JCPP advances最新文献

Background: Adolescent girls with diagnoses of autism, ADHD and/or developmental coordination disorder (DCD) are at higher risk for mental health problems than boys with the same diagnoses and neurotypical girls. These girls are called neurodivergent here, though neurodivergence includes a broader range of diagnoses. One possible reason for this mental health disparity could be camouflaging, a coping strategy used more by girls. Camouflaging is when the individual pretends to be neurotypical, often involving substantial effort. This study aims to understand: (a) if the use of camouflaging has started by early adolescence, (b) how components of camouflaging (assimilation, masking, and compensation) present at this age, (c) if age predicts camouflaging and (d) what is the relationship with mental health.

Methods: Participatory methods: A co-production team of 15 adult neurodivergent women co-produced the project and ranked camouflaging as their most important research theme.

Main Study: Participants were 119 girls (70 neurodivergent, 49 neurotypical) aged 11-14 years. A transdiagnostic approach was adopted and the neurodivergent group had a diagnosis of autism, ADHD and/or DCD. Girls completed self-report measures of camouflaging, anxiety, and depression in an online meeting with a researcher.

Results: Neurodivergent and neurotypical girls presented similarly on two components of camouflaging namely masking and compensation, components related to presenting in a socially acceptable way and mimicry. Groups differed on the assimilation component, which is related to trying to fit in and involves the feelings of pretending/acting. Age had a medium effect on camouflaging with higher levels of camouflaging observed in older girls. Camouflaging scores strongly predicted anxiety and depression scores in both groups.

Conclusions: The use of camouflaging, specifically assimilation, is evident in a transdiagnostic sample of 11-14 year old neurodivergent girls. Importantly, the strong relationship between camouflaging and poor mental health is present at this early age, substantiating the co-production team's insights.

Background: Self-harm and suicide related behaviours are increasing in young people, and clinical support is not adequately meeting needs. Improved approaches to assessment and the clinical management of self-harm will result from codesign processes and include greater shared decision-making between young people and practitioners. The CaTS-App (an adapted digital version of the existing Card-Sort Task for Self-harm research tool) aims to facilitate a collaborative understanding of adolescent self-harm and support decision-making within clinical settings. The codevelopment of a digital, clinical tool which meets the needs of multiple stakeholders requires careful consideration.

Methods: We present a case-study describing the participatory aspects of the development of the CaTS-App, which included comprehensive patient involvement, research activities and coproduction with diverse young people aged 17-24 with lived experience of self-harm. We share our processes and activities to deliver safe, engaging, sustainable, ethical and responsible participatory practice and co-created knowledge, in the codevelopment of the CaTS-App.

Results: Activities spanned a 48-month period in both face-to-face and online settings. Example processes and activities are provided in narrative, tabular and diagrammatic form, alongside discussion of the rationale for choices made. A summary methodology is also shared to stimulate continued discussion and development of participatory approaches in digital mental health.

Conclusions: The paper contributes important insight and practical detail for the delivery of genuine participatory processes in digital mental health development when working with a population who may be considered vulnerable.

Involving young people with lived experience in youth mental health research is important. In recognition of the value of collaborating with experts by experience, international funders are increasingly mandating that mental health research is developed by teams that include individuals from the population of study. Yet, research into how Patient Public Involvement, specifically co-production and co-design, is implemented in youth mental health research is limited to date. The current review examined this question and identified common practices for collaborating with experts by experience in young people's mental health research. Academic databases were systematically searched for studies that had involved young people in mental health research, had described these activities, and had reported some demographic information about the experts by experience. From a total of 2130 studies that were screened, 37 studies were eligible for inclusion. The use of co-production and co-design spanned a wide range of topics, including interventions, digital support tools and psychometric studies. Interactive workshops were the primary method of engaging experts by experience, although some studies utilised interviews or focus groups. From the reviewed studies we identified common methodological practices including: Scene setting, utilising a cyclical process, ensuring appropriate engagement and recognition of the cultural context. We draw on these findings to suggest common methods for conducting co-production and co-design activities, and emphasise the importance of ensuring experts by experience are respected and safeguarded throughout their collaboration in research. We also outline areas that deserve future attention and development, and include a response from two young people aged 16-18 and their suggestions for improving and extending co-production methods.

Background: There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms-length advice. To address this, the Regulating Emotions-Strengthening Adolescent Resilience (RE-STAR) programme has co-developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.

Methods: Development - Building on the track record of successful collaboration between RE-STAR academic researchers (ARs) and its Youth Researcher Panel (Y-RP), a cycle of meetings was convened to co-develop a collaborative protocol for the participatory approach. Implementation - ARs and Y-RPers applied the general protocol to study a specific topic. This involved co-designing and co-delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co-analysing the interviews. Evaluation - ARs, Y-RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open-ended surveys (N = 22).

Results: Development - The protocol for the participatory approach gave detailed advice on how to engage Y-RP members (or equivalent) in the co-design, co-delivery and co-analysis of interviews. Implementation - The approach was successfully implemented by ARs and Y-RPers working together to co-design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co-deliver it and then co-analyse the interview scripts. Evaluation - The implementation experience of the Y-RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.

Conclusions: This new RE-STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.

We are pleased to present our Special Issue on Participatory Research. In this editorial, we outline how the disability rights movement has been instrumental to the development of participatory approaches, before giving consideration to some of the debates and criticisms associated with participatory research in practice. We summarise the contributions offered by the studies within this issue and propose four areas of consideration, drawn from the body of included research, to inform future developments.

Background: Adolescents' engagement with online mental health support (e.g., apps, social media) may affect their engagement with traditional support, including in schools. However, research has typically considered engagement with online- and school-based mental health support separately meaning the mesosystemic interaction between the two is overlooked. Using co-produced exploratory qualitative methods, the present study explored adolescents' and adult stakeholders' perceptions of how and why adolescents engage with school-based and online mental health support, the interaction between these two modalities, and the associated risks and opportunities.

Methods: A youth advisory board (n = 4; Age = 18-25) co-created data collection methods, ethics procedures, and data analysis. For the main phase of data collection, 27 adolescents (Age M = 15.42, SD = 1.58, Range = 12-18, Girls = 73.1%, White = 84.6%) with mental health difficulties who had engaged with online support while at school were recruited from across England. Participants chose to participate in an interview (n = 10) or focus group (n = 17, 5 groups). In addition, interviews were conducted with 12 adult stakeholders who worked in fields related youth mental health.

Results: Data was analysed using template analysis resulting in four themes; (a) Support is abundant, but accessing what you need when you need it is tough, (b) Human connection is vital and can be achieved in diverse ways, (c) Striving for autonomy and control, (d) Navigating credibility and trust across contexts.

Conclusions: Different types of support met adolescents' needs in different ways, and each offered relative strengths and weaknesses. Findings highlight how adolescents value autonomy and choice when engaging with support, using multiple different sources of support in complementary and self-directed ways to meet their needs. Several challenges were identified across settings, which could be overcome through increased collaboration. This improved collaboration has potential to improve the quality of support available to adolescents.

Background: As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected.

Methods: Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council 'Mental Health' was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self-help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.).

Results: The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research.

Conclusions: To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6-12 years. This is associated with a child-friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.

The importance of embedding participatory methods within youth mental health research is well accepted and often a funding prerequisite. However, we argue that there is a need to revisit the core values of the approach in order to ensure that participatory methods remain meaningful, effective and authentic. This should entail rigorously examining 'why' and 'how' to approach participatory methods - not merely outlining the 'what' and 'when'. We need to prioritise the naturalistic epistemic advantage youth can bring to our research, assigning them a unique collaborative role to reflect this rather than seeking to professionalise our participants. Similarly, we should explore innovative methods to empower youth to apply their lived experience and knowledge alongside the researcher. Equally, we must continue to reflect on our roles as researcher, ensuring we develop the skills necessary for participatory research with children and young people.

Despite progress in youth involvement in mental health research, considerable gaps remain in our understanding, conceptualisation, and implementation of involving children and young people in this field. This Editorial Perspective reflects on how these gaps present challenges to our research practices and often serve as barriers to meaningfully involving youth voices and experiences into the research process. We take a critical perspective to recent advances in the field of youth involvement in mental health research, reflected by the studies included in this special issue, and highlight examples of good practice paving the way for more equitable and inclusive approaches. Meaningful progress in mental health research relies on the active involvement of young people. Researchers, practitioners and policymakers have an ethical and moral responsibility to create a safe and inclusive environment that empowers young people to participate in research that impacts their lives, care, and overall quality of life.