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Background: Since the mid-20th century, mental illness has become a leading cause of health burden, particularly among adolescents and emerging adults, with most disorders emerging before the age of 25. Over the past two decades, mental ill health has surged to alarming levels, with evidence confirming that the increase is not just due to better awareness or diagnosis but reflects a genuine public health crisis. Study design/method: We explore the evolving landscape of youth mental health and its contributing factors, including family dynamics, educational pressures, climate change, social media, and socio-economic challenges, potentially linked to neoliberal policies. A narrative review methodology was employed to analyze these factors and their role in the trends of mental ill-health among young people. Study results: We document mental health trends since the mid-1990s, focusing on mental and substance use disorders among young people and their current needs. Potential new explanatory factors and megatrends, potentially flowing from a paradigm shift in the global political economy which has largely passed under the radar, yet which has produced fragmentation and inequality, are identified, with the COVID-19 pandemic further intensifying these trends. We discuss methodologies to estimate the contribution of these megatrends and outline potential barriers to implementation, along with strategies to overcome them. Conclusion: This review calls for a comprehensive global action plan, emphasizing prevention, early intervention, and improved treatment strategies. In addition to strengthening prevention, which may take time and be elusive, immediate action is needed to innovate and expand services, which are currently under-resourced and overwhelmed. [ABSTRACT FROM AUTHOR]

Objective: As highlighted in Australia's Productivity Commission Inquiry into mental health, subgroups of individuals are failing to have their needs met, or are 'falling through the cracks' in the current system – a phenomenon increasingly referred to as the 'missing middle'. A barrier to devising solutions is that the term 'missing middle' is not clearly defined. Using the Delphi method, we aimed to define the term and explore acceptability. Method: Three expert groups were recruited: carers and young people with a lived experience of mental ill-health; clinicians and service providers; researchers, policymakers and commissioners of mental health services. Using a three-stage Delphi process, we elicited definitions, refined and developed a consensus definition. Results: Ten subthemes describing the 'missing middle' were identified, with four endorsed across all expert groups from the outset: service gap, inflexibility, inadequate service quality and duration, and social disadvantage. Additional subthemes were later endorsed. Feedback was sought on a consensus-driven definition that encompassed the original four endorsed subthemes. Findings supported a shift to a systemic focus – framing the 'missing middle' as a care gap. Conclusions: A consensus definition was developed, repositioning the term to a systems lens, describing a 'missing middle service gap'. The definition represents the 'missing middle' as a term to describe a gap in care where existing mental health services are not meeting the needs of individuals in a meaningful way. Research was carried out in relation to youth mental health in Australia and the definition may need to be adapted for other contexts. [ABSTRACT FROM AUTHOR]

Aims: Most lifetime mental health disorders begin by age 25 years, and the prevalence among young people has been increasing over recent years. We sought to understand what impact, if any, social determinants have had on this increase through the analysis of an Australian longitudinal dataset (with data from 2007 to 2021). Methods: The analysis focused on five social determinants: loneliness and lack of social support, family relationships, participation in education and employment, receipt of government benefits and relative socio-economic status. We analysed cross-sectional changes in self-reported psychological distress between 2007 and 2021 (using the Kessler-10 item; K10 scores) and examined the effects of these five social determinants on psychological distress using weighted linear regression models. Results: We identified a significant increase in psychological distress among Australians from 2007 to 2021, with the sharpest rise among those aged 15 to 25 years, who saw more than doubling in the percentage of high and very high K10. This period also saw an increase in the prevalence of social determinants such as loneliness and lack of social support, as well as poor family relationships, particularly in 2021 post COVID-19 pandemic. Regression models suggest loneliness and lack of social support had the most pronounced and increasing impact on psychological distress, followed by poor family relationships. Discussion: The observed significant and steady increases in psychological distress and related social determinant factors, particularly loneliness and lack of social support among young people, highlight the urgent need for comprehensive actions. Coordinated research and community-based initiatives are needed to deliver intrapersonal, interpersonal and socially-focused interventions with a holistic approach to support psychosocial wellbeing. Policymakers must adopt a comprehensive shift in political commitment and a whole-of-government approach to address these challenges. [ABSTRACT FROM AUTHOR]

Objective: This article provides researchers with an illustrative guide for a workshop model that facilitates evidence-informed policy. The Policy Lab model supports collaboration between experts and policymakers; in the example provided, participants considered digital technologies with near-term potential to improve youth mental health care. Method: The Policy Lab model uses structured workshop activities to explore a policy question, before narrowing the focus on potential answers. The barriers, enablers, and implementation mechanisms of potential policies are then considered. From this data policy proposal(s) are drafted, reviewed, and reported. Results: Through the Policy Lab activities, participants identified two priority technologies and generated data to inform the formulation of two policies. The policies were focused on (1) using artificial intelligence to improve the personalisation and precision of youth mental health care and (2) the expanded use of integrated data to improve youth mental health service quality. Conclusions: Evidence-informed policy is a collaborative process. To potentially influence policy requires timely engagement with policymakers and an understanding of the policy context. Researchers considering using the model are encouraged to include a range of expertise. What is known about the topic? Guidance on how researchers can influence policy is broad, tending to focus on communicating with policy audiences, rather than how to engage policy professionals. While the term evidence-based policy implies that researchers will have access to policymakers, in reality they have limited engagement with evidence, relying instead on briefs from advisers and policy professionals. What does this paper add? This paper provides an illustrative guide for a workshop model that facilitates evidence-informed policy. What are the implications for practitioners? Understanding what policy professionals require and when best to engage with the policy process will maximise the role researchers and other experts can have on informing policy. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Hazelwood Health Study was set up to study long‐term health effects of a mine fire that blanketed residents of the Latrobe Valley with smoke for 45 days in 2014. The Respiratory Stream specifically assessed the impact of fine particulate matter <2.5 μm diameter (PM2.5) exposure from mine fire smoke on lung health. The multiple breath nitrogen washout (MBW) test assesses ventilation heterogeneity, which may detect sub‐clinical airways dysfunction not identified using standard tests such as spirometry. This analysis assessed the association of PM2.5 exposure with measures of ventilation heterogeneity. Methods: Exposed (Morwell) and unexposed (Sale) participants were recruited 3.5–4 years after the fire from those who had participated in an Adult Survey. MBW was performed to measure lung clearance index (LCI), functional residual capacity (FRC), acinar (Sacin) and conductive (Scond) ventilation heterogeneity. PM2.5 exposure was estimated with emission and chemical transport models. Multivariable linear regression models were fitted controlling for confounders. Results: We recruited 519 participants. MBW tests were conducted on 504 participants with 479 acceptable test results (40% male; 313 exposed, 166 unexposed). Exposure to mine fire‐related PM2.5 was associated with increasing Scond (β = 1.57/kL, 95%CI: 0.20–2.95, p = 0.025), which was comparable to the estimated effect on Scond of 4.7 years of aging. No other MBW outcomes were statistically different. Conclusion: Increasing exposure to PM2.5 was associated with increased ventilation heterogeneity in the conductive region of the lungs 4 years after the event. [ABSTRACT FROM AUTHOR]

Introduction Climate change continues to increase the occurrence and severity of natural hazards, such as heatwaves and landscape fires. (1) Fires affecting ground deposits of peat and coal are especially [...], Background: Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain. Objective: Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care. Methods: We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012-2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5 [micro]m (P[M.sub.2.5]) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient P[M.sub.2.5] and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children. Results: Prenatal exposure to fire-related P[M.sub.2.5] was associated with ED presentations for allergies/skin rash [odds ratio (OR) = 1.34, 95% confidence interval (CI): 1.01, 1.76 per 240[micro]g/[m.sup.3] increase]. Exposure in utero to ambient P[M.sub.2.5] was associated with overall presentations (OR= 1.18, 95% CI: 1.05, 1.33 per 1.4 [micro]g/[m.sup.3]) and visits for infections (ED: OR = 1.13, 95% CI: 0.98, 1.29; hospitalizations: OR = 1.23, 95% CI: 1.00, 1.52). Exposure in infancy to fire-related P[M.sub.2.5] compared to no/minimal exposure, was associated with ED presentations for respiratory (OR = 1.37, 95% CI: 1.05, 1.80) and infectious conditions (any: OR = 1.21, 95% CI: 0.98, 1.49; respiratory-related: OR= 1.39, 95% CI: 1.05, 1.83). Early life exposure to ambient P[M.sub.2.5] was associated with overall ED visits (OR = 1.17, 95% CI: 1.05, 1.30 per 1.4 [micro]g/[m.sup.3] increase). Discussion: Higher episodic and lower ambient concentrations of P[M.sub.2.5] in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. https://doi.org/10.1289/EHP12238

There are concerns that the field of sport and exercise psychology is limited by insufficient consideration for the demographic, socioeconomic and cultural identities and experiences of participants. This study specifically quantified gender balance among sport and exercise psychology samples for the very first time. Articles published within five leading journals in the field across three separate years (2010, 2015, 2020) were included. Across the 627 studies, data were collected from 258,160 participants. Of these, 138,133 were men/boys (54%), 119,398 were women/girls (46%), and 629 were non-binary or not reported (0.2%; 432 not reported, 197 identified as non-binary or another gender). We demonstrated that studies which focused on sport – rather than exercise – psychology, significantly under-represented women/girls. Specifically, the OR for sport as compared to exercise, was 4.94 (95% CI = 3.19–7.64, p <.001), suggesting a markedly increased likelihood of male participation. Nearly one in five studies in sport psychology included exclusively male participants, compared to just 7% with females. Studies conducted in Europe, as well as those exploring interventions and experimental research, were also associated with an over-representation of male participants. Important questions are raised as to the conduct of representative research in the field of applied sport psychology, with recommendations provided. [ABSTRACT FROM AUTHOR]

Aims: Young people with first-episode psychosis (FEP) or at ultra-high risk (UHR) of psychosis often have lower vocational engagement than their peers. This study examines the effect of treatment in early intervention for psychosis services in Australia on engagement in education and employment. Methods: This is a naturalistic sample of young people aged 12–25 with FEP (n = 1574) and UHR (n = 1515), accessing treatment in the headspace Early Psychosis (hEP) programme. Engagement in education and employment was assessed at baseline and every 90 days in treatment. Mixed effects logistic regression were used to analyse changes over time. Results: On entering the hEP programme, approximately 49% of the young people with FEP and 28% of the young people at UHR status identified as Not in Education, Employment or Training (NEET). The odds of being NEET were reduced by 27% (95% confidence interval = [14, 39]) for every 6 months treatment for the FEP group, but no change in NEET status was observed in the UHR group. In both groups, absence from daily activities was significantly reduced during time in treatment. Conclusion: While there are methodological challenges analysing real-world non-control group cohort data, the findings indicate positive effects of the hEP programme on vocational and daily activity engagement for young people with FEP and at UHR status. A large proportion of the young people still identified as NEET after receiving treatment services, suggesting further refinement to ensure targeted and consistent vocational support throughout care. [ABSTRACT FROM AUTHOR]

Background and aim: There are few long-term studies of respiratory health effects of landscape fires, despite increasing frequency and intensity due to climate change. We investigated the association between exposure to coal mine fire PM2.5 and fractional exhaled nitric oxide (FeNO) concentration 7.5 years later. Methods: Adult residents of Morwell, who were exposed to the 2014 Hazelwood mine fire over 6 weeks, and unexposed residents of Sale, participated in the Hazelwood Health Study Respiratory Stream in 2021, including measurements of FeNO concentration, a marker of eosinophilic airway inflammation. Individual exposure to coal mine fire PM2.5 was modelled and mapped to time-location diaries. The effect of exposure to PM2.5 on log-transformed FeNO in exhaled breath was investigated using multivariate linear regression models in the entire sample and stratified by potentially vulnerable subgroups. Results: A total of 326 adults (mean age: 57 years) had FeNO measured. The median FeNO level (interquartile range [IQR]) was 17.5 [15.0] ppb, and individual daily exposure to coal mine fire PM2.5 was 7.2 [13.8] µg/m3. We did not identify evidence of association between coal mine fire PM2.5 exposure and FeNO in the general adult sample, nor in various potentially vulnerable subgroups. The point estimates were consistently close to zero in the total sample and subgroups. Conclusion: Despite previous short-term impacts on FeNO and respiratory health outcomes in the medium term, we found no evidence that PM2.5 from the Hazelwood coal mine fire was associated with any long-term impact on eosinophilic airway inflammation measured by FeNO levels. [ABSTRACT FROM AUTHOR]