Streamlined pediatric anxiety program for school mental health services

There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20–30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.     

Consumer participation in a youth mental health service

Aim: Consumer participation is increasingly being understood in both a policy and a practice context as an essential component of mental health service planning, delivery and evaluation. Existing models of participation benefit from adaptation to suit the early intervention context. Methods: This paper describes a unique programme of ‘youth’ consumer participation occurring at Orygen Youth Health (OYH) – an early intervention service in Melbourne, Australia. Flexibility and support are key components of the model. As well as supporting increased consumer‐centredness of service delivery, the model aims to support the recovery of those involved in participation activities. Results: The programme described is comprehensive, multimodal, continues to evolve and is successful based on anecdotal feedback. However, there are no evaluation data to support its attainment of outcomes. Conclusion: Consumer participation is an essential part of mental health service development, delivery and evaluation and must be incorporated into early intervention services. As programmes of participation evolve, comprehensive models of evaluation must be developed to acknowledge their outcomes.     

The development and modification of temperamental risk for anxiety disorders: prevention of a lifetime of anxiety?

This review poses the question, is it possible to prevent the development of anxiety disorders through selective interventions? The article begins with a review of the major psychosocial risk factors for anxiety disorders. Evidence is reviewed to support the role of inhibited temperament, parent anxiety, environmental support of avoidant coping, and vicarious and instructional learning of avoidance as risks for anxiety. It is argued that the central focus of these risks is an inhibited temperament and that the other risk factors are likely to be both moderated and mediated by this temperamental style. Thus, a clear option for prevention would be to modify early inhibition. Some preliminary data are presented from the Macquarie University Preschool Intervention Project, a longitudinal study of a brief parent education program for the reduction of inhibited temperament in preschool children. Although there remains considerable room for stronger effects, preliminary results show clear promise that it may be possible to modify early risk for anxiety disorders.     

School-based prevention of anxiety and depression: a pilot study in Sweden

Anxiety disorders are the most prevalent form of psychopathology in children. Anxiety disorders often begin early in life, involve great suffering, and predict psychiatric problems. Unfortunately, only a few children with anxiety disorders will receive effective treatment. The purpose of this study was to examine the effectiveness of FRIENDS for Life, an Australian school-based prevention programme, with children from Sweden. Participants were 50 children, and the impact of the programme was measured at three time points on the outcomes of anxiety, depression, and general mental health. Results showed a decrease in depressive symptoms and difficulties, and an increase in strengths, for those children receiving the programme. For those children at risk for anxiety receiving the programme, the results also showed a decrease in anxiety symptoms. Overall, the study suggests that FRIENDS for Life could be a promising intervention for Swedish children.     

Attempting to prevent depression in youth: a systematic review of the evidence

Aim: The aim of this review was to update the information on prevention and early intervention programmes for depression in adolescents. Method: We searched the literature to the end of July 2006 for published randomized controlled trials of psychological interventions specifically designed to prevent the onset of depression among children and adolescents (aged 5 to 19 years) who did not already meet the criteria for a clinical diagnosis of depressive illness. Results: Findings have been mixed. Positive results after intervention and at follow‐up have been reported in a number of targeted studies, although an attempt to replicate findings in a school and in a primary care setting were unsuccessful. Most studies of universal interventions have shown a short‐term effect that did not persist at follow‐up. There are a number of methodological problems with studies to date. Issues that have not been addressed include taking into account the placebo effect, measuring the incidence of depressive disorder following intervention and ensuring the quality and fidelity of intervention is adequate. Interventions to date may have been too short to create durable change. Conclusions: There is no clear evidence to date that depression prevention is effective and implementation of depression prevention programmes would be premature on current evidence. However, given the positive finding in some studies, and the cost of depressive disorder, further research is warranted. Attempts to reduce depressive disorder in the community should address wider social issues, as well as improving on the narrower interventions focusing on individual protective and risk factors.     

SARS-CoV-2 consequences for mental health: Neuroinflammatory pathways linking COVID-19 to anxiety and depression

The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased prevalence of mental health disorders, particularly anxiety and depression. Moreover, the COVID-19 pandemic has caused stress in people worldwide due to several factors, including fear of infection; social isolation; difficulty in adapting to new routines; lack of coping methods; high exposure to social media, misinformation, and fake reports; economic impact of the measures implemented to slow the contagion and concerns regarding the disease pathogenesis. COVID-19 patients have elevated levels of pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, and other inflammation-related factors. Furthermore, invasion of the central nervous system by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may potentially contribute to neuroinflammatory alterations in infected individuals. Neuroinflammation, a consequence of psychological stress due to the COVID-19 pandemic, may also play a role in the development of anxiety and depressive symptoms in the general population. Considering that neuroinflammation plays a significant role in the pathophysiology of depression and anxiety, this study investigated the effects of SARS-CoV-2 on mental health and focused on the impact of the COVID-19 pandemic on the neuroinflammatory pathways.     

Outcome of patients attending a specialist educational and mental health service for social anxiety disorders

The purpose of this study was to evaluate the outcome of adolescents with anxiety-based school attendance problems enrolled in a specialist adolescent educational and mental health program that provides educational assistance and social skills development, and to suggest key elements that may account for its apparent effectiveness. Young people attending the Sulman Program in Sydney, Australia, between March 2003 and December 2004 were identified. Baseline information was gathered from the medical records, pre and postintervention personal development questionnaires were given to students, and pre and postratings of function were made. Those attending the program showed improvement in their general level of functioning indicated by completion of a year-long course of study (17 of 24), preparation for employment (17), increased independent travel (5), and self-rated improvement in social skills, stress tolerance and emotional literacy. Pre and poststaff ratings on the Health of the Nation Outcomes Scales Child and Adolescent (HoNOSCA), Children's Global Assessment Scale (CGAS) and Global Assessment of Functioning (GAF) indicated improvement in personal and social functioning. Parental satisfaction was rated as high. The findings confirm the effectiveness of, and need for, flexible programs to support adolescents with social anxiety disorder and other longer-term mental health problems to offset the adverse consequences of early withdrawal from educational and social environments. Several elements may help to explain the program's effectiveness and provide guidance for similar programs elsewhere.     

Acceptability and feasibility of a multidomain harmonized data collection protocol in youth mental health

Objective

To develop targeted treatment for young people experiencing mental illness, a better understanding of the biological, psychological, and social changes is required, particularly during the early stages of illness. To do this, large datasets need to be collected using standardized methods. A harmonized data collection protocol was tested in a youth mental health research setting to determine its acceptability and feasibility.

Method

Eighteen participants completed the harmonization protocol, including a clinical interview, self-report measures, neurocognitive measures, and mock assessments of magnetic resonance imaging (MRI) and blood. The feasibility of the protocol was assessed by recording recruitment rates, study withdrawals, missing data, and protocol deviations. Subjective responses from participant surveys and focus groups were used to examine the acceptability of the protocol.

Results

Twenty-eight young people were approached, 18 consented, and four did not complete the study. Most participants reported positive subjective impressions of the protocol as a whole and showed interest in participating in the study again, if given the opportunity. Participants generally perceived the MRI and neurocognitive tasks as interesting and suggested that the assessment of clinical presentation could be shortened.

Conclusion

Overall, the harmonized data collection protocol appeared to be feasible and generally well-accepted by participants. With a majority of participants finding the assessment of clinical presentation too long and repetitive, the authors have made suggestions to shorten the self-reports. The broader implementation of this protocol could allow researchers to create large datasets and better understand how psychopathological and neurobiological changes occur in young people with mental ill-health.     

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders

Objective

This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization.

Method

This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization.

Results

Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29).

Conclusion

Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings.