Child and adolescent mental health problems in Tyva Republic,Russia, as possible risk factors for a high suicide rate

High rates of child mental health problems in the Russian Federation have recently been documented; the rates of youth suicide are among the highest in the world. Across the Russian regions, Republic of Tyva has one of the highest rates of child and adolescent suicide and the lowest life expectancy at birth. The aim of this study was to investigate the prevalence and associations of mental health problems in Native Tyvinian children and adolescents using internationally recognised measures and diagnoses. A two-stage, two-phase design involved selection of schools in five rural settlements in Western Tyva and two schools in the capital city followed by selection of Native Tyvinian children in grades 3–4 (ages 9–10) and 6–7 (ages 14–15). In the first phase, a screening measure of psychopathology, the Rutter Teacher Questionnaire, was obtained on 1048 children with a 97 % participation rate. In the second phase, more detailed psychiatric assessments were carried out for subgroups of screen-positive and screen-negative children. The prevalence of mental health problems was about 25 %, ranging from 40 % in adolescent boys from rural areas to 9 % in adolescent girls from the city. The patterning of disorders and risk factors were similar to those in other countries, rural areas were associated with an increased risk of psychopathology. The findings indicate that there is an urgent need for interventions to reduce risk in this population and provide effective help for Tyvinian children and adolescents with mental health problems.     

Self-labelling and stigma as predictors of attitudes towards help-seeking among people at risk of psychosis: 1-year follow-up

Mental health service use is helpful but rare among young people at risk of psychosis. The label and stigma associated with mental illness may affect attitudes towards help-seeking. We examined 67 individuals at risk of psychosis over the course of 1 year. An increase of self-labelling as “mentally ill” predicted more positive attitudes towards psychiatric medication, while increased perceived stigma and the cognitive appraisal of stigma as a stressor predicted poorer attitudes towards psychotherapy after 1 year. Early intervention could improve non-stigmatizing awareness of at-risk mental state and reduce the public stigma associated with at-risk status to facilitate help-seeking.     

Help-seeking and pathways to care in the early stages of psychosis

Purpose

Delay in the treatment of a first psychotic episode can have a negative influence on the future course of the disease. In this context, it is important to examine pathways to care to understand factors contributing to delay in access to adequate care.

Methods

Using the Basel Interview for Psychosis, we examined the help-seeking behaviour of 61 individuals with an at-risk mental state for psychosis and 37 patients with a first episode of psychosis in a low threshold health care system as part of the Basel early detection of psychosis study.

Results

The median duration of untreated illness was 3.4 years, of untreated psychosis 12 months. Eighty-six percent of all individuals sought help of some kind before reaching our specialised early detection outpatient clinic, with a mean number of help-seeking contacts of 1.5 prior to referral. The most frequent first help-seeking contacts were family members or relatives n = 24 (26.7 %), close friends n = 17 (17.9 %), psychiatrists in private practice n = 13 (14.4 %) or general practitioners n = 11 (12.2 %). Most patients consulted other health professionals in the early course of the illness before reaching our specialised service; help-seeking with non-medical institutions was rare. Women had more help-seeking contacts than men before contact with our early detection clinic.

Conclusions

Family, close friends and medical professionals play an important role in help-seeking leading to specialised psychiatric care. Men seek help less often; specific strategies for encouraging young, at-risk men to seek help should be developed.     

Help-seeking for child psychopathology: pathways to informal and professional services in the Netherlands

OBJECTIVE: To devise and test a model describing the process of help-seeking for child psychopathology in professional and informal service settings. METHOD: Using structural equation modeling, associations between several help-seeking stages, and the influence of child, family, and context characteristics on these stages were investigated in 246 Dutch children (4-11 years old) between April 2000 and July 2002. Children were selected for having emotional or behavioral problems from a representative general practice sample; 68% of the selected children participated. RESULTS: School personnel played an important role in the process of help-seeking for child psychopathology, in both detecting service need and the provision of and the referral for help. Although Dutch general practitioners are supposed to be gatekeepers of mental health care, their role in help-seeking for child psychopathology was limited. Various family characteristics were shown to influence service need and informal or professional help-seeking. The influence of child characteristics on the help-seeking process was limited. CONCLUSIONS: Educating parents about child psychopathology and the availability and accessibility of care, improving general practitioners' skills in detecting child psychopathology, and direct contact of mental health professionals with general practitioners and schools may enhance access to care for children in need.     

The distribution of self-reported psychotic-like experiences in non-psychotic help-seeking mental health patients in the general population; a factor mixture analysis

Purpose

Factor mixture analysis (FMA) and item response mixture models in the general population have shown that the psychosis phenotype has four classes. This study attempted to replicate this finding in help-seeking people accessing mental health services for symptoms of non-psychotic mental disorders.

Methods

All patients (18–35 years old) referred for non-psychotic mental health problems to the secondary mental healthcare service in The Hague between February 2008 to February 2010 (N = 3,694), were included. Patients completed the Prodromal Questionnaire (PQ). Hybrid latent class analysis was applied to explore the number, size and symptom profiles of the classes.

Results

The FMA resulted in four classes. Class 1 (N = 1,039, 28.1 %) scored high on conceptual disorganization, inattention and mood disorder. Patients in Class 2 (N = 619, 16.8 %) endorsed almost all PQ-items, were more often screened as being psychotic or at high risk of developing psychosis, without care takers noticing. In Class 3 (N = 1,747, 47.3 %) perplexity, paranoia and negative symptoms were more prevalent. Patients were more often at high risk of developing psychosis. Class 4 (N = 286, 7.7 %) represented the ‘normative’ group with low probabilities for all items.

Discussion

The results support the hypothesis that a representation in four classes of psychotic-like experiences can also be applied in a help-seeking population.     

Depression and social anxiety in help-seeking patients with an ultra-high risk for developing psychosis

Knowledge on associations between ultra-high risk (UHR) for developing psychosis and on non-psychotic psychopathology in help-seeking populations is limited with respect to differences between male and female patients. The present study tests the hypothesis that both social anxiety and depression are highly prevalent in an UHR population, particularly among women. From February 2008 to February 2010 baseline data were collected from help-seeking subjects (14–35 years) who were included in the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Two recruiting strategies were used: a two-stage screening strategy in a population of consecutive help-seeking and distressed subjects of secondary mental health services, and a referral strategy. This study included 201 patients with a mean age of 22.7 years. Of these, 102 (51%) were female, 58% of the patients met the criteria for clinical depression on the Beck Depression Inventory and 42% met the criteria for clinical social phobia on the Social Interaction Anxiety Scale. Women showed more depression and social anxiety than men. The results support the hypothesis that UHR is associated with depression and social anxiety, particularly in women. Screening a help-seeking population with depression and anxiety may be effective in detecting patients at UHR for developing psychosis.     

‘It just doesn’t feel right’: a mixed methods study of help-seeking in Irish schools

Schools are a key setting for mental health promotion and the provision of emotional support to students. As teachers and school counsellors are adults with whom adolescents have regular contact, it is likely they would be used as a help source by distressed students however there are few studies on this from an Irish context. A mixed methods design was used to identify the extent of adolescent help-seeking in addition to exploring what influences a young person’s decision to seek help in school. Findings generated through surveys (N = 856) and four focus group interviews (N = 35) with adolescents indicate that young people do not regard teachers and school counsellors as a potential help source. Barriers to seeking help include dislike of the dual role of counsellor/teacher and concerns about confidentiality. The provision of independent school counselling and increased mental health education were identified as factors that might increase help-seeking in school.     

Family structure, marital discord and offspring’s psychopathology in early adulthood: a prospective study

With marital breakdown and discord relatively common, we examined whether family structure and the quality of marital relationship have a long-term impact on offspring’s psychopathology in early adulthood. This study aimed to examine the association of family structure and marital discord in the family with a wide range of offspring’s mental health and problem behaviours at 21 years. Data were from the Mater-University of Queensland Study of Pregnancy, a population based birth cohort study, which commenced in Brisbane, Australia in 1981. Mothers and children were followed up at birth, 6 months and 5, 14 and 21 years after the initial interview. Marital status and marital quality were assessed at the 14 year follow-up. Young Adult Self-Report sub-scales of mental health and problem behaviours were measured at the 21-year follow-up. Type of family structure and the quality of marital relationship (at the 14-year follow-up) predicted offspring’s psychopathology at 21 years. When a selected group of confounding factors were included in the multivariate analyses, children who lived with a step-father, un-partnered mother, or in families where parents had conflict in marital relationship reported higher symptoms of psychopathology at 21 years. The association between marital problems and young adult psychopathology does not appear to be confounded by a wide range of confounding variables. Further research is needed to explore the mechanism of these associations to develop preventive programmes.     

Improving the recognition of depression in adolescence: can we teach the teachers?

This study evaluated the effectiveness of a schools-based psychoeducational intervention designed to help teachers recognize the symptoms of clinical depression in their adolescent pupils. Around 151 teachers in eight high schools in Scotland, UK were randomly assigned to experimental and control groups and all received training on depression. The ability of the experimental teachers to report which pupils were depressed was compared with the control group whose reporting task occurred before they had received training. The teachers were reporting on 2262 pupils who had been independently screened for clinical depression using a two-stage screening procedure with the Mood and Feelings Questionnaire (MFQ) and semi-structured clinical interview (K-SADS). Systematic evaluation showed that training teachers with this package did not improve their ability to recognize their depressed pupils. Recognizing depressive illness in adolescence is one of the main public health challenges for adolescent mental health services and this study adds to the growing literature on the difficulties in achieving this.     

The different stages and actors involved in the process leading to the use of adolescent mental health services

Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12-17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.     

Adolescents with mental health problems: what do they say about health services?

This study explored the health-related views and experiences of adolescent users of mental health services through semi-structured interviews with 32 14-20-year olds who had been diagnosed with a mental illness. The majority of respondents had both negative and positive things to say about their contact with health services. These relate to: the doctor-patient relationship, treatment received, the health-care system, and the environs of the hospital or clinic. The views and experiences of young people with regard to their health care must be taken into account in efforts to boost help-seeking, attendance and compliance rates and, generally, to improve child and adolescent mental health services. In particular, further attention needs to be given to the development of empathic communication skills by health professionals working with adolescents with mental health problems. Work on the health-related views and experiences of representative samples of young people with mental health problems should be prioritized.     

Russian child mental health A cross-sectional study of prevalence and risk factors

Abstract Background The fall of communism and subsequent economic crises have been followed by major social and health problems. High rates of child mental health problems are frequently cited by the Russian media, though there is little relevant evidence. Aims The aim of this study was to investigate the prevalence and associations of child mental health problems in Russia using internationally recognised measures and diagnostic systems. Method A two-stage, two-phase cross-sectional survey of the mental health of 7- to 14-year-olds involved random sampling of schools, followed by random sampling of pupils from school lists. A sample of 448 children was obtained, representing an 83% participation rate. In the first phase, screening measures of psychopathology and risk were administered to parents, teachers and 11- to 14-year-olds. In the second phase, more detailed psychiatric assessments were carried out for subgroups of screen-positive and screen-negative children (N=172). Results The prevalence of psychiatric disorder was about 70% higher than that recently found in Britain with comparable measures, but there were few differences between Britain and Russia in type of disorder or key risk factors. Conclusion There is a pressing need for evidence-based mental health treatments to be made widely available to Russian children and adolescents.     

Investigating the impact of masculinity on the relationship between anxiety specific mental health literacy and mental health help-seeking in adolescent males

BackgroundPoor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship between i) anxiety mental health literacy, ii) alignment with traditional masculinity norms and iii) help-seeking attitudes, intentions and behaviour in a sample of adolescent males.Methods1732 adolescent males (aged 12–18 years) participated online whilst at school.ResultsParticipant attitudes towards formal help-seeking, intentions to seek help from a family member and from an online source were found to predict professional help-seeking behaviour by the adolescent and/or by their parents on the adolescents’ behalf. In adolescents with a low or average personal alignment with norms of hegemonic masculinity, greater anxiety mental health literacy was positively associated with more favourable attitudes towards formal and informal help-seeking. However, this relationship was not found in adolescent males with a greater alignment with norms of hegemonic masculinity.LimitationsThe study had a correlational research design and used self-report measures.ConclusionsMental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population.     

Help seeking for emotional and behavioural problems in children and adolescents

In order to understand the discrepancy between rates of child and adolescent psychopathology and rates of mental health service use, variables influencing the help-seeking process need to be investigated. The present article aims to extend and refine previous findings by reviewing 47 recent empirical studies on parental and adolescent problem recognition and help seeking, and problem recognition by the general practitioner (GP). Several variables (child age, the presence of medical and school-related problems, informal help seeking, past treatment of parents or relatives, family size, and type of maltreatment) were discovered to influence parental/adolescent problem recognition and/or help seeking,while refinements were found for the effects of type of psychopathology, child gender, adolescent attitudes and personality, parental psychopathology, social support, and sociodemographic variables. Although recent studies uncovered several determinants of problem recognition by the GP (child gender, age, past treatment, academic problems, family composition, life events, type of visit, and acquaintance with child), this aspect of the help-seeking pathway remains relatively uncharted and, therefore, needs to be the focus of future research.     

Service use in adolescents at risk of depression and self-harm: prospective longitudinal study

Purpose

Although depression and self-harm are common mental health problems in adolescents, there are barriers to accessing help. Using a community-based sample, this study investigates predictors of service contacts for adolescents at high risk of depression and self-harm.

Methods

Three thousand seven hundred and forty-nine (3,749) 12- to 16-year-olds in UK secondary (high) schools provided baseline and 6 months’ follow-up data on mood, self-harm and service contacts with a range of primary and secondary healthcare services.

Results

Although most adolescents at high risk of depression or self-harm had seen their general practitioner (GP) in the previous 6 months, less than one-third had used primary or secondary healthcare services for emotional problems. 5 % of adolescents who reported self-harm had seen specialist child and adolescent mental health services in the previous 6 months. In longitudinal analyses, after adjustment for confounders, both depression and self-harm predicted the use of any healthcare services [adjusted odds ratio (AOR) = 1.34 (95 % CI 1.09, 1.64); AOR = 1.38 (95 % CI 1.02, 1.86), respectively] and of specialist mental health services [AOR = 5.48 (95 % CI 2.27, 13.25); AOR = 2.58 (95 % CI 1.11, 6.00), respectively]. Amongst those with probable depression, 79 % had seen their GP and 5 % specialist mental health services in the preceding year.

Conclusions

Most adolescents at high risk of depression or self-harm see their GP over a 6-month period although only a minority of them access specialist mental health services. Their consultations within primary care settings provide a potential opportunity for their identification and for signposting to appropriate specialist services.     

Service Use by At-Risk Youths After School-Based Suicide Screening

ObjectiveWe sought to examine follow-up service use by students identified at risk for suicidal behavior in a school-based screening program and assess barriers to seeking services as perceived by youths and parents.MethodWe conducted a longitudinal study of 317 at-risk youths identified by a school-based suicide screening in six high schools in New York State. The at-risk teenagers and their parents were interviewed approximately 2 years after the initial screen to assess service use during the intervening period and identify barriers that may have interfered with seeking treatment.ResultsAt the time of the screening, 72% of the at-risk students were not receiving any type of mental health service. Of these students, 51% were deemed in need of services and subsequently referred by us to a mental health professional. Nearly 70% followed through with the screening's referral recommendations. The youths and their parents reported perceptions about mental health problems, specifically relating to the need for treatment, as the primary reasons for not seeking service.ConclusionsScreening seems to be effective in enhancing the likelihood that students at risk for suicidal behavior will get into treatment. Well-developed and systematic planning is needed to ensure that screening and referral services are coordinated so as to facilitate access for youths into timely treatment.     

Gender Differences in Factors Associated with Perceived Need and Use of Korean Adolescents Mental Health Services

This study investigated the socio-demographic characteristics and emotional and behavioral factors associated with the perceived need and actual use of adolescent mental health services according to genders in Korea. We assessed 1,857 middle school students aged 14–16 years. We administered a self-reported questionnaire including questions on their socio-demographic data, Korean Youth Self Report, and self perceived need and actual use of mental health services. Overall, 11.6 % of the adolescents demonstrated a self perceived need for mental health services regarding their emotional or behavioral problems, while 2.1 % had sought mental health services. There were discrepancies between the perceived need and actual use. Most adolescents (81.6 %) used mental health services without self-perceived need, and only 3.3 % of adolescents with self-perceived need utilized mental health services. The perceived need of mental health services is positively influenced by the adolescent’s anxious/depressed problems in both genders. The use of them is negatively influenced by the withdrawn problem in adolescent boys, while positively influenced by the aggressive behavior in adolescent girls. To increase the actual use of mental health services more attention needs to be focused on their internalizing problems, such as anxious/depressed and withdrawn problems, in addition to externalizing problems in both genders.     

An evaluation of participation in a schools-based youth mental health peer education training programme

The use of peer education has been well documented within the discipline of health promotion, but not within the youth mental health domain. This paper describes an evaluation of an innovative schools-based peer education training programme that involved preparing young people to deliver a mental health workshop to their peers. Participants (n = 30) were recruited from five post-primary schools in Ireland. After each training session (n = 4), participants completed a questionnaire assessing their reactions to training. Participants also completed measures of self-esteem, help-seeking, mental health knowledge and skills at their first and final training session, and at the end of the programme. Significant changes in participants’ presentation skills, mental health knowledge and beliefs about help-seeking were observed. Participants also reported that training was well facilitated and well timed. Overall, findings indicate participation in a schools-based mental health peer education training programme is enjoyable and beneficial for young people.     

General Self-efficacy and Its Relationship to Self-reported Mental Illness and Barriers to Care: A General Population Study

Given the prevalence of mental illness worldwide, it is important to better understand the dynamics of mental health help-seeking behavior to improve access to care. The aim of this study was to investigate if general self-efficacy (GSE) was associated with self-reported mental illness and help-seeking behavior and barriers to care in a randomized population. This study utilized a mailed questionnaire completed by 3,981 persons aged 19–64 years who resided in Western Sweden. GSE was measured and logistic regression models calculated, controlling for various sociodemographic variables. Results showed that 25 % of men and 43 % of women reported a lifetime prevalence of mental illness that they felt could have benefitted from treatment. Of those, 37 % of the men and 27 % of the women reported barriers to care. Men and women with low GSE were more likely to suffer from mental illness compared with persons high in GSE, but GSE did not enhance help-seeking behavior or perceived barriers to care. The most prevalent barriers to care for both sexes were beliefs that the illness will pass by itself, doubt whether treatment works, lack of knowledge of where to go and feelings of shame. Overall, GSE scores did not differ among those who experienced various barriers to care with the exception of two barriers only among women.     

Developing primary mental healthcare for children and adolescents

PURPOSE OF REVIEW: Governmental initiatives to enhance child and adolescent mental healthcare are giving renewed impetus to work in primary care. This review identifies and discusses critically new findings in this area. RECENT FINDINGS: Research reviews and new studies continue to highlight the burden of unidentified and hence untreated psychopathology among children attending primary care. Expression of parental concern appears to provide important help in improving recognition. Shared protocols have been developed for primary care use for clinical conditions such as attention deficit hyperactivity disorder, but adherence to protocols is still limited. Randomized controlled trials have shown the feasibility and efficacy of suitably adapted therapeutic interventions for adolescent depression in primary healthcare and in educational settings. Surveys indicate a significant amount of child and adolescent mental health work by social services in countries such as the UK, and attest to the usefulness of protocols to attend to children in foster care. The new role of primary mental health worker has the potential to help support the interface between primary and specialist child and adolescent mental health services. SUMMARY: There is increased interest in further clarifying and enhancing the role of primary care child and adolescent mental health services.