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Four Steps To My Future (4STMF): acceptability, feasibility and exploratory outcomes of a universal school-based mental health and well-being programme, delivered to young adolescents in South Africa 迈向我未来的四个步骤(4STMF):面向南非青少年的校本心理健康和幸福普及计划的可接受性、可行性和探索性成果。
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-13 DOI: 10.1111/camh.12660
Bronwynè Coetzee, Maria Loades, Suzanne Human, Hermine Gericke, Gerrit Laning, Martin Kidd, Paul Stallard

Objective

Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom-based programme for the promotion of mental health in young adolescents.

Method

We pilot tested an 8 session, cognitive-behavioural therapy-based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners (n = 222; Meanage = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt-out, child assent, assessment completion at baseline and follow-up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one-month follow-up.

Results

Most eligible learners at both schools agreed to participate (85% – school 1; 91% – school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre–post differences on self-esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow-up.

Conclusions

This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school-based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self-esteem and emotion regulation and was liked by the learners.

目的:在南非,心理健康失调影响着许多儿童,他们很容易患上心理疾病,而治疗方法却很有限。我们试图确定一项以课堂为基础的普及计划的可行性和可接受性,以促进青少年的心理健康:我们在两所学校试点测试了一项为期 8 个课时、以认知行为疗法为基础的计划--"迈向我未来的 4 个步骤"(4STMF)。参与者为五年级学生(n = 222;平均年龄 = 10.62(标准差 = 0.69))。4STMF 由经过培训的心理学研究生在课堂上讲授。在基线、干预后和一个月的随访中收集了可行性(家长选择退出率、儿童同意率、基线和随访中的评估完成率、课程完成率、课程出勤率和课程忠实度)、可接受性(教师反馈和与学习者进行的焦点小组讨论)以及人口统计学数据和一系列心理测量数据:两所学校大多数符合条件的学生都同意参与(85% - 学校 1;91% - 学校 2),80%以上的学生完成了干预后的测量。学习者的课程出勤率和计划忠诚度都很高。教师对辅导员的信心、准备情况、热情和课堂管理给予了高度评价,并观察到孩子们很喜欢这项计划。焦点小组的数据表明,学习者喜欢该计划,能够回忆起计划内容,并与家人分享了部分内容。对结果的探索性分析表明,学校 1 在自尊方面、学校 1 和学校 2 在情绪调节方面存在显著的前后差异,并在后续活动中保持不变:这项试点研究表明,4STMF 可以作为一项以学校为基础的普及预防计划,在课堂上向南非小学的青少年学生提供。该计划适合学校环境,可由非专业人员实施,在自尊和情绪调节方面有明显改善,深受学生喜爱。
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引用次数: 0
An additional note on help-seeking as some gaps are bigger than others: a commentary on ‘Don't mind the gap – why do we not care about the gender gap in mental health?’ Patalay and Demkowicz (2023) 关于寻求帮助的另一个说明,因为有些差距比其他差距更大:一篇关于“不要介意差距——为什么我们不关心心理健康方面的性别差距?”Patalay and Demkowicz (2023)
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-13 DOI: 10.1111/camh.12670
Amy McCulloch, Sarah Parry
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引用次数: 0
Debate: Neurodiversity, autism and healthcare 辩论:神经多样性、自闭症和医疗保健
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-12 DOI: 10.1111/camh.12663
Jonathan Green

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years—with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.

我们正处于一个对自闭症的理解和应对的空前变化的时代,包括我们对临床服务作用的理解。对于任何从事儿童发展和儿童心理健康服务的临床医生来说,大多数经验可能是压倒性的需求,然后可能是困惑。近年来,神经发育疾病,尤其是自闭症的转诊在英国CAMHS转诊中所占比例越来越大,因此等待时间延长至数年,有时相当于儿童在此之前的整个寿命。服务部门正在努力制定应对策略来满足用户的沮丧情绪,而目前使用的大多数干预措施都没有很好的有效性证据,这对这项任务没有帮助。因此,制定了大量的地方办法和举措。在这篇文章中,我将讨论这些临床和相关问题。我讨论了自闭症一词目前的不同用途,以及与智力残疾的关系,并介绍了自闭症作为突发性和交易性的概念,这与当前的发展和干预科学是一致的。这可以在神经多样性和临床观点之间架起桥梁,并意味着早期干预支持的框架,该框架具有强有力的临床试验证据,并为我所描述的合理和先发制人的循证护理途径提供基础。
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引用次数: 1
Commentary: A spectrum for all? A response to Green et al. (2023), neurodiversity, autism and health care 评论:所有人的光谱?对Green等人(2023),神经多样性,自闭症和医疗保健的回应
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-11 DOI: 10.1111/camh.12666
Andrew Whitehouse

The broadening of the clinical definition of autism over time—the so-called, autism spectrum—has run in parallel with the growth of a neurodiversity movement that has reframed the concept of autism entirely. Without a coherent and evidence-based framework through which both of these advances can be situated, the field is at risk of losing definition altogether. In his commentary, Green describes such a framework, which has appeal because of its grounding in basic and clinical evidence, and its ability to guide its users through its real-world application in health care. An endless spectrum creates barriers to autistic children having their human rights met, but a denial of neurodiversity principles has the same effect. Green's framework holds great promise in coherently framing this sentiment. The real test of the framework is in its implementation, and all communities should walk that path together.

随着时间的推移,自闭症临床定义的扩大——即所谓的自闭症谱系——与神经多样性运动的发展并行,神经多样性运动已经完全重新定义了自闭症的概念。如果没有一个连贯的、以证据为基础的框架来支撑这两种进步,该领域就有可能完全失去定义。在他的评论中,格林描述了这样一个框架,它具有吸引力,因为它以基础和临床证据为基础,并且能够指导用户通过其在卫生保健中的实际应用。无穷无尽的谱系给自闭症儿童的人权创造了障碍,但否认神经多样性原则也会产生同样的效果。格林的框架在连贯地表达这种情绪方面大有希望。对该框架的真正考验是在其实施过程中,所有社区都应该共同走过这条道路。
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引用次数: 1
Commentary: Reviewing neurodiversity, autism, and healthcare by Jonathan Green (2023) from an autistic perspective 评论:乔纳森·格林(2023)从自闭症的角度回顾神经多样性,自闭症和医疗保健
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-11 DOI: 10.1111/camh.12668
Rhiannon Hawkins
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引用次数: 0
The role of sleep in prospective associations between parent reported youth screen media activity and behavioral health 睡眠在家长报告的青少年屏幕媒体活动与行为健康之间的前瞻性关联中的作用。
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-10 DOI: 10.1111/camh.12665
Darlynn M. Rojo-Wissar, Juliana Acosta, Karissa DiMarzio, Megan Hare, Chelsea F. Dale, Wesley Sanders, Justin M. Parent

Background

Screen media activity (SMA) can negatively affect youth behavioral health. Sleep may mediate this association but has not been previously explored. We examined whether sleep mediated the association between SMA and youth behavioral health among a community sample.

Method

Parents completed questions about their child (N = 564) ages 3–17 at Wave 1, Wave 2 (4–8 months later), and Wave 3 (12 months later). Path analyses were conducted to examine links between Wave 1 SMA and Wave 3 behavioral health problems (i.e., internalizing, externalizing, attention, peer problems) through Wave 2 sleep disturbance and duration.

Results

SMA was significantly associated with greater sleep disturbance, β = .11, 95% CI [.01, .21] and shorter sleep duration, β = −.16 [−.25, −.06], and greater sleep disturbance was associated with worse youth behavioral health across internalizing, β = .14 [.04, .24], externalizing, B = .23 [.12, .33], attention, β = .24 [.15, .34], and peer problems, β = .25 [.15, .35]. Longer sleep duration was associated with more externalizing, β = .13 [.04, .21], and attention problems, β = .12 [.02, .22], and fewer peer problems, β = −.09 [−.17, −.01], but not with internalizing problems. Lastly, there was a direct effect of SMA on peer problems, β = −.15 [−.23, −.06] such that higher SMA that does not impact sleep may have a positive impact on reducing peer problems.

Conclusions

Sleep (i.e., disturbances and shorter duration) may partially account for the small associations observed between SMA and worse behavioral health in youth. To continue expanding our understanding, future research should utilize more diverse representative samples, use objective measures of SMA and sleep, and examine other relevant aspects of SMA, including content, device type, and timing of use.

背景:屏幕媒体活动(SMA)会对青少年的行为健康产生负面影响。睡眠可能是这种关联的中介,但此前尚未进行过研究。我们在社区样本中研究了睡眠是否能调节屏幕媒体活动与青少年行为健康之间的关系:方法:家长在第一波、第二波(4-8 个月后)和第三波(12 个月后)填写有关其 3-17 岁子女(564 人)的问题。我们进行了路径分析,通过第 2 波的睡眠障碍和持续时间,研究第 1 波的 SMA 与第 3 波的行为健康问题(即内化、外化、注意力、同伴问题)之间的联系:SMA与较严重的睡眠障碍(β = .11,95% CI [.01, .21])和较短的睡眠持续时间(β = -.16 [-.25, -.06])明显相关,较严重的睡眠障碍与青少年行为健康问题(内化问题,β = .14 [.04, .24])、外化问题(B = .23 [.12, .33])、注意力问题(β = .24 [.15, .34])和同伴问题(β = .25 [.15, .35])的恶化相关。睡眠时间较长与较多的外部化问题(β = .13 [.04, .21])和注意力问题(β = .12 [.02, .22])有关,与较少的同伴问题(β = -.09 [-.17, -.01])有关,但与内部化问题无关。最后,SMA 对同伴问题有直接影响,β = -.15 [-.23, -.06],因此,SMA 越高,但不影响睡眠,可能对减少同伴问题有积极影响:结论:睡眠(即干扰和持续时间较短)可能是导致观察到的 SMA 与青少年行为健康恶化之间存在微小关联的部分原因。为了继续加深我们的理解,未来的研究应该利用更多样化的代表性样本,使用客观的 SMA 和睡眠测量方法,并研究 SMA 的其他相关方面,包括内容、设备类型和使用时间。
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引用次数: 0
Debate: Prevention of psychosis in adolescents – does CAMHS have a role? 争论:预防青少年精神病——CAMHS有作用吗?
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-09 DOI: 10.1111/camh.12662
Gonzalo Salazar de Pablo, Celso Arango
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引用次数: 3
Technology Matters: Online, self-help single session interventions could expand current provision, improving early access to help for young people with depression symptoms, including minority groups 技术问题:在线、自助的单次干预措施可以扩大目前的服务范围,改善有抑郁症症状的年轻人(包括少数群体)早期获得帮助的机会。
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-07-06 DOI: 10.1111/camh.12659
Maria E. Loades, Jessica L. Schleider

Current mental health service provision for young people was primarily designed based on an assumption of repeat attendance to enable access to interventions. This applies to in-person therapy and, in recent years, digitally provided apps and programmes. Yet, discontinuation after only one or two attendances or uses is a common problem. However, there is a different model, which is intentionally designing provision without assuming repeat attendance, that is, single session interventions. Evidence from the United States, where a suite of digital, self-help single session interventions, accessible anonymously, have been designed, indicates that these are helpful to young people with reductions in depression symptoms at up to 9 months later. These interventions also have had better reach into currently underserved populations (e.g. LGBTQ+ and ethnic minority adolescents). Therefore, these may be a potentially helpful way to expand existing provision at scale, enabling all young people to access evidence-based help quickly.

目前为年轻人提供的心理健康服务主要是基于重复就诊的假设,以便能够获得干预措施。这适用于面对面治疗,以及近年来数字提供的应用程序和程序。然而,只有一两次就诊或使用后就停药是一个常见的问题。然而,还有一种不同的模式,即有意设计不假设重复出席的规定,即单次会议干预。来自美国的证据表明,这些干预措施有助于减少9岁以下的年轻人的抑郁症状 几个月后。这些干预措施也更好地惠及目前服务不足的人群(如LGBTQ+和少数民族青少年)。因此,这可能是一种潜在的有助于大规模扩大现有供应的方式,使所有年轻人都能迅速获得循证帮助。
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引用次数: 1
A commentary on “Don't mind the gap: Why we do not care about the gender gap in mental health?” by P. Patalay and O. Demkowicz 《别介意差距:为什么我们不关心心理健康方面的性别差距?》P. Patalay和O. Demkowicz著
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-05-16 DOI: 10.1111/camh.12653
Maria Kovacs

In their article, Drs. Patalay and Demkowicz raise important questions about research regarding the sex/gender gap in depression rates. However, their perspective on this topic is rather polarizing and yields statements of questionable accuracy. In this Commentary, I respond to several statements in the Article, which I consider potentially misleading. My goal is to present a broader perspective on sex/gender and depression and encourage further discussion of this important topic.

在他们的文章中。Patalay和Demkowicz对抑郁症发病率的性别差异研究提出了重要的问题。然而,他们对这个话题的看法是相当两极分化的,并产生了可疑的准确性陈述。在这篇评论中,我对文章中的一些我认为可能具有误导性的陈述作出回应。我的目标是提出一个关于性/性别和抑郁症的更广泛的观点,并鼓励对这个重要话题的进一步讨论。
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引用次数: 1
Review: Improving access to mental health interventions for children from birth to five years: A Scoping Review 回顾:改善出生至五岁儿童获得心理健康干预的机会:范围审查。
IF 6.1 3区 医学 Q1 PEDIATRICS Pub Date : 2023-05-03 DOI: 10.1111/camh.12652
Lyndal Hickey, Louise Harms, Jackson Evans, Tahnee Noakes, Henrietta Lee, Amity McSwan, Helena Bean, Judith Hope, Lynne Allison, Sophie Price, Nicole Harris

Background

In spite of infants and children aged 0–5 years experiencing mental health difficulties being estimated to be in the range of 6%–18% globally, the mental health care needs for this age group are often overlooked in the design of specialist mental health services. Although there is increasing recognition of the importance of infant mental health services and treatments for younger children, access remains a barrier. Mental health services specifically designed for children 0–5 years are vital; however, little is known about how these services ensure access for infants at risk of mental health difficulties and their families. This scoping review seeks to address this knowledge gap.

Methods

A scoping review methodology framework was used to search for relevant articles published between January 2000 and July 2021, identified using five databases: MEDLINE, CINAHL, PsycINFO, SocIndex and Web of Science. The selection of studies was based on empirical research about access to infant mental health services and models of care. A total of 28 relevant articles met the eligibility criteria for inclusion in this review.

Results

Findings can be summarised under five broad themes: (1) accessibility for at-risk populations (2) the importance of early detection of infants in need of mental health services and interventions; (3) the promotion of culturally responsive services and interventions; (4) ensuring the sustainability of IMH services and programs and (5) the integration of innovative interventions to improve existing practice models.

Conclusions

The findings from this scoping review highlight barriers to access and provision of infant mental health services. Future infant mental health service design, informed by research, is needed to improve access for infants and young children with mental health difficulties and their families.

背景:据估计,全球有 6%-18%的 0-5 岁婴幼儿存在心理健康问题,但在设计专科心理健康服务时,这个年龄段的婴幼儿的心理健康需求往往被忽视。尽管人们越来越认识到婴幼儿心理健康服务和治疗对低龄儿童的重要性,但获取服务仍然是一个障碍。专为 0-5 岁儿童设计的心理健康服务至关重要;然而,人们对这些服务如何确保有心理健康问题风险的婴儿及其家庭能够获得这些服务却知之甚少。本范围界定综述旨在填补这一知识空白:方法:采用范围界定综述方法框架,搜索 2000 年 1 月至 2021 年 7 月间发表的相关文章,并使用五个数据库进行识别:MEDLINE、CINAHL、PsycINFO、SocIndex 和 Web of Science。选择研究的依据是有关婴儿心理健康服务获取途径和护理模式的实证研究。共有 28 篇相关文章符合纳入本综述的资格标准:研究结果可归纳为五大主题:(1) 高危人群的可及性;(2) 早期发现需要心理健康服务和干预的婴儿的重要性;(3) 促进文化适应性服务和干预;(4) 确保 IMH 服务和项目的可持续性;(5) 整合创新干预措施以改善现有实践模式:本次范围界定审查的结果凸显了在获取和提供婴儿心理健康服务方面存在的障碍。未来的婴儿心理健康服务设计需要以研究为基础,以改善有心理健康问题的婴幼儿及其家庭获得服务的机会。
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引用次数: 0
期刊
Child and Adolescent Mental Health
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