± 12.1 [mean ± standard deviation]) with RTT as part of routine clinical care within the Centre for Interventional Paediatric Psychopharmacology (CIPP) Rett Centre, a National and Specialist Child and Adolescent Mental Health Service (CAMHS) in the UK. The clinical severity of patients was assessed using the RTT-anchored Clinical Global Impression Scale (RTT-CGI). Results: The clinical severity symptom distribution varied between the homozygous and heterozygous MTHFR rs1801133 and rs1801131 genotypes. Those with the homozygous genotype had a narrower spread of severity scores across several domains (language and communication, ambulation, hand-use and eye contact clinical domains). Patients with the homozygous genotype had statistically significantly greater CGI-Severity scores than individuals with a non-homozygous MTHFR genotype (Z = −2.44, p = 0.015). When comparing the ratings of moderately impaired (4), markedly impaired (5), severely impaired (6) and extremely impaired (7), individuals with the homozygous MTHFR genotype were more impaired than those with the non-homozygous MTHFR genotype (Z = −2.06, p = 0.039). There was no statistically significant difference in the number of prescribed anti-epileptic drugs between the genotypes. Conclusions: Our findings show that in those with a pathogenic RTT genetic variant, co-occurring homozygotic MTHFR rs1801133 and rs1801131 polymorphisms may act as associative genetic modifiers of clinical severity in a subset of patients. Profiling of rs1801133 and rs1801131 in RTT may therefore be useful, especially for high-risk patients who may be at the most risk from symptom deterioration. [ABSTRACT FROM AUTHOR]

This article discusses the need to expand access to home-based behavioral health services (HBHS) for children in foster care. It highlights the case of Rosie D., who experienced multiple foster care placements and hospitalizations due to her behavioral health needs. The article emphasizes the importance of providing HBHS to children in foster care to prevent unnecessary hospital stays and improve outcomes. It also mentions the variation in HBHS utilization among different states and calls for research, data collection, and policy reforms to address barriers to accessing HBHS for children in foster care. [Extracted from the article]

Objectives Methods Results Conclusions Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems – depression and anxiety – via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies.We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK ‘Talking Therapies’ services. We examined socio‐demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis.A 2‐item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long‐term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk.Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully. [ABSTRACT FROM AUTHOR]

Objective: The overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received. Methods: We adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques. Results: Three prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery. Conclusions and implications for practice: These findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population. [ABSTRACT FROM AUTHOR]

The article discusses the issue of protecting and providing mental healthcare for affluent children who are in conflict with the law. It highlights two specific cases in India, the Nirbhaya case and the Pune Porsche case, which generated public outrage and raised questions about the treatment of child offenders. The article explores the complexities of balancing child rights and public safety, particularly in cases involving social class, wealth, and privilege. It emphasizes the need for mental health professionals to maintain a scientific and professional perspective in order to provide effective interventions for children and families in such situations. The article also examines the vulnerabilities and risks faced by affluent children, including neglect, substance use, and mental health issues. It calls for a re-examination of notions of vulnerability and a restorative approach to holding individuals accountable for their actions. [Extracted from the article]

Consultation between mental health professionals and other professionals working with young people can bring together multiple agencies to ensure young people are appropriately supported and referred to specialist care where needed. The aim of this research is to explore the consultation and liaison model of support for young people who are at high risk of engaging in harmful behaviors (e.g., harm to self and others), through the experiences of professionals liaising with specialist Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Interviews with referring professionals (N = 34, from 34 services) were analyzed thematically, themes focused on referrer experiences; impact on the network; and impact on young people and their parents/carers. The combination of forensic mental health expertise in risk assessment and management, with the ability to provide overarching and indirect support to the network is fundamental to the model. Community F:CAMHS' capacity to manage anxiety in the professional network is likely helped by the one-step-removed position afforded in the consultative role. Adopting a position of authority led to clearer, more co-ordinated and more robust risk management plans. Consideration could be given to adopting the model when working with referrals involving multiple agencies and high levels of anxiety within the network. [ABSTRACT FROM AUTHOR]

The association was investigated between healthcare practitioners' actions of routinely identifying children of adults with mental illness by asking whether they have children under the age of 18 and practitioners' perspectives and practices regarding supporting parents and their children. The factors that contribute to practitioners' such routine identification were also determined. A cross-sectional nationwide survey was conducted using an anonymous self-report questionnaire among Japanese healthcare practitioners. The responses (84.7% were nurses) from 1138 participants were analysed. More than half of the participants (73.7%) routinely identified whether adults with mental illness had children. Participants who routinely identified children also provided more support to children and to the client regarding his or her parenting. Three factors were found to contribute to the participants' routine identification of children: (1) recognising 'difficulty with parenting' as a reason why support for children is necessary; (2) 'assessing parenting status when supporting a parent with a mental illness' and (3) realising that participants 'do not know how to provide support' as a reason why support for children is difficult. Providing education to practitioners regarding supporting children whose parents have a mental illness will help increase the routine identification of children in mental health services. [ABSTRACT FROM AUTHOR]

Background: Single parenthood is becoming increasingly common in today's society for various reasons such as divorce, the death of a spouse, or the choice of parenthood. Regrettably, there seems to be no significant concern among world leaders regarding depression arising from single parenting. Aim: This article aimed to explore the prevalence of depression in single parents, the factors contributing to it, and its effects on their physical and emotional well‐being. Additionally, it aims to investigate the long‐lasting effects of depression in single parents, effective therapeutic approaches to tackle these issues and offer proactive suggestions for relevant global stakeholders. Methodology: A selection of studies was identified through electronic databases such as PubMed, Embase, and PsycINFO databases. The search strategy encompassed terms related to single parenthood, depression, mental health, prevalence, risk factors, and treatment modalities. Included studies comprised of peer‐reviewed research articles, systematic reviews, meta‐analyses, and observational studies published in English. Result: Today, there is a growing prevalence of single parenthood due to a range of factors, including divorce, the loss of a partner, and intentional decisions regarding single parenthood. However, this transition comes with challenges, including the risk of developing depression. Depression is a serious mental health condition affecting many individuals worldwide. Raising a child alone increases the likelihood of developing depression for the parent due to the increased burden and responsibilities. Such parents tend to have low self‐esteem, suicide/suicide attempts, and so forth and children born by those parents are vulnerable to depression, physical abuse, infections, etc. Conclusion: Future research should focus on identifying effective interventions for treating depression among single parents and improving the availability of mental health facilities for this vulnerable population, especially in places with a high prevalence of depression. Mental health physicians in collaboration with obstetricians and gynecologists across the globe should offer counseling and mediation services during pre‐conception care visits for both single and partnered parents. [ABSTRACT FROM AUTHOR]

Objective: Although patients with systemic lupus erythematosus (SLE) experience high levels of depression and anxiety disorders, evidence concerning patient perceptions of facilitators and barriers to effective uptake of mental health services (eg, referral to therapists and psychiatrists, psychoeducational interventions, or support groups) is limited. Methods: We conducted semistructured qualitative interviews with 15 adults with SLE to explore patient experiences and perceptions of mental health services to identify facilitators and barriers to accessing mental health care among patients with SLE. Qualitative interviews were conducted via telephone and audio recorded for transcription and directed content analysis using NVivo software by two coders. Results: The median age of the 15 participants was 48 years, 87% were female, 33% identified as Black or African American, and 33% identified as Hispanic or Latino. Qualitative themes were organized into three domains: barriers, facilitators, and preferences for mental health services. Barriers to the use of mental health services include mental health stigma, sociodemographic factors, lack of autonomy, and time commitment. Facilitators to the use of mental health services included strong relationships with their rheumatologists and mental health care clinician experience with patients with SLE. Preferences for mental health services included education‐based formats, mental health providers who work with patients with SLE, peer group formats, demographically and disease‐matched psychological resources, and an emphasis on non–disease‐related activities. Conclusion: In the setting of persistent unmet psychosocial needs of patients living with SLE, data from this qualitative study will inform the development and refinement of mental health interventions that bolster psychological wellbeing in the SLE population. [ABSTRACT FROM AUTHOR]

This article explores the impact of climate change on children's mental health, specifically focusing on the increased rates of post-traumatic stress disorder, anxiety, and depression in children exposed to climate-related disasters. It emphasizes the need for a comprehensive approach to climate change education that includes mental health considerations and addresses social inequalities. The article suggests actions such as empowering education, bridging the gap in climate change education, building resilience, investing in accessible mental health care, and fostering open communication about climate change with children. It also highlights the role of communities, schools, and environmental organizations in supporting children's mental health and fostering a sense of connection to nature. By involving children in environmental projects and giving them a voice, schools and communities can help them feel empowered and hopeful, ultimately benefiting their mental well-being and contributing to a brighter future for the planet. [Extracted from the article]

Background: Many parents report the transition from hospital to home as challenging after the birth of a preterm-born child. This study investigates parental perceptions of community-based follow-up services after hospital discharge, alterations in parental self-efficacy during the early months at home, the prevalence of depressive symptoms among parents, and the relationship between these factors and both NICU experiences and children's regulative behaviors. Methods: In this second phase of a descriptive study, 110 parents returned a digital questionnaire when their child was four months corrected for prematurity. Parents were recruited while hospitalized with their child, in one of eight Norwegian neonatal intensive care units (NICUs). Thus, the study provides insight into follow-up services across a broad geographical range. Parents' perception of self-efficacy was reported on the Karitane Parenting Confidence Scale, and depressive symptoms were evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Children's regulative behavior was reported on the 6-month version of the Ages and Stages Questionnaire: Social and Emotional (ASQ: SE). Using SPSS, associations between variables were investigated in multiple regression analysis in addition to descriptive analysis. Additionally, the examination of repeated measures of parental self-efficacy involved the application of linear mixed models. Results: Parents reported improved perception of self-efficacy from postdischarge to the children's age of four months (F (1,167) = 1233.2, p < 0.001). On average, fathers' self-efficacy improved more than that of mothers. Parents' perception of being well informed prior to discharge from hospital predicted improved self-efficacy (F [1, 29] = 10.4, p = 0.003). Reports of depressive symptoms were at a similar level as previously reported among new parents, as 10.4% of mothers and 6.7% of fathers reported EPDS scores ≥ 10 points. Parents' reports on ASQ: SE show that 15% of the children scored above the recommended cutoff score for three- to nine-month-old children. The parent-reported benefit of follow-up services showed considerable variation. The importance of specific knowledge about prematurity among public health nurses and physicians was frequently mentioned, and public health nurses were perceived as coordinators and mediators of various services. Conclusions: Parents reported improved self-efficacy, and depressive symptoms at similar levels as new parents in general, a few months after discharge from hospital. Childrens' regulatory behavior were reported at levels comparable with term-born infants. [ABSTRACT FROM AUTHOR]

Background: Videoconferencing is considered an alternative to face-to-face consultations and a possibility to help overcome access-to-care barriers in mental health care services. Barriers to child and adolescent mental health services are particularly apparent in the case of children and adolescents receiving child welfare services. This scoping review aims to provide an overview of research on videoconferencing in the mental health treatment of children and adolescents receiving support from child welfare services. Methods: This scoping review follows the review framework outlined by the Joanna Briggs Institute. The following databases were searched from January 2012 to April 2024: Scopus, Web of Science, PubMed, PsycINFO (Ovid), CINAHL Plus, Social Services Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Google Scholar. Results: The search yielded 4322 unique records and resulted in the inclusion of 22 articles that met the inclusion criteria. The studies originated from Denmark, England, Australia, Norway, Canada, Chile, and the USA, and were grouped into four areas: (1) videoconferencing to increase access to mental health treatment for vulnerable groups (2) young people's perspectives (3) videoconferencing in interdisciplinary collaborative meetings, and (4) use, awareness, and acceptance of videoconferencing among health and social care providers. Conclusions: This scoping review shows that if videoconferencing in mental health care is to become an established and trusted method aimed at children and adolescents receiving child welfare services, several unresolved and potentially negative issues need attention and more research. This particularly applies to whether videoconferencing decreases or exacerbates inequalities in access to mental health services. A further question is whether new barriers are raised by screen-based treatment to threaten good therapeutic relationships, and by extension treatment quality and clinical outcomes. [ABSTRACT FROM AUTHOR]

Risk factors for psychological distress among help-seeking youth are poorly understood. Addressing this gap is important for informing mental health service provision. This study aimed to identify risk factors among youth attending Jigsaw, a youth mental health service in Ireland. Routine data were collected from N = 9,673 youth who engaged with Jigsaw (Mean age = 16.9 years, SD = 3.14), including presenting issues, levels of psychological distress, age, and gender. Confirmatory Factor Analysis identified thirteen factors of clustering issues. Several factors, including Self-criticism and Negative Thoughts, were strongly associated with items clustering as psychological distress, however these factors were poorly predictive of distress as measured by the CORE (YP-CORE: R2 = 14.7%, CORE-10: R2 = 6.9%). The findings provide insight into associations between young people's identified presenting issues and self-identified distress. Implications include applying appropriate therapeutic modalities to focus on risk factors and informing routine outcome measurement in integrated youth mental health services. [ABSTRACT FROM AUTHOR]

The nature and the complex intermingling of the difficulties encountered by Inuit youth calls for a close collaboration between health and social professionals from different fields, the families of youth and their communities. Promising practices within Indigenous communities are described as being collaborative, community-driven and culturally grounded. Ideally most professionals would be of Indigenous heritage, and families would have access to Indigenous healing approaches if desired. Despite the documented importance of collaboration and self-determination of services, very little is known regarding how collaboration takes place in Indigenous communities, and what the facilitators and barriers to collaboration may be. This paper presents results from a study that took place in Nunavik Quebec between 2014 and 2015 and is based on qualitative interviews conducted with 42 key informants including community workers, social workers, doctors, teachers, family members and more. Using a combination of network and qualitative analyses, we explore the principal characteristics of health and social networks in child and youth mental health in Nunavik, Québec. Our findings show that while collaboration is desired by all participants, at the time of the interviews, non-Inuit and institutional actors were more central in collaborations than informal and community ressources, even if they were considered essential elements in service delivery. Participants spoke of many ways to foster collaboration; however, our project shows that collaboration is often hindered by structural and colonial challenges. [ABSTRACT FROM AUTHOR]

Background: This paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS). Method: This retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019–14 March 2020), pandemic (15 March 2020–14 March 2021), and post-pandemic (15 March 2021–14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic. Results: The results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%–98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful. Conclusions: The study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access. [ABSTRACT FROM AUTHOR]

Suicide in children is a significant and growing problem. The "zero suicide" framework (ZSF) is one approach to suicide prevention used in health services for adults and children. This paper reports on the introduction of the first suicide prevention pathway (SPP) based on ZSF at a Child and Youth Mental Health Service (CYMHS) in Australia. It begins by describing the adaptations made to elements of the SPP originally designed for adults to meet the needs of children. Lessons learned in applying the SPP in the service are then discussed. The aim is to inform and improve practice in the use of zero suicide approaches in child and youth mental health settings in Australia and worldwide. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic resulted in dramatic changes to social interaction and service access. The effect of this on the mental health of children and young people with acquired brain injuries (ABI) remains relatively unexplored. Nineteen parents of children and young people with ABIs (one parent of each child, representing 19 children) completed questionnaires on service access and the mental health of their children. Three parent-child dyads (n=6 participants) also completed semi-structured interviews. Results revealed children and young people with ABI experienced greater peer problems and emotional problems than those without an ABI during Covid-19. Interviews found that parents felt unsupported with their children's education and they experienced isolation. This study shows the mental health risk of social isolation for this population but also explores what positives can be learned from the Covid-19 pandemic such as, the benefits of a less demanding learning environment and online/in-person hybrid service delivery. [ABSTRACT FROM AUTHOR]

Background: serious emotional and behavioral problems in children/adolescents can be identified by informants through screening instruments, which can increase their chances of receiving care in mental health services. Objectives: verify and compare serious emotional and behavioral problems in elementary school students depending on school type and correlate these problems with the use of mental health services. Method: observational cross-sectional study with a convenience sample composed of 357 children and adolescents between 6 and 12 years old without mental health complaints, from public and private schools. Instruments: Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and questionnaire for use of mental health services. To identify serious emotional and behavioral problems, critical items from the behavioral problem syndrome scales and scales guided by the CBCL/6-18 DSM were used. Results: different types of serious emotional and behavioral problems were identified using critical items, such as physically attacking other people (16.5%), saying they are going to kill themselves (5.6%), seeing things that don't exist (3, 9%), setting things on fire (7.9%) and hearing sounds or voices that don't exist (2.8%). Bivariate analysis showed that, despite the frequency of these serious emotional and behavioral problems, the use of mental health services was extremely low (0.84%). Conclusion: the critical items of the CBCL/6-18 help to screen for serious emotional and behavioral difficulties that can negatively impact the mental health of children/adolescents. The lack of parental recognition of serious mental health problems still demands theoretical and empirical deepening. [ABSTRACT FROM AUTHOR]

This paper assesses the effects of adverse economic shocks on children's mental health. We rely on the Brazilian High-Risk Cohort Study for mental conditions, which provides an unprecedented array of data on psychopathology, life events, family medical history as well as parental behaviour and polygenic scores for mental disorders over a ten-year period. Our empirical strategy exploits parental job loss events over time in a difference-in-differences framework. We document that parental job loss significantly worsens children's mental health, resulting in increased clinical diagnoses of mental disorders. These results are robust to several specifications and pre-trends. Heterogeneous results and mechanism analysis indicate that psychological distress in the household brought about by job loss events may be a key mechanism affecting children's mental health. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the Pro Kind program, a German adaptation of the US Nurse Family Partnership (NFP) home visiting program. The study found that the program had positive effects on cognitive development, mother-child interactions, and maternal investments. It also showed that the program had persistent effects on mental health disorders, particularly when a single home visitor (a midwife) interacted with the families. The study suggests that the effectiveness of the program may be due to differences in qualifications, the content of home visits, and the establishment of a trusting relationship with the home visitor. These findings have implications for the prevention of mental disorders and the design of public health programs. [Extracted from the article]

The article "Spillovers and Training Effects on Mental Health Prescribing for Children" examines the prescribing practices of individual physicians for mental health medications in children. The study analyzes data on prescriptions filled at retail pharmacies and finds significant variation in treatment practices, with some prescriptions raising concerns. The study emphasizes the need to understand the sources of this variation to improve patient outcomes. The article also discusses a statistical model used to analyze prescribing behavior, which considers factors such as doctor training and spillover effects from other doctors in the same area. The results show that individual doctors have their own prescribing styles and that spillover effects from other doctors play a role, particularly for nonpsychiatrists. The study highlights the importance of further research to understand these spillover effects. [Extracted from the article]

This paper describes the practice of an integrated family approach to treatment in mental health care in which the focus is on the whole family and treatment is carried out by professionals of adult and child mental health services together. It is presented as an example of a best practice in finding a way to overcome barriers in implementing an integrated family approach in treatment for the benefit of families with a variety of interrelated problems. Even though there is a lot of knowledge about the importance of a family approach in mental health care with specific attention to the patients’ parental role, the children, family relationships, and the social economic context, this is worldwide rarely implemented in the practice of mental health care. Barriers to keep the whole family in mind are identified on different levels: organizational policy, interagency collaboration, professionals, and patients themselves. As a solution, a model of an integrated family approach in mental health care is presented: how it is defined; which domains in the family are targeted; which key elements it contains; what the treatment consists of; and which procedures are followed in practice. A case illustrates how this approach might work in practice. [ABSTRACT FROM AUTHOR]

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), selfesteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services. [ABSTRACT FROM AUTHOR]

Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models' internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the association between user satisfaction and clinical outcomes with child and adolescent mental health services (CAMHS) from the perspective of young people and their parents. The evidence bases for CAMHS user satisfaction measures are limited, with few studies investigating the link between user satisfaction and clinical outcomes. In particular, the perspectives of young people are missing. Methods: The parent and youth versions of the Experience of Service Questionnaire (ESQ), which evaluates the factors of general satisfaction (GS), satisfaction with care (SWC) and satisfaction with environment (SWE), were used to measure user satisfaction. The outcome measures were scores on the Strengths and Difficulties Questionnaire (SDQ), Children's Global Assessment Scale (CGAS), and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Hierarchical regression analysis was conducted on data collected from 233 young people and 495 parents who utilized CAMHS services. Results: GS and SWC predicted outcomes for both young people (ΔR2 = 0.08, p <.05) and parents (ΔR2 = 0.01, p <.05), indicating that user satisfaction had a significant impact on clinical outcomes for CAMHS users. In addition, GS and SWC significantly predicted young people-reported outcomes in the interaction model (ΔR2 = 0.10, p <.05), while no significant association was found with parent-reported outcomes (ΔR2 = 0.02, p =.09). Conclusion: User satisfaction, particularly for young people, has a significant impact on clinical outcomes. The causal relationship between user satisfaction and mental health outcomes requires further study. [ABSTRACT FROM AUTHOR]

Introduction: When parents of dependent children are treated in psychiatric inpatient hospital, it typically involves separation of parent and child for the duration of treatment, which can be highly distressing to the dyad and can result in disruption to the parent-child relationship. Parents who have experienced hospitalisation have expressed a desire for their parenting identity to be recognized and appropriately engaged with during their treatment. This recognition includes provision of interventions which support them as parents to limit the impact of their mental health on their children. The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. Methods: The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. This project involved the adaptation and extension of a prior parentingfocused course for parents high in anxiety to meet the needs of parents being treated in inpatient settings. In the first two stages of the three-phase project, patients, carers and mental health practitioners contributed to the revision and delivery plan for the course including developing new content for the intervention. In the final stage, which took the form of a participatory evaluation, the intervention was delivered to 11 parents receiving inpatient treatment who then provided extensive feedback. A series of iterative adaptations to the intervention were made in response to this feedback alongside stakeholder input. Results: The final intervention comprises five modules focused on exploring the experience of parents alongside specific learning and skills orientated toward boosting their connection with their children during hospitalisation and in readiness for discharge. Preliminary feedback from patients and ward staff has been positive and the process of delivering the project on inpatient wards was associated with no increase in negative clinical outcomes. Discussion: The successful development of a targeted intervention within inpatient psychiatric units offers a signal that parents treated in this setting welcome the opportunity to be supported in their parenting role. As the first known UK intervention of its kind to be developed in partnership with patients, ward staff and management, it is specifically tailored to the context and needs of this group with the potential to be delivered by a range of health professionals in this setting. [ABSTRACT FROM AUTHOR]

Background: Globally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15–19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,. Method(s): The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis. Results: The findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners. Conclusions: Stress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system. [ABSTRACT FROM AUTHOR]

Introduction: The Patient Journey Project aimed to analyze the scenario among Italian Mental Health Services (MHS) to understand the clinical interventions that are properly implemented and the ones deserving further implementation to design an effective treatment plan for patients living with schizophrenia (PLWS). Methods: The 60-items survey was co-designed with all the stakeholders (clinicians, expert patients and caregivers) involved in the Patient Journey and focused on three phases of schizophrenia course: early detection and management, acute phase management, long-term management/continuity of care. Respondents were Heads of the Mental Health Departments and Addiction Services (MHDAS) or facilities directors throughout Italian MHS. For each statement, respondents expressed the consensus on the importance and the degree of implementation in clinical practice. Results: Considering the importance of the statement, strong consensus was reached for most of the statements. Good levels of implementation were found on 2/17 statements of early detection and management, on 3/16 statements for acute phase management and on 1/27 statements of long-term management/continuity of care. Poor levels of implementation were found on 1/17 statements of early detection and management, none of acute phase management, and 4/27 statements for long-term management/continuity of care. Moderate levels of implementation were found on 14/17 statements for early detection and management, on 13/16 statements of acute phase management, and on 22/27 statements of long-term management/continuity of care. Thus, among Italian MHDAS, most interventions for PLWS were moderately implemented in clinical practice. Discussion: Italian MHS have to provide new strategies and structural actions to overcome these current limitations and barriers to effectively improve the journey of PLWS. The areas that deserve most implementation include interventions during the early stage (especially the continuity of care between Child and Adolescent Mental Health Services and Adult Mental Health Services), the evidence-based psychosocial interventions during the chronic stages of the disorder, and the continuity of care after acute hospitalization. [ABSTRACT FROM AUTHOR]

Background: Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings. Methods: A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up. Results: FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant postintervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included. Conclusion: The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere. [ABSTRACT FROM AUTHOR]