Pub Date : 2026-06-01Epub Date: 2025-12-15DOI: 10.1016/j.ssmmh.2025.100574
Theoni Stathopoulou , Konstantinos Bourazas , Korina Hatzinikolaou , Eirini Adamopoulou , Lina Zirganou-Kazolea , Jennifer Cavounidis , Natalia Spyropoulou , Giampaolo Nicolais , Catherine Panter-Brick , Richard F. Mollica
Background: Understanding the mental health challenges of refugee adolescents is critical for informing targeted educational policies and interventions. Yet few studies identify which school-based factors most strongly relate to their resilience and well-being. This study draws on a multi-informant dataset from 170 refugee students attending school in Greece, applying Bayesian variable selection to identify key predictors of mental health outcomes. Methods: We collected student (), teacher () and parent/guardian () data about each student (Strengths and Difficulties Questionnaire, SDQ; Child and Youth Resilience Measure-Revised, CYRM-R); sense of belonging, school attendance. We ran two models, one based on student self-reports, the other based on teacher, parent, and guardian data. Results: The self-reported sense of belonging was the most consistent protective factor of SDQ and CYRM-R outcomes, while bullying, discrimination, and disrupted schooling were associated with greater vulnerability. In triangulated analysis, student self-reports contributed the largest share of predictive information, followed by adult reports Discussion: This study highlights the importance of centering youth perspectives in mental health assessment and intervention and the critical role of inclusive school environments and educational continuity in supporting refugee integration. The Bayesian approach offers a robust framework for guiding evidence-based interventions for supporting the integration of refugee students in host-country educational settings.
{"title":"Belonging, discrimination, and risk in displacement: Bayesian variable selection in predicting mental health and resilience among refugee adolescents in Greece","authors":"Theoni Stathopoulou , Konstantinos Bourazas , Korina Hatzinikolaou , Eirini Adamopoulou , Lina Zirganou-Kazolea , Jennifer Cavounidis , Natalia Spyropoulou , Giampaolo Nicolais , Catherine Panter-Brick , Richard F. Mollica","doi":"10.1016/j.ssmmh.2025.100574","DOIUrl":"10.1016/j.ssmmh.2025.100574","url":null,"abstract":"<div><div>Background: Understanding the mental health challenges of refugee adolescents is critical for informing targeted educational policies and interventions. Yet few studies identify which school-based factors most strongly relate to their resilience and well-being. This study draws on a multi-informant dataset from 170 refugee students attending school in Greece, applying Bayesian variable selection to identify key predictors of mental health outcomes. Methods: We collected student (<span><math><mrow><mi>n</mi><mo>=</mo><mn>170</mn></mrow></math></span>), teacher (<span><math><mrow><mi>n</mi><mo>=</mo><mn>165</mn></mrow></math></span>) and parent/guardian (<span><math><mrow><mi>n</mi><mo>=</mo><mn>124</mn></mrow></math></span>) data about each student (Strengths and Difficulties Questionnaire, SDQ; Child and Youth Resilience Measure-Revised, CYRM-R); sense of belonging, school attendance. We ran two models, one based on student self-reports, the other based on teacher, parent, and guardian data. Results: The self-reported sense of belonging was the most consistent protective factor of SDQ and CYRM-R outcomes, while bullying, discrimination, and disrupted schooling were associated with greater vulnerability. In triangulated analysis, student self-reports contributed the largest share of predictive information, followed by adult reports Discussion: This study highlights the importance of centering youth perspectives in mental health assessment and intervention and the critical role of inclusive school environments and educational continuity in supporting refugee integration. The Bayesian approach offers a robust framework for guiding evidence-based interventions for supporting the integration of refugee students in host-country educational settings.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100574"},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2025-12-19DOI: 10.1016/j.ssmmh.2025.100579
Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan
Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.
{"title":"Psychosocial stressors related to extreme weather events and multiple resource insecurities: qualitative insights from refugee youth in an Ugandan humanitarian setting","authors":"Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan","doi":"10.1016/j.ssmmh.2025.100579","DOIUrl":"10.1016/j.ssmmh.2025.100579","url":null,"abstract":"<div><div>Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100579"},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-01-26DOI: 10.1016/j.ssmmh.2026.100591
Joseph P. Gone
Fifty years ago, Congressional passage of the Indian Self-Determination and Education Assistance Act heralded a new era in U.S. Indian affairs, ostensibly repudiating the long history of federal intrusion, domination, and control of American Indian lives. Since then, self-determination has come to define federal Indian policy, so much so that the term remains in widespread colloquial usage throughout Indian Country. Even as Tribal governments assumed administrative control of their own human services during this time, inequities in the mental health status of Indigenous communities have persisted. In response, American Indian communities have engaged, critiqued, and recast knowledge and expertise in the mental health professions. The result is an “alter-Native psy-ence” of mental health, comprising Indigenous visions of flourishing vitality and holistic well-being. In these enduring views of a good life, Indigenous communities retain esteem for both personal autonomy and capacious relationality. This fusion of regard for exercising agency and freedom alongside regard for fulfilling roles and duties entails a dynamic configuration of selfhood-in-relation to others. Moreover, these others include both human and non-human persons, for whom personhood itself is defined by the capacity to exercise agency, autonomy, and self-determination. In this article, description and illustration of relational Indigenous expressions of self and expansive Indigenous attributions of personhood illuminate diverse forms of well-being that extend well beyond the culturally myopic orientations of the mental health professions. Recognition of these alter-Native modalities of living by the “psy” disciplines harbors potential for Indigenous "survivance" and “futurity” in robust anticolonial fashion.
{"title":"The alter-Native psy-ence of Indigenous well-being: Relational expressions of self and expansive attributions of personhood","authors":"Joseph P. Gone","doi":"10.1016/j.ssmmh.2026.100591","DOIUrl":"10.1016/j.ssmmh.2026.100591","url":null,"abstract":"<div><div>Fifty years ago, Congressional passage of the Indian Self-Determination and Education Assistance Act heralded a new era in U.S. Indian affairs, ostensibly repudiating the long history of federal intrusion, domination, and control of American Indian lives. Since then, <em>self-determination</em> has come to define federal Indian policy, so much so that the term remains in widespread colloquial usage throughout Indian Country. Even as Tribal governments assumed administrative control of their own human services during this time, inequities in the mental health status of Indigenous communities have persisted. In response, American Indian communities have engaged, critiqued, and recast knowledge and expertise in the mental health professions. The result is an “alter-Native psy-ence” of mental health, comprising Indigenous visions of flourishing vitality and holistic well-being. In these enduring views of a good life, Indigenous communities retain esteem for <em>both</em> personal autonomy and capacious relationality. This fusion of regard for exercising agency and freedom alongside regard for fulfilling roles and duties entails a dynamic configuration of selfhood-in-relation to others. Moreover, these others include both human and non-human persons, for whom personhood itself is defined by the capacity to exercise agency, autonomy, and self-determination. In this article, description and illustration of relational Indigenous expressions of self and expansive Indigenous attributions of personhood illuminate diverse forms of well-being that extend well beyond the culturally myopic orientations of the mental health professions. Recognition of these alter-Native modalities of living by the “psy” disciplines harbors potential for Indigenous \"survivance\" and “futurity” in robust anticolonial fashion.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100591"},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-17DOI: 10.1016/j.ssmmh.2025.100494
Aimi Nur Athira Putri Baharuddin , Nik Ruzyanei Nik Jaafar , Normala Ibrahim , Abdul Rahman Ahmad Badayai , Hajar Mohd Salleh Sahimi , Nurul Ain Mohamad Kamal , Nur Husna Ismail , Ely Salwana , Mohd Pilus Abdullah , Mohd ‘Ammar Ihsan Ahmad Zamzuri
Background
The REAL™ module was developed to impart social and emotional learning (SEL) skills to early Malaysian adolescents using virtual reality (VR) components at school within the local social and cultural dynamics. This study aimed to evaluate the effectiveness of the intervention in improving 1) emotional regulation (ER) skills and 2) depression and anxiety in adolescents attending lower secondary schools in Malaysia.
Methods
This randomized controlled trial study was conducted from February 2023 to November 2023. A total of 226 participants aged 13 and 14 years old from lower secondary school students were recruited from four secondary schools selected by multistage cluster sampling in Selangor, Malaysia. Data were collected across four-time points (T0: baseline, T1: immediate post-test, T2: three-month post-test, and T3: six-month post-test) via a locally translated and validated set of questionnaires, including The Difficulties in Emotion Regulation Scale (DERS) for the emotional regulation score, Beck Depression Inventory (BDI) for depression scores and Beck Anxiety Inventory for anxiety scores. A repeated-measures ANCOVA was performed to evaluate the effect of the intervention versus the control group on emotional regulation scores, depression scores, as well as anxiety scores.
Results
A significant main effect of the group intervention was observed for emotional regulation (F (1, 223) = 20.05, p < 0.001), depression (F (1, 223) = 51.16, p < 0.001), and anxiety (F (1, 223) = 32.75, p < 0.001). The intervention group showed a sustained reduction for all domains compared to the control group, particularly at time T3. These findings reflect differences in outcomes between the intervention and control groups.
Conclusion
This study showed that the REAL™ intervention improved adolescents' emotional regulation skills and reduced their depression and anxiety scores. The program features a feasible school-based delivery using a socioculturally sensitive module integrated with VR components. This could facilitate adolescents’ learning engagement and resonate with their sociocultural context, making the skills relatable and attainable.
开发REAL™模块是为了在当地社会和文化动态的学校中使用虚拟现实（VR）组件向早期马来西亚青少年传授社交和情感学习（SEL）技能。本研究旨在评估干预在改善马来西亚初中青少年情绪调节技能和改善抑郁和焦虑方面的效果。方法随机对照研究于2023年2月至2023年11月进行。通过多阶段整群抽样，从马来西亚雪兰莪州的四所中学招募了226名13至14岁的初中学生。通过一套当地翻译和验证的问卷，包括情绪调节困难量表（DERS）的情绪调节评分，贝克抑郁量表（BDI）的抑郁评分和贝克焦虑量表（Beck Anxiety Inventory）的焦虑评分，在四个时间点（T0：基线，T1：测试后立即，T2：测试后三个月和T3：测试后六个月）收集数据。采用重复测量ANCOVA来评估干预组与对照组在情绪调节评分、抑郁评分和焦虑评分方面的影响。结果小组干预对情绪调节有显著的主效应(F (1,223) = 20.05, p <；0.001)，抑郁(F (1,223) = 51.16, p <；0.001)，焦虑(F (1,223) = 32.75, p <；0.001)。与对照组相比，干预组的所有领域都持续下降，特别是在T3时间。这些发现反映了干预组和对照组之间结果的差异。结论REAL™干预提高了青少年的情绪调节技能，降低了他们的抑郁和焦虑得分。该计划的特点是可行的基于学校的交付，使用社会文化敏感模块与VR组件相结合。这可以促进青少年的学习参与，并与他们的社会文化背景产生共鸣，使技能具有相关性和可实现性。
{"title":"The effectiveness of the REAL™, a school-based, virtual reality-integrated social emotional learning intervention to promote mental health for early Malaysian adolescents","authors":"Aimi Nur Athira Putri Baharuddin , Nik Ruzyanei Nik Jaafar , Normala Ibrahim , Abdul Rahman Ahmad Badayai , Hajar Mohd Salleh Sahimi , Nurul Ain Mohamad Kamal , Nur Husna Ismail , Ely Salwana , Mohd Pilus Abdullah , Mohd ‘Ammar Ihsan Ahmad Zamzuri","doi":"10.1016/j.ssmmh.2025.100494","DOIUrl":"10.1016/j.ssmmh.2025.100494","url":null,"abstract":"<div><h3>Background</h3><div>The REAL™ module was developed to impart social and emotional learning (SEL) skills to early Malaysian adolescents using virtual reality (VR) components at school within the local social and cultural dynamics. This study aimed to evaluate the effectiveness of the intervention in improving 1) emotional regulation (ER) skills and 2) depression and anxiety in adolescents attending lower secondary schools in Malaysia.</div></div><div><h3>Methods</h3><div>This randomized controlled trial study was conducted from February 2023 to November 2023. A total of 226 participants aged 13 and 14 years old from lower secondary school students were recruited from four secondary schools selected by multistage cluster sampling in Selangor, Malaysia. Data were collected across four-time points (T0: baseline, T1: immediate post-test, T2: three-month post-test, and T3: six-month post-test) via a locally translated and validated set of questionnaires, including The Difficulties in Emotion Regulation Scale (DERS) for the emotional regulation score, Beck Depression Inventory (BDI) for depression scores and Beck Anxiety Inventory for anxiety scores. A repeated-measures ANCOVA was performed to evaluate the effect of the intervention versus the control group on emotional regulation scores, depression scores, as well as anxiety scores.</div></div><div><h3>Results</h3><div>A significant main effect of the group intervention was observed for emotional regulation (F (1, 223) = 20.05, p < 0.001), depression (F (1, 223) = 51.16, p < 0.001), and anxiety (F (1, 223) = 32.75, p < 0.001). The intervention group showed a sustained reduction for all domains compared to the control group, particularly at time T3. These findings reflect differences in outcomes between the intervention and control groups.</div></div><div><h3>Conclusion</h3><div>This study showed that the REAL™ intervention improved adolescents' emotional regulation skills and reduced their depression and anxiety scores. The program features a feasible school-based delivery using a socioculturally sensitive module integrated with VR components. This could facilitate adolescents’ learning engagement and resonate with their sociocultural context, making the skills relatable and attainable.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100494"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-21DOI: 10.1016/j.ssmmh.2025.100514
Costina-Ruxandra Poetar , Ionuț Stelian Florean
The present study aimed to investigate the psychometric properties, factorial structure, and measurement invariance of the Romanian version of the Regulating Emotions in Parenting (REPS) scale. This was a cross-sectional study conducted in Romaniawith parents (N = 1566, Mage = 40.84 years, SD = 6.42) of children and adolescents aged 8–17 years old. Psychometric properties were tested via Confirmatory Factor Analysis (CFA), Multigroup CFA, Pearson's correlation, and Cronbach's alpha. The three-factor solution of REPS was confirmed (RMSEA = .077, CFI = .99, TLI = .99). Measurement invariance was supported for parents' psychological distress levels (difference between configural and scalar models: RMSEA = .007, ΔCFI = −.001, ΔTLI = .003), and across parents' sex (difference between configural and scalar models: ΔRMSEA = .011, ΔCFI < −.001, ΔTLI = −.003). Thus, the comparison of the latent means of REPS across parents' distress levels and sex was supported. The scale provided good internal consistency (Cronbach's Alpha was .78 or higher) and concurrent validity with measures of parenting practices (e.g., the correlation between adaptive strategies and positive parenting practices was r = .37) and parents' psychological distress (e.g., the correlation between adaptive strategies and psychological distress was r = −.33). The results are consistent with previous literature, and their implications are discussed.
{"title":"Validation of the Romanian version of the regulating emotions in parenting scale: psychometric properties and measurement invariance across mothers and fathers and across parents' psychological distress levels","authors":"Costina-Ruxandra Poetar , Ionuț Stelian Florean","doi":"10.1016/j.ssmmh.2025.100514","DOIUrl":"10.1016/j.ssmmh.2025.100514","url":null,"abstract":"<div><div>The present study aimed to investigate the psychometric properties, factorial structure, and measurement invariance of the Romanian version of the Regulating Emotions in Parenting (REPS) scale. This was a cross-sectional study conducted in Romaniawith parents (N = 1566, <em>M</em><sub>age</sub> = 40.84 years, <em>SD</em> = 6.42) of children and adolescents aged 8–17 years old. Psychometric properties were tested via Confirmatory Factor Analysis (CFA), Multigroup CFA, Pearson's correlation, and Cronbach's alpha. The three-factor solution of REPS was confirmed (RMSEA = .077, CFI = .99, TLI = .99). Measurement invariance was supported for parents' psychological distress levels (difference between configural and scalar models: RMSEA = .007, ΔCFI = −.001, ΔTLI = .003), and across parents' sex (difference between configural and scalar models: ΔRMSEA = .011, ΔCFI < −.001, ΔTLI = −.003). Thus, the comparison of the latent means of REPS across parents' distress levels and sex was supported. The scale provided good internal consistency (Cronbach's Alpha was .78 or higher) and concurrent validity with measures of parenting practices (e.g., the correlation between adaptive strategies and positive parenting practices was r = .37) and parents' psychological distress (e.g., the correlation between adaptive strategies and psychological distress was r = −.33). The results are consistent with previous literature, and their implications are discussed.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100514"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-24DOI: 10.1016/j.ssmmh.2025.100483
Alexandra Malia Jackson , Adrienne Dillard , B. Puni Kekauoha , Mahealani Mahiai Austin , Pokiʻi Balaz , Errol Kiaʻi Lee , Natlie Dutro , Paige Mayeda , Angeliyah Kahoku Dutro , Kelly O'Sullivan , Jordan P. Lewis , Scott K. Okamoto , Kenneth Hepburn , Raven H. Weaver
Caregiving interventions can reduce caregiver burden and promote caregiver competence, yet caregiving is rooted in culture, with differing impacts of the caregiving role. Culturally adapted interventions may better address the unique experiences of diverse family caregivers. In this exploratory study, we aimed to adapt the Savvy Caregiver Program (SCP), an evidence-based caregiving intervention, with a Native Hawaiian community in Hawaiʻi. First, a community action board (CAB) and research team tailored the curriculum to include Hawaiian values, language, proverbs and examples while maintaining the program core components. Then, Native Hawaiian adults participated in the preliminary adapted program, ʻAuamo Kuleana O Nā Maʻi Poina (ʻAuamo Kuleana). We describe the experiences of caregiving for a Native Hawaiian adult living with ADRD and how we obtained feedback to refine ‘Auamo Kuleana prior to pilot testing. Individuals who participated in the 7-week session of ʻAuamo Kuleana (N = 6) were asked to complete a survey and a focus group or interview to share their experiences and provide feedback that informed a process evaluation of the program. The CAB and research team analyzed qualitative data using thematic analysis. Only one participant was actively providing care; the other five participants were interested in proactive training to support their community. Caring as a community was a common theme. Participants shared positive feedback about ʻAuamo Kuleana and participants appreciated the tailored content. As such, no changes were made to the program. Two suggestions were identified: include all family members in the program to be in alignment as a ʻohana (family) in providing care and add information about planning for their own care. Future Native Hawaiian-focused caregiving interventions should consider incorporating cultural practices and values, proactive training about dementia and caregiving, caring as a community, and family-centered (rather than dyadic) caregiving.
{"title":"Caring for loved ones as community: Supporting caregivers of Native Hawaiians living with dementia","authors":"Alexandra Malia Jackson , Adrienne Dillard , B. Puni Kekauoha , Mahealani Mahiai Austin , Pokiʻi Balaz , Errol Kiaʻi Lee , Natlie Dutro , Paige Mayeda , Angeliyah Kahoku Dutro , Kelly O'Sullivan , Jordan P. Lewis , Scott K. Okamoto , Kenneth Hepburn , Raven H. Weaver","doi":"10.1016/j.ssmmh.2025.100483","DOIUrl":"10.1016/j.ssmmh.2025.100483","url":null,"abstract":"<div><div>Caregiving interventions can reduce caregiver burden and promote caregiver competence, yet caregiving is rooted in culture, with differing impacts of the caregiving role. Culturally adapted interventions may better address the unique experiences of diverse family caregivers. In this exploratory study, we aimed to adapt the Savvy Caregiver Program (SCP), an evidence-based caregiving intervention, with a Native Hawaiian community in Hawaiʻi. First, a community action board (CAB) and research team tailored the curriculum to include Hawaiian values, language, proverbs and examples while maintaining the program core components. Then, Native Hawaiian adults participated in the preliminary adapted program, ʻAuamo Kuleana O Nā Maʻi Poina (ʻAuamo Kuleana). We describe the experiences of caregiving for a Native Hawaiian adult living with ADRD and how we obtained feedback to refine ‘Auamo Kuleana prior to pilot testing. Individuals who participated in the 7-week session of ʻAuamo Kuleana (<em>N</em> = 6) were asked to complete a survey and a focus group or interview to share their experiences and provide feedback that informed a process evaluation of the program. The CAB and research team analyzed qualitative data using thematic analysis. Only one participant was actively providing care; the other five participants were interested in proactive training to support their community. Caring as a community was a common theme. Participants shared positive feedback about ʻAuamo Kuleana and participants appreciated the tailored content. As such, no changes were made to the program. Two suggestions were identified: include all family members in the program to be in alignment as a ʻohana (family) in providing care and add information about planning for their own care. Future Native Hawaiian-focused caregiving interventions should consider incorporating cultural practices and values, proactive training about dementia and caregiving, caring as a community, and family-centered (rather than dyadic) caregiving.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100483"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-06DOI: 10.1016/j.ssmmh.2025.100467
Marco Thimm-Kaiser, Katherine M. Keyes
{"title":"Small effects, big questions: the unfinished business of social media restriction science","authors":"Marco Thimm-Kaiser, Katherine M. Keyes","doi":"10.1016/j.ssmmh.2025.100467","DOIUrl":"10.1016/j.ssmmh.2025.100467","url":null,"abstract":"","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100467"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-04DOI: 10.1016/j.ssmmh.2025.100561
Ram P. Sapkota , Vanessa Peynenburg , Blake F. Dear , Nick Titov , Heather D. Hadjistavropoulos
Disorder-specific Internet-delivered cognitive behavioral therapy (ICBT) for Adjustment Disorder (AD) has shown moderate effect sizes but may lack scalability in routine care, where clients present with diverse concerns. Transdiagnostic ICBT, which targets common emotional and behavioral difficulties regardless of diagnosis, may offer a more scalable solution. This study explored the utility of a transdiagnostic ICBT course for individuals with high AD symptoms. Between June 15th, 2022, and June 19th, 2023, 585 participants (72.1 % women; 83.2 % White) who completed a therapist-guided, transdiagnostic ICBT course and met the inclusion criteria for the present study were included in the analysis. AD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up using the Adjustment Disorder–New Module 8 (ADNM-8). At pre-treatment, 356 (60.9 %) of participants scored above the clinical cut-off (>23) on the ADNM-8. Large within-group reductions in AD symptoms were observed from pre-to post-treatment (Cohen's d = 1.31, 95 % CI [1.13, 1.48]) and pre-treatment to follow-up (d = 1.61, 95 % CI [1.41, 1.81]). Approximately 70 % of participants with high AD symptoms scored below the cut-off at post-treatment, increasing to 75 % at follow-up. Treatment engagement and satisfaction were high across groups, with 76.9 % completing four or more lessons and 81.5 % reporting overall satisfaction. Transdiagnostic ICBT appears to be a useful and acceptable treatment for individuals with high AD symptoms. Symptom improvement was comparable to those from disorder-specific interventions. The high number of self-reported AD symptoms highlights the need for early identification and scalable treatment options in routine care.
针对适应障碍（AD）的特定网络认知行为疗法（ICBT）已显示出中等效果，但在常规护理中可能缺乏可扩展性，因为客户存在不同的关注点。跨诊断ICBT针对的是常见的情绪和行为困难，而不考虑诊断，它可能提供一个更可扩展的解决方案。本研究探讨了跨诊断ICBT课程对AD高症状个体的效用。在2022年6月15日至2023年6月19日期间，585名参与者（72.1%为女性，83.2%为白人）完成了治疗师指导的跨诊断ICBT课程，并符合本研究的纳入标准。使用调整障碍-新模块8 （ADNM-8）在治疗前、治疗后和3个月的随访中评估AD症状。在治疗前，356名（60.9%）参与者在ADNM-8上的得分高于临床临界值（>23）。从治疗前到治疗后（Cohen’s d = 1.31, 95% CI[1.13, 1.48]）和治疗前到随访期间（d = 1.61, 95% CI [1.41, 1.81]）， AD症状在组内显著减轻。大约70%的阿尔茨海默病症状高的参与者在治疗后得分低于临界值，在随访中增加到75%。各组的治疗参与度和满意度都很高，76.9%的人完成了四个或更多的课程，81.5%的人报告了总体满意度。跨诊断ICBT似乎是一种有用的和可接受的治疗个体的高AD症状。症状改善与疾病特异性干预相当。大量自我报告的阿尔茨海默病症状突出了在常规护理中早期识别和可扩展治疗方案的必要性。
{"title":"Exploring the utility of transdiagnostic internet-delivered cognitive behavioral therapy for symptoms of adjustment disorder: A longitudinal observational study in a routine online care setting in Western Canada","authors":"Ram P. Sapkota , Vanessa Peynenburg , Blake F. Dear , Nick Titov , Heather D. Hadjistavropoulos","doi":"10.1016/j.ssmmh.2025.100561","DOIUrl":"10.1016/j.ssmmh.2025.100561","url":null,"abstract":"<div><div>Disorder-specific Internet-delivered cognitive behavioral therapy (ICBT) for Adjustment Disorder (AD) has shown moderate effect sizes but may lack scalability in routine care, where clients present with diverse concerns. Transdiagnostic ICBT, which targets common emotional and behavioral difficulties regardless of diagnosis, may offer a more scalable solution. This study explored the utility of a transdiagnostic ICBT course for individuals with high AD symptoms. Between June 15th, 2022, and June 19th, 2023, 585 participants (72.1 % women; 83.2 % White) who completed a therapist-guided, transdiagnostic ICBT course and met the inclusion criteria for the present study were included in the analysis. AD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up using the Adjustment Disorder–New Module 8 (ADNM-8). At pre-treatment, 356 (60.9 %) of participants scored above the clinical cut-off (>23) on the ADNM-8. Large within-group reductions in AD symptoms were observed from pre-to post-treatment (Cohen's <em>d</em> = 1.31, 95 % CI [1.13, 1.48]) and pre-treatment to follow-up (<em>d</em> = 1.61, 95 % CI [1.41, 1.81]). Approximately 70 % of participants with high AD symptoms scored below the cut-off at post-treatment, increasing to 75 % at follow-up. Treatment engagement and satisfaction were high across groups, with 76.9 % completing four or more lessons and 81.5 % reporting overall satisfaction. Transdiagnostic ICBT appears to be a useful and acceptable treatment for individuals with high AD symptoms. Symptom improvement was comparable to those from disorder-specific interventions. The high number of self-reported AD symptoms highlights the need for early identification and scalable treatment options in routine care.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100561"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-11DOI: 10.1016/j.ssmmh.2025.100506
Fiona C. Thomas , Katherine McGuire , Ophélie Ng Ha Kwong , Puneet K. Parmar , Bee Goldgruber , Shannon Doherty , Nuwan Jayawickreme , Karen Milligan , Giselle Dass , Sambasivamoorthy Sivayokan , Rajendra Surenthirakumaran
Perinatal stress is a well-established risk factor for maternal and child health outcomes. Pregnant women in conflict-affected countries experience unique traumatic stressors, including displacement, material loss, loss of loved ones, and other war-related stressors. This qualitative study examines maternal mental health and parenting practices in Northern Sri Lanka, a region impacted by decades of civil war and displacement. Participants included 34 mothers who were pregnant at the time of the study, have one or more young children, and resided in the Northern Province during the conflict in Sri Lanka. The study explores the interrelationship between early adversity, chronic stressors, and maternal well-being. Qualitative insights highlight themes of unsupported resilience, emotion regulation amidst chronic stressors, and the erosion of traditional community support systems. Mothers reported navigating isolation within nuclear family structures, compounded by societal pressures and diminished communal trust. Despite these challenges, participants emphasized the importance of parenting values rooted in resilience and fostering an appreciation for overcoming hardship as they raise their own children. The study underscores the critical need for culturally sensitive, family-centered interventions that address maternal mental health and support parenting in post-conflict settings. These findings provide a foundation for tailoring maternal and child health policies to the unique needs of war-affected communities in Sri Lanka and beyond.
{"title":"From villages to floating islands: A qualitative study exploring maternal experiences of support and isolation in Northern Sri Lanka","authors":"Fiona C. Thomas , Katherine McGuire , Ophélie Ng Ha Kwong , Puneet K. Parmar , Bee Goldgruber , Shannon Doherty , Nuwan Jayawickreme , Karen Milligan , Giselle Dass , Sambasivamoorthy Sivayokan , Rajendra Surenthirakumaran","doi":"10.1016/j.ssmmh.2025.100506","DOIUrl":"10.1016/j.ssmmh.2025.100506","url":null,"abstract":"<div><div>Perinatal stress is a well-established risk factor for maternal and child health outcomes. Pregnant women in conflict-affected countries experience unique traumatic stressors, including displacement, material loss, loss of loved ones, and other war-related stressors. This qualitative study examines maternal mental health and parenting practices in Northern Sri Lanka, a region impacted by decades of civil war and displacement. Participants included 34 mothers who were pregnant at the time of the study, have one or more young children, and resided in the Northern Province during the conflict in Sri Lanka. The study explores the interrelationship between early adversity, chronic stressors, and maternal well-being. Qualitative insights highlight themes of unsupported resilience, emotion regulation amidst chronic stressors, and the erosion of traditional community support systems. Mothers reported navigating isolation within nuclear family structures, compounded by societal pressures and diminished communal trust. Despite these challenges, participants emphasized the importance of parenting values rooted in resilience and fostering an appreciation for overcoming hardship as they raise their own children. The study underscores the critical need for culturally sensitive, family-centered interventions that address maternal mental health and support parenting in post-conflict settings. These findings provide a foundation for tailoring maternal and child health policies to the unique needs of war-affected communities in Sri Lanka and beyond.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"8 ","pages":"Article 100506"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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