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We explore the potential of mindfulness-based cognitive therapy, a skills-based intervention that provides participants with sustainable tools for adaptive responses to stress and negative mood, for the large group of young people with depression or anxiety who only partially or briefly respond to currently available first-line interventions.
Declaration of interest
T.B. is the co-author of a book on mindfulness-based cognitive therapy (MBCT) and has received fees and honoraria for teaching MBCT workshops. W.K. is Director of the University of Oxford Mindfulness Centre. He donates all speaker fees to the not-for-profit Oxford Mindfulness Foundation. J.F. has been paid to deliver mindfulness-based intervention (MBI) programmes in the workplace and has delivered MBIs to elite performers at his own expense.
Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.
Key learning aims
(1)To understand CBT evidence and procedures for young individuals with ARMS.
(2)To reflect on the current limitations in the literature on CBT for ARMS.
(3)To understand the importance and clinical implications of assessing worry in ARMS.
(4)To focus on changes in worry as an outcome after CBT for ARMS.
(5)To reflect on future research directions on the role of worry in CBT for ARMS.
Young people with 22q11.2 deletion syndrome (22q11.2DS) are at high risk for neurodevelopmental disorders. Sleep problems may play a role in this risk but their prevalence, nature and links to psychopathology and cognitive function remain undescribed in this population.
Sleep problems, psychopathology, developmental coordination and cognitive function were assessed in 140 young people with 22q11.2DS (mean age = 10.1, s.d. = 2.46) and 65 unaffected sibling controls (mean age = 10.8, s.d.SD = 2.26). Primary carers completed questionnaires screening for the children's developmental coordination and autism spectrum disorder.
Sleep problems were identified in 60% of young people with 22q11.2DS compared to 23% of sibling controls (OR 5.00, p < 0.001). Two patterns best-described sleep problems in 22q11.2DS: restless sleep and insomnia. Restless sleep was linked to increased ADHD symptoms (OR 1.16, p < 0.001) and impaired executive function (OR 0.975, p = 0.013). Both patterns were associated with elevated symptoms of anxiety disorder (restless sleep: OR 1.10, p = 0.006 and insomnia: OR 1.07, p = 0.045) and developmental coordination disorder (OR 0.968, p = 0.0023, and OR 0.955, p = 0.009). The insomnia pattern was also linked to elevated conduct disorder symptoms (OR 1.53, p = 0.020).
Clinicians and carers should be aware that sleep problems are common in 22q11.2DS and index psychiatric risk, cognitive deficits and motor coordination problems. Future studies should explore the physiology of sleep and the links with the neurodevelopment in these young people.
This article examines the growth of resilience-focused youth policy in Scotland, and its association with the proliferation of the ACE (Adverse Childhood Experiences) agenda. To do this, it critically compares policy discourse with qualitative data on young people’s experiences of growing up in two similar, low-income neighbourhoods. This combination leads us to problematise resilience-informed practice, relative to the voices of young people. Our review demonstrates that by emphasising individual protective factors, resilience discourse reframes inequalities embedded within certain neighbourhoods, and the specific impacts on young people who live there. The consequence is not an assets-based youth policy that supports all young people, but rather a form of resilience which promotes the ‘steeling’ of young people; making them stronger and more resistant to adversities. These adversities, we conclude, may be preventable within a more just social order.
Young people’s well-being has attracted significant policy and research attention in Australia and internationally for at least three decades. Despite this, there is no consensus about what it means, how it can be measured or, most importantly, what supports young people’s well-being. This paper adopts a definition of well-being as a multidimensional process, comprising subjective, material and relational factors. Drawing on self-report data collected at two time points from young people (aged 9–14 years) living in rural and regional New South Wales (N = 342 at baseline and N = 217 Wave 2), this paper seeks to identify the salience of these factors to well-being, measured through Perceived Self-Efficacy. Our analysis suggests that a sense of belonging, safety and the presence of supportive adults all appear to support enhanced well-being. The paper concludes with recommendations for policy makers and communities wishing to better support the development of young people’s well-being.
This paper outlines a psychological skills group for unaccompanied asylum-seeking young people with a focus on cultural adaptations in the context of a UK mental health service. Unaccompanied asylum-seeking young people have typically experienced multiple losses, traumatic experiences, significant disruption and psychosocial stressors. These experiences occur during a key developmental period and outside of the context of a supportive family environment. Mental health difficulties are estimated to be present in 41–69% of this population. Prevalence rates are higher than among children seeking asylum with their families or children who are not from refugee or asylum-seeking backgrounds. Cognitive behavioural approaches were considered to be applicable and useful when working with this client group. Group approaches may offer unique benefits for this population through peer support and normalization. The group described was planned around three key themes: physical health needs, emotional wellbeing and resilience-building. A number of adaptations were made to meet the needs of this population which included engagement, considering physical health needs, sleep, language needs, issues related to power, race and status, and thinking about the needs of the group as young people. Attendance ratings, session rating scale outcomes, preliminary effectiveness data and qualitative feedback from young people identified that this is an acceptable approach for these young people. Unaccompanied asylum-seeking young people require a broad package of care; however, making adaptations to routine practice allowed access to evidence-based interventions to support mental health and wellbeing.
Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake.
Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3–18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD.
We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes.
Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
In this article, we present a pragmatic approach to neuroethics, referring back to John Dewey and his articulation of the “common good” and its discovery through systematic methods. Pragmatic neuroethics bridges philosophy and social sciences and, at a very basic level, considers that ethics is not dissociable from lived experiences and everyday moral choices. We reflect on the integration between empirical methods and normative questions, using as our platform recent bioethical and neuropsychological research into moral cognition, action, and experience. Finally, we present the protocol of a study concerning teenagers’ morality in everyday life, discussing our epistemological choices as an example of a pragmatic approach in empirical ethics. We hope that this article conveys that even though the scope of neuroethics is broad, it is important not to move too far from the real life encounters that give rise to moral questions in the first place.
Identifying young people at risk of developing serious mental illness and identifying predictors of onset of illness has been a focus of psychiatric prediction research, particularly in the field of psychosis. Work in this area has facilitated the adoption of the clinical staging model of early clinical phenotypes, ranging from at-risk mental states to chronic and severe mental illness. It has been a topic of debate if these staging models should be conceptualised as disorder-specific or transdiagnostic. In order to inform this debate and facilitate cross-diagnostic discourse, the present scoping review provides a broad overview of the body of literature of (a) longitudinal at-risk approaches and (b) identified antecedents of (homotypic) illness progression across three major mental disorders [psychosis, bipolar disorder (BD) and depression], and places these in the context of clinical staging. Stage 0 at-risk conceptualisations (i.e. familial high-risk approaches) were identified in all three disorders. However, formalised stage 1b conceptualisations (i.e. ultra-high-risk approaches) were only present in psychosis and marginally in BD. The presence of non-specific and overlapping antecedents in the three disorders may support a general staging model, at least in the early stages of severe psychotic or mood disorders.
This article draws upon ethnographic research which was conducted among young Cossacks (members of officially registered and informal Cossack clubs) in southern Russia. It presents young people's participation in the Cossack “nativism” as a physical and material mode of socialization into the mnemonic community. The research puts forward an argument that such corporal and sensorial experiences is effective in recruiting some young members to the Cossack movement. At the same time, the performative character of neo-Cossack identity destabilizes contemporary Cossacks' claims of authenticity related to the status of the legitimate heirs of historical Cossackdom. At the more general level of discussion this paper juxtaposes bodily activities, social memory, and revivalist discourses.
This paper presents findings from research exploring young people's perspectives on the strengths, challenges and needs of their local community in a disadvantaged area of Sydney, Australia. These findings contribute to the growing body of literature that seeks to better understand the life experiences and support needs of vulnerable children and families. Young people's perspectives were gathered using a Photovoice methodology. Participants photographed aspects of their community that they considered to be a strength or challenge, and these photographs served as conversation prompts in subsequent individual interviews. Five key themes were identified from qualitative analysis of the data: (1) Local People and Places; (2) Financial Struggles and Opportunities; (3) Personal Resilience and Skills; (4) Health and Wellbeing and (5) The Impact of Stereotyping Media Constructions. Young people also made recommendations about what they perceived to be the most important forms of service and government investment in their community. This research gives emphasis to the importance of including the perspectives of young people in research and in providing an opportunity for them to identify the issues of most importance. It also discusses the community impact associated with the relentlessly deficit driven approach employed by researchers and the media when examining disadvantaged communities.
Subjective well-being incorporates elements of life satisfaction, happiness and optimism. It is increasingly relevant in the assessment of population health and economic development. There are strong continuities in well-being from youth into later life. Despite its significance, few global surveys capture subjective well-being. This paper describes patterns of well-being among young people in five Eastern European countries [Belarus, Bosnia and Herzegovina (BiH), the Former Yugoslav Republic of Macedonia, Serbia and Ukraine] and investigates association between demographic factors and well-being.
Nationally representative household surveys, including large Roma population samples, were conducted as part of UNICEF's Multiple Indicator Cluster Survey programme. Young people aged 15–24 years (N = 11 944) indicated their satisfaction with life, happiness and expectations about the future. Multilevel logistic regressions were conducted to determine the impact of individual-level predictors while accounting for country- and cluster-level variability.
Around 40% of young people considered themselves very happy or very satisfied with their life overall. Three quarters reported optimism. Yet well-being varied greatly between countries, with youth in BiH and Ukraine reporting lowest levels of well-being. Current marriage, increasing wealth, higher education, rural residence and not having children were associated with greater well-being.
Patterns of well-being in youth vary substantially between countries and are only partly accounted for by standard demographic characteristics. Despite higher rates of adolescent marriage and childbearing, and lower levels of educational attainment and employment, Roma youth had similar levels of well-being to the general population.
Living with a parent who is approaching the end of life is profoundly troubling for young people. Research indicates that family communication about life-limiting parental illness can influence how young people manage living with dying. In particular, open communication between family members has been shown to be helpful. This paper reports on a study of young people's experiences of family interaction when a parent is dying and considers the practice of open communication in the context of young people's involvement in giving and receiving family care.
A narrative approach was employed based on in-depth semistructured interviews with 10 young people (aged 13–21) living with a parent thought to be in the last year of life.
Young people's attitudes toward open communication between family members were more ambivalent and ambiguous than previous research suggests. Parental attempts at open communication were sometimes overlooked by young people, indicating that there may be differences between knowledge given and young people's acknowledgment of sensitive information. Some young people valued open communication as a signifier of the close relationships between family members, while others wanted to exercise more control over what they knew, when, and how. Young people's accounts challenged the positioning of young people as passive recipients of information. Young people were active in shaping family communication in their everyday lives, and deliberative acts of speaking or remaining silent were one way in which young people exercised care for themselves and others.
Significance of Results:
This study extends research on communication within families when a parent has a life-limiting illness and suggests that supporting young people's agency in determining how they receive information may be more beneficial than promoting open communication between family members.
Research on European identity focuses mainly on majority populations in Western European countries without differentiating among specific population groups and generations, and, above all, disregarding ethnic minority groups living in Central and Eastern Europe. This paper addresses this gap by investigating the development of European identity among three ethnic minority groups in Lithuania: Belarusians, Poles, and Russians. Theoretically, the project is based on the instrumental approach, which argues that European identity is closely related to perceived benefits from “being European,” and on the cultural approach, which holds a common history, ancestry, and culture responsible for the development of European identity. Existing research has, above all, emphasized the importance of instrumental considerations. Analyzing qualitative interviews collected in the FP7 research project “ENRI-East,” the paper compares how young and adult members of ethnic minority groups construct European identity due to “instrumental” and “cultural” considerations. The results show that both instrumental and cultural considerations are relevant and further development of European identity depends on which age group or ethnic minority group an individual belongs to.
Mobile mood-monitoring applications are increasingly used by mental health providers, widely advocated within research, and a potentially effective method to engage young people. However, little is known about their efficacy and usability in young populations.
A systematic review addressing three research questions focused on young people: (1) what are the psychometric properties of mobile mood-monitoring applications; (2) what is their usability; and (3) what are their positive and negative clinical impacts? Findings were synthesised narratively, study quality assessed and compared with evidence from adult studies.
We reviewed 25 articles. Studies on the psychometric properties of mobile mood-monitoring applications were sparse, but indicate questionable to excellent internal consistency, moderate concurrent validity and good usability. Participation rates ranged from 30% to 99% across studies, and appeared to be affected by methodological factors (e.g. payments) and individual characteristics (e.g. IQ score). Mobile mood-monitoring applications are positively perceived by youth, may reduce depressive symptoms by increasing emotional awareness, and could aid in the detection of mental health and substance use problems. There was very limited evidence on potential negative impacts.
Evidence for the use of mood-monitoring applications in youth is promising but limited due to a lack of high-quality studies. Future work should explicate the effects of mobile mood-monitoring applications on effective self-regulation, clinical outcomes across disorders and young people's engagement with mental health services. Potential negative impacts in this population should also be investigated, as the adult literature suggests that application use could potentially increase negativity and depression symptoms.
To examine general practitioners’ (GPs) clinical expertise in assessing, communicating with, and managing suicidal young people aged 14–25 to inform the development of an educational intervention for GPs on youth suicide prevention.
Suicide is the second leading cause of death for young people worldwide. GPs are ideally suited to facilitate early identification and assessment of suicide risk. However, GPs’ levels of competence, knowledge, and attitudes towards suicidal young people have not yet been explored.
A cross-sectional survey on GPs’ levels of confidence in assessing and managing young people at risk of suicide; knowledge of risk factors and warning signs of suicide in young people; attitudes towards young suicidal people; and training preferences on managing suicide risk.
Seventy GPs completed the survey (30 males). The majority of GPs reported high levels of confidence in assessing and managing suicidality in young people. Experienced GPs demonstrated high levels of knowledge of suicide risk factors in young people but low levels of knowledge of warning signs that might indicate heightened risk. Although 48% of GPs disagreed that maintaining compassionate care is difficult with those who deliberately self-harm, GPs perceived communication with young people to be difficult, with one-third reporting frustration in managing those at risk of suicide. A total of 75% of GPs said they would be interested in receiving further training on assessing and managing young people at risk of suicide.
The study has important implications for providing specialist training to support GPs in assessing and managing youth suicide risk and facilitating attitudinal change. GP education on youth suicide risk assessment and management should promote a holistic understanding and assessment of risk and its individual, social and contextual influences in line with clinical recommendations to facilitate therapeutic engagement and communication with young people.
Recent studies suggest that the online and offline behaviors young people display in romantic relationships are closely related. However, the differential effects of the dimensions of couple quality in the online context have not yet been explored in depth. The aim of this study was to explore online couple quality in young-adult relationships, and its association with romantic relationship satisfaction, also looking at effects of gender, age, and length of the relationship. 431 university students currently in a romantic relationship (68.2% females; mean age = 21.57) participated in this study. They completed different self-report measures to tap the online quality of their romantic relationships (online intimacy, control, jealousy, intrusiveness, cyberdating practices, and communication strategies) and level of satisfaction with those relationships. Results showed that participants more often reported online intimacy (Mmen = 2.49; Mwomen = 2.38) than the negative scales of online quality (mean ranged from .43 to 1.50), and all the online quality scales decreased with age (correlations ranged from –.12 to –.30) and relationship length (correlations ranged from –.02 to –.20). Linear regression analyses indicated that online intimacy (b = .32, p = .001) and intrusiveness (b = .11, p = .035) were positively related to relationship satisfaction, while cyberdating practices (b = –.20, p = .001) and communication strategies (b = –.34, p = .001) were negatively correlated with relationship satisfaction. Moreover, gender and relationship length moderated some of these associations. Results indicate that while online quality and relationship satisfaction are related, the impact of different online quality dimensions on relationship satisfaction differs depending on a participant’s sex, age, and relationship length.
Background: Of young people with first episode psychosis (FEP), over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder (PTSD) or symptoms. Currently no evidence-based interventions exist for PTSD in FEP. Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation. Scant research suggests that talking about trauma in therapy can be distressing for some people. Aims: To explore young people's reactions to a trauma-focused treatment for PTSD in FEP. Method: Semi-structured interviews were conducted with eight participants (age 18–27 years) with co-morbid PTSD and FEP, after completing a trauma-focused intervention. Transcripts were analysed using an interpretative phenomenological approach. Participants’ baseline and end-of-treatment PTSD and psychotic symptoms were assessed. Results: Three themes related to participants’ reactions were identified from the analysis: (1) distress in session; (2) feeling relieved in and out of session; and (3) symptom exacerbation out of session. All but one participant reported experiencing increased distress in session. Four participants described PTSD, psychotic symptoms and/or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions. 86% of participants showed improvement in their PTSD and psychotic symptoms at end of treatment. All participants described the intervention as beneficial and worthwhile. Conclusions: Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment. Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP. Clinicians should be aware of, plan for, and clearly inform their clients of treatment risks.
Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.
This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.
3 58 383 registered patients aged 6–18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.
Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.
Background: Social anxiety disorder is common and typically starts in childhood or adolescence. Cognitive Therapy for Social Anxiety Disorder (CT-SAD) in adults is a well-established treatment that shows strong evidence of differential effectiveness when compared to other active treatments. In contrast, CBT approaches to social anxiety in young people have yet to demonstrate differential effectiveness and there is some evidence that young people with social anxiety disorder respond less well than those with other anxiety disorders. Aims: To adapt CT-SAD for use with adolescents and conduct a pilot case series. Method: Five adolescents, aged 11–17 years, with a primary DSM-5 diagnosis of social anxiety disorder received a course of CT-SAD adapted for adolescents. Standardized clinical interview and questionnaire assessments were conducted at pre and posttreatment, and 2 to 3-month follow-up. Results: All five participants reported severe social anxiety at baseline and achieved remission by the end of treatment. Significant improvements were also observed in general anxiety, depression, concentration in the classroom, and putative process measures (social anxiety related thoughts, beliefs and safety behaviours). Conclusions: An adapted form of CT-SAD shows promise as a treatment for adolescents.