Identifying adolescents at risk through voluntary school-based mental health screening

This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66-70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52-8.73) or community-based services (AOR: 20.02 95%CI 2.66-150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.     

School-Based Screening: A Population-Based Approach to Inform and Monitor Children’s Mental Health Needs

School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.     

Post-disaster service provision following proactive identification of children with emotional distress and depression

OBJECTIVE: Proactive, school-based psychological testing for emotional distress and depression was employed 6 months after a bushfire disaster. The service provision aim was to provide children with the greatest emotional distress the relatively limited therapeutic resources available in the post-disaster environment. Specific hypotheses were tested: that the prevalence of emotional distress and depression would be elevated 6 months post disaster; that emotional distress would be correlated with traumatic events; and that depression would be related to experiences of loss. METHOD: Six months after a bushfire disaster grade 4, 5, and 6 students (n = 601) participated in screening using a test battery measuring emotional distress, depressive symptoms and trait anxiety. RESULTS: Twelve percent (n = 72) of children experienced severe emotional distress 6 months after the bushfire. Rates of depression were similar to rates in non-traumatised child community samples. Multivariate analysis suggested that emotional distress was significantly associated with trait anxiety, evacuation experience, the perception that parents may have died during the bushfire, and depressive symptoms. Depressive symptoms were associated with total distress score, trait anxiety and perception of threat to the parents. CONCLUSIONS: Substantial mental health morbidity was identified 6 months after a bushfire disaster. The usefulness of post-disaster service provision influenced by proactive screening is discussed and reasons for further research highlighted.     

Bullying victimization and emotional distress: is there strength in numbers for vulnerable youth?

ObjectiveThe present study examines whether the prevalence of vulnerable peers in school protects the emotional health of youth who are lesbian, gay, bisexual or questioning (LGBQ), overweight, or have a disability, and if the adverse emotional effects of bullying victimization are mitigated by the presence of these peers.MethodsSurvey data come from a large school-based sample of adolescents attending 505 schools. The primary independent variable was the percent of students in school with each vulnerability characteristic. Multilevel logistic regression models estimated the odds of internalizing problems, self-harm, suicidal ideation and suicide attempts among students who were LGBQ, overweight or had a disability. Cross-level interaction terms were added to determine if the association between being victimized and emotional distress was moderated by the presence of vulnerable peers.ResultsGreater presence of similar students was, on average, protective against emotional distress for LGBQ girls and overweight boys. In contrast, greater presence of students with a disability was, on average, a risk factor among girls with a disability. Several tests of effect modification indicated that odds of emotional distress for those who had been victimized were lower in schools with a higher proportion of vulnerable youth.ConclusionsThe presence of a similar peer group may increase the likelihood that a bystander or witness to bullying will react in a helpful way. School personnel, health care providers and other youth service professionals should inquire about social relationships at school, including experiences of harassment and perceptions of peer support, to buffer negative experiences.     

Online health promotion, early identification of difficulties, and help seeking in young people

OBJECTIVE: To examine the use and impact of a dedicated health information Web site for adolescents. METHOD: Five hundred fifty-eight (27.2%) of all students in grades 7 through 12 from 4 schools logged onto the Web site; 1775 (86.4%) of all students in these grades completed a year-end health survey, with 455 (81.5%) of the students who used the Web site completing the survey. Dependent variables were help seeking and satisfaction ratings plus visits to specific Web site sections. Predictor variables were demographic characteristics, mental health, and psychosocial difficulties assessed at years' end. RESULTS: Students logged on >11,000 times during the year. Female students, students wanting professional help, those scoring higher on depressive vulnerability measures, and students reporting more severe mood problems were related to logging on frequently over longer periods of time, as well as viewing information sheets, posting and viewing questions and answers, and completing the symptom screen. Students accessing the Web site from 1 to 7 A.M. reported higher levels of distress than did students who accessed the Web site at other times of the day. Visits to the Web site were positively associated with visits to school health centers and guidance counselors and referrals to a health professional. CONCLUSIONS: Results are consistent with a health-needs model of utilization of this Internet-based health resource. A school-based health information Web site holds significant promise for health promotion and early self-identification for emotional problems.     

Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach

Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools’ service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing “compensatory approaches” designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems’ decision-making about the adoption of a new school mental health service.     

Factors Associated with Mental Health Service Need and Utilization among Unaccompanied Refugee Adolescents

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.     

上海市中学生对心理卫生问题的知晓度调查

目的 了解并比较上海初中生与高中生对心理卫生问题的知晓情况。方法 采用儿童心理卫生知晓问卷和长处与困难问卷（SDQ）对737名中学生进行了研究。结果 初中生在同伴交往和社会行为方面问题多于高中生组。高中生在情绪、注意力上问题多于初中生。高中生对严重心理卫生问题的识别力高于初中生。初中生和高中生对服药和与人谈论来解决心理问题的方法都不认可,尤其是高中生。都认为家庭对心理卫生问题的影响很大,初中生更相信他们的父母能发现并帮助他们解决心理问题,而高中组中则相反。结论 上海初中生和高中生对心理卫生问题的知晓情况存在差别。     

Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study

Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the UK. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4 %) scored above cut-offs for emotional and behavioural problems, 34.6 % for anxiety and 23.4 % for depression. Ordinary least squares regression indicated a significant dose–response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.     

Evaluation of universal screening for military-related sexual trauma

OBJECTIVES: In response to growing concerns about sexual violence as an underrecognized traumatic consequence of military service, Veterans Health Administration policy requires universal screening for sexual trauma sustained during military service. This prospective study, the first to evaluate national efforts to screen for military sexual trauma, investigated whether sexual trauma screening is associated with increased utilization of mental health services. METHODS: This study examined data for all male (N=540,381) and female (N=33,259) veterans who had valid responses to screens for military sexual trauma in 2005. The use of mental health services during the three months after screening was examined for persons who screened positive for military sexual trauma and for those who screened negative. Findings were stratified by use of mental health services in the six months before the screening. RESULTS: Compared with negative screens, positive screens were associated with significantly increased rates of postscreen mental health treatment. A more than twofold increase was observed for patients without previous use of mental health treatment (women: relative risk [RR]=2.52, 95% confidence interval [CI]= 2.38-2.66; men: RR=2.47, 95% CI=2.34-2.61). In this group, the number of positive screens needed for one additional patient to access treatment was 5.5 for women and 7.2 for men. CONCLUSIONS: Our findings suggest that detection via screening is associated with increased rates of mental health treatment. An effective screening program that promotes detection of sexual trauma and access to mental health care can help to reduce the burden of psychiatric illness for those who have experienced military sexual trauma.     

Effects of School-Based Mental Health Programs on Mental Health Service Use by Adolescents at School and in the Community

Many schools provide counseling to adolescents with behavioral and emotional problems on-site, but little is known about the use of school-based counseling services in the United States, and it is unclear whether these services complement or substitute for counseling services available outside of school. In this study data on mental health services offered in schools are used to estimate the probability of receiving emotional counseling at school and elsewhere. Where mental health services were available on-site, students were substantially more likely to see a counselor in the previous year, controlling for mental health status, health insurance coverage, and other factors. The effects of availability were greater for students enrolled in special education programs than for other students. However, these data also suggest that, relative to other schools, schools offering on-site mental health counseling do not increase or reduce use of counseling services outside of school on average.     

Intentional,explicit, systematic: Implementation and scale-up of effective practices for supporting student mental well-being in Ontario schools

Increasingly, the potential for school mental health programming to enhance the well-being of children and youth is being recognized and realized. When evidence-based practices in mental health promotion and prevention are adopted in a whole school manner, students show positive social emotional and academic benefits. These findings have stimulated a proliferation of mental well-being programming for Canadian schools, with variability across offerings in terms of supporting evidence, costs and ease of implementation. In the absence of coordination and guidance, there has been uneven uptake of high-quality programming, resulting in a patchwork of sometimes competing efforts across our country. In order to build cohesive and sustainable evidence-based programming, intentional, explicit and systematic effort must be afforded to matters of implementation and scale-up. In Canada, School Mental Health ASSIST has been developed to provide leadership, implementation support and embeddable resources to the province of Ontario’s 72 school districts, and 5000 schools, with a view to ensuring long-term sustainability of best-in-class school mental health practices. Key elements for uptake and scale-up are described, with an implementation science lens and an emphasis on aspects that are generalizable across jurisdictions.     

A dual-factor model of mental health: toward a more comprehensive understanding of youth functioning

Traditional mental health models focus on psychological problems and distress; accordingly, health is viewed as the absence of illness or disability. In contrast, a dual-factor model of mental health incorporates both indicators of positive subjective well-being (SWB) and measures of psychopathological symptoms to comprehensively determine an individual's psychological adjustment. This study used such a dual-factor model to measure the mental health status of young adolescents. A total of 764 middle school students were classified into one of four distinct groups based on having high or low psychopathology and high or low SWB. Furthermore, group differences in student engagement, academic achievement, and environmental support for learning were investigated. Results demonstrated the existence of a traditionally neglected group of adolescents (low SWB and low psychopathology) who are nonetheless at risk for academic and behavior problems in school and who performed no better than the most troubled group of adolescents. Overall, both the presence of positive well-being and the absence of symptoms were necessary for ensuring the most advantageous school performance. These results highlight the importance of incorporating positive indicators of well-being along with traditional negative factors in more fully understanding relationships between individuals' mental health and educational outcomes.     

团体心理干预对初中生自我概念与心理健康的影响

目的 探讨团体心理干预对初中生自我概念与心理健康的影响.方法 采用自我描述问卷和中学生心理健康量表对上海市松江区146名初中生进行测查.将学生随机分为两组,对照组进行学校的常规开展的心理健康课程,实验组在此基础上合并参加每周1次共6次的团体心理辅导.干预后1周对所有的学生再次进行自我描述问卷和中学生心理健康量表的测量.结果 两组被试干预前自我概念与心理健康总均分及各因子分差异均无统计学意义.实验组在干预后自我概念总分、外貌、一般自我、诚实可信、情绪稳定、一般学校情况、与同性关系、与异性关系评分高于对照组,心理健康总均分、敌对、焦虑、情绪不平衡评分低于对照组,差异均有统计学意义（P＜0.05）.对照组干预前后评分结果差异均无统计学意义.实验组干预后自我概念总分、外貌、一般自我、情绪稳定、一般学校情况因子分高于干预前,而心理健康总均分、偏执、敌对、抑郁、焦虑、学习压力、适应不良、情绪不平衡、心理不平衡因子分低于干预前,差异均有统计学意义（P＜0.05）.结论 团体心理干预能有效提高初中生自我概念及心理健康水平.     

中学生心理卫生状况调查及相关因素分析

目的：研究中学生心理健康水平及影响因素。方法：以群体分层抽样法，共抽取受试样本2066例。采用症状自评量表（SCL-90）、艾森克个性问卷（EPQ）、青少年心理卫生调查表（自编），对宝鸡市12所中学初一至高三的六个年级的中学生进行问卷调查。结果：表明约9％的中学生有心理健康问题。中学生心理健康问题依次为强迫、人际关系敏感、敌对、偏执、抑郁、焦虑等。偏相关分析发现中学生心理健康水平与神经质、精神质、年级、学习任务、性别等呈正相关。结论：中学生心理健康值得高度重视；神经质与精神质的个性倾向、年级、学习任务等是影响中学生心理健康的重要因素。     

The relationship between perceived stress and emotional distress during the COVID-19 outbreak: Effects of boredom proneness and coping style

The outbreak of a novel coronavirus (COVID-19) pandemic was a great threat to the physical and mental health of the general population. Our research aimed to investigate the relationship between perceived stress and emotional distress during the initial outbreak. Furthermore, potential risks and protective factors, i.e., coping and boredom proneness, of stress-related emotional distress were also explored. Data from 3233 participants in China were collected through an online survey platform during the initial outbreak of the COVID-19 from January 31 to February 9 in 2020. Results showed that higher perceived stress was associated with more emotional distress including depression, fear, compulsion-anxiety, neurasthenia, and hypochondria. Boredom proneness significantly and positively mediated the relationship between perceived stress and emotional distress. Moreover, coping style moderated the stress-emotional distress relationship, i.e., individuals who mainly adopted positive coping strategies suffered fewer symptoms of depression, compulsion-anxiety, and neurasthenia under stress, while negative coping strategies aggravated emotional distress. These results from the present study provide practical value for mental health intervention during the emergent public health events.     

Exploring Psychosocial Mechanisms and Interactions: Links Between Adolescent Emotional Distress,School Connectedness,and Educational Achievement

Internalizing mental health issues are a significant developmental and clinical concern during adolescence, but rarely identified as a problem among school staff. Using data from the National Longitudinal Study of Adolescent Health, this study examined the associations between adolescent emotional distress, school connectedness, and educational achievement by exploring potential mechanistic and interactive roles of perceived school connectedness on the emotion–education association. Emotional distress was negatively associated with adolescents’ perceptions of belonging to school, which, in turn, may negatively influence educational achievement. School connectedness also had both additive and multiplicative interaction effects on the emotion–education relationship. Results support previous evidence of school connectedness as a protective factor for adolescents with internalizing mental health concerns, although much of the work to date has focused on externalizing problems. This study informs our understanding of how, why, and for whom emotional problems influence educational outcomes in light of social support in the school context.     

Psychosocial working conditions: An analysis of emotional symptoms and conduct problems amongst adolescent students

This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands.     

Universal Adolescent Suicide Screening in a Pediatric Urgent Care Center

The aim of this article is to describe the implementation of a 2-question suicide screening tool in a pediatric urgent care center to identify patients at risk of suicide. Adolescents presenting during a 12-month period completed the screening tool. Positive response to either question triggered further social work evaluation, including a Columbia-Suicide Severity Rating Scale (C-SSRS). Of 4,786 patients screened, 95 (2%) responded positively. Of these, 75 (79%) also had a positive C-SSRS. Only 7 (7%) had chief complaints related to mental health. A group of 78 patients (82%) were discharged with outpatient mental health referral, and 10 (10%) were admitted to a psychiatric facility. Universal adolescent suicide screening in an acute care setting did not significantly affect flow in our pediatric urgent care and was able to detect patients at risk of suicide, especially those with chief complaints unrelated to mental health.