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

Individuals at Clinical High Risk for Psychosis (CHR-P) demonstrate heterogeneity in clinical profiles and outcome features. However, the extent of neuroanatomical heterogeneity in the CHR-P state is largely undetermined. We aimed to quantify the neuroanatomical heterogeneity in structural magnetic resonance imaging measures of cortical surface area (SA), cortical thickness (CT), subcortical volume (SV), and intracranial volume (ICV) in CHR-P individuals compared with healthy controls (HC), and in relation to subsequent transition to a first episode of psychosis. The ENIGMA CHR-P consortium applied a harmonised analysis to neuroimaging data across 29 international sites, including 1579 CHR-P individuals and 1243 HC, offering the largest pooled CHR-P neuroimaging dataset to date. Regional heterogeneity was indexed with the Variability Ratio (VR) and Coefficient of Variation (CV) ratio applied at the group level. Personalised estimates of heterogeneity of SA, CT and SV brain profiles were indexed with the novel Person-Based Similarity Index (PBSI), with two complementary applications. First, to assess the extent of within-diagnosis similarity or divergence of neuroanatomical profiles between individuals. Second, using a normative modelling approach, to assess the 'normativeness' of neuroanatomical profiles in individuals at CHR-P. CHR-P individuals demonstrated no greater regional heterogeneity after applying FDR corrections. However, PBSI scores indicated significantly greater neuroanatomical divergence in global SA, CT and SV profiles in CHR-P individuals compared with HC. Normative PBSI analysis identified 11 CHR-P individuals (0.70%) with marked deviation (>1.5 SD) in SA, 118 (7.47%) in CT and 161 (10.20%) in SV. Psychosis transition was not significantly associated with any measure of heterogeneity. Overall, our examination of neuroanatomical heterogeneity within the CHR-P state indicated greater divergence in neuroanatomical profiles at an individual level, irrespective of psychosis conversion. Further large-scale investigations are required of those who demonstrate marked deviation.

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

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

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

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

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