Historical nonsuicidal self-injury and current coping strategies: the role of emotion regulation

Supporting individuals to develop adaptive coping strategies is critical to improve health and wellbeing. A history of nonsuicidal self-harm (NSSI) is linked with increased risk of maladaptive coping strategies. We aimed to identify whether emotion regulation (ER) mediated the relationship between historical NSSI behaviours and coping strategy use in adults from the general population. Participants reported their lifetime frequency of NSSI; then they completed self-report measures of emotion regulation, maladaptive coping strategy use (behavioural disengagement, self-blame and substance use) and adaptive coping strategy use (active coping, instrumental support use and emotional support use). Regression analyses investigated relationships between historical NSSI and coping strategies, with mediation analysis testing for the mediating role of ER. A total of 303 individuals participated: 180 with a history of NSSI and 123 without. Results indicated that poor emotion regulation mediated the relationship between having a history of NSSI and the use of maladaptive coping strategies; however, there was no notable association between adaptive coping strategies and historical NSSI. These findings highlight the necessity for ER development in people with a history of NSSI and suggest important avenues for future research, including exploring the role of ER to support NSSI cessation.</p

Sleep in children with anxiety disorders

Sleep disturbance has long been known to present as a symptom of anxiety disorders. However, the relationship between sleep and anxiety in children has gained growing attention over the past 20 years, with particular attention given to a potential longitudinal relationship and the need to examine underlying mechanisms that might link sleep and anxiety. The high occurrence of sleep disturbance amongst young people has also led researchers to ask whether they need targeted intervention. This chapter will provide an overview of our knowledge regarding the association between sleep and anxiety in children, the challenges with methodologies, and future directions

‘I am tired, sad and kind’: self-evaluation and symptoms of depression in adolescents

Introduction: Although self-evaluation i.e., negative perceptions of the self is a common depression symptom in adolescents, little is known about how this population spontaneously describe their self and available data on adolescent self-evaluation is limited. This study aimed to generate and report on a list of words used by healthy adolescents and those with elevated depression symptoms to describe their selfevaluation. Linguistic analysis (LIWC) was then used to compare self-evaluation between the two groups. Methods: Adolescents aged 13-18 years (n = 549) completed a measure of depression symptoms (the Mood and Feelings Questionnaire) and a measure of self-evaluation (the Twenty Statements Test). Responses were then collated and presented in a freely accessible resource and coded using Linguistic Inquiry Word Count (LIWC) analysis. Results: Self-evaluation words generated by adolescents were uploaded to a publicly accessible site for future research: https://doi.org/10.15125/BATH-01234. Adolescents with elevated depression symptoms described themselves as ‘Tired’ and ‘Sad’ more than healthy adolescents. However, there was no difference between groups in respect to their use of specific positive, prosocial self-evaluation ‘words’ (i.e., ‘Caring’ and ‘Kind). Following Linguistic Inquiry Word Count (LIWC) analysis, adolescents with elevated depression symptoms generated significantly more words than healthy adolescents, generated more words classified as negative emotion, anxiety and sadness and generated fewer words classified positive emotion than healthy adolescents. Conclusions: As predicted by the cognitive model of depression, our findings suggest that adolescents with elevated symptoms of depression generated more negative selfevaluation words than healthy adolescents; however they also generated prosocial 3 positive self-evaluation words at the same rate as non-depressed adolescents. These novel data therefore identify an ‘island’ of resilience that could be targeted and amplified by psychological treatments for adolescent depression, and thus provide an additional technique of change. </p

‘I am tired, sad and kind’: self-evaluation and symptoms of depression in adolescents

Introduction: Although self-evaluation i.e., negative perceptions of the self is a common depression symptom in adolescents, little is known about how this population spontaneously describe their self and available data on adolescent self-evaluation is limited. This study aimed to generate and report on a list of words used by healthy adolescents and those with elevated depression symptoms to describe their selfevaluation. Linguistic analysis (LIWC) was then used to compare self-evaluation between the two groups. Methods: Adolescents aged 13-18 years (n = 549) completed a measure of depression symptoms (the Mood and Feelings Questionnaire) and a measure of self-evaluation (the Twenty Statements Test). Responses were then collated and presented in a freely accessible resource and coded using Linguistic Inquiry Word Count (LIWC) analysis. Results: Self-evaluation words generated by adolescents were uploaded to a publicly accessible site for future research: https://doi.org/10.15125/BATH-01234. Adolescents with elevated depression symptoms described themselves as ‘Tired’ and ‘Sad’ more than healthy adolescents. However, there was no difference between groups in respect to their use of specific positive, prosocial self-evaluation ‘words’ (i.e., ‘Caring’ and ‘Kind). Following Linguistic Inquiry Word Count (LIWC) analysis, adolescents with elevated depression symptoms generated significantly more words than healthy adolescents, generated more words classified as negative emotion, anxiety and sadness and generated fewer words classified positive emotion than healthy adolescents. Conclusions: As predicted by the cognitive model of depression, our findings suggest that adolescents with elevated symptoms of depression generated more negative selfevaluation words than healthy adolescents; however they also generated prosocial 3 positive self-evaluation words at the same rate as non-depressed adolescents. These novel data therefore identify an ‘island’ of resilience that could be targeted and amplified by psychological treatments for adolescent depression, and thus provide an additional technique of change. </p

Psychometric properties of the Thai Mood and Feelings Questionnaire (MFQ) for adolescent depression

Background The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity and to determine the optimal clinical cut-off of the Thai MFQ. Methods The Thai MFQ was evaluated in two parts. In part 1, The MFQ was translated and back translated into the Thai language and piloted on a small number of Thai adolescents. Then 1275 young people aged 12–18 years from three secondary schools in Thailand completed the MFQ and related measures of depression. In part 2, 138 students were invited to take part in a structured diagnostic interview (the Thai translation of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (the K-SADS-PL). Of those, 103 students were interviewed and completed the Thai MFQ a second time to assess test–retest reliability. Receiver Operating Characteristics (ROC) analyses were conducted to evaluate diagnosis accuracy and examine the optimal cut-off score of the Thai MFQ. Results The Thai MFQ had excellent internal consistency (a?=?0.92) and good to moderate test–retest reliability in 2-week and 4-week intervals. The Thai MFQ also had good convergent validity with related measures of depression. The ROC analyses demonstrated that the Thai MFQ also had excellent accuracy distinguishing between depressed and non-depressed adolescents [AUC?=?0.95, 95% CI [0.92, 0.99]. A total score of 28 on the Thai MFQ was the optimal cut-off score (sensitivity was 0.97 and specificity was 0.83). Discussion The Thai MFQ demonstrated excellent psychometric properties and accurately distinguished between depressed and non-depressed adolescents. It is appropriate to use as a screening measure to identify adolescents with depression in community settings in Thailand

Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents

Background It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). Aims To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Methods Data was gathered from 179 participants with an anxiety disorder (11-17 years) who had previously engaged with the outpatient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset [n = 73] had outcome data, which was used to examine changes in sleep following CBT. Results At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents’ weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. Conclusions The study relied upon subjective measurement of sleep and there was no control group, however the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.</p

The experience of sleep problems for adolescents with depression in short-term psychological therapy

A growing body of literature demonstrates a strong relationship between sleep disturbances and depression in adolescence. In spite of this, few studies have explored how adolescents with depression experience sleep problems. The present study aimed to qualitatively explore the experience of sleep problems in adolescents with depression, including their understanding of how a psychological therapy impacted on these sleep difficulties. The sample included 12 adolescents with sleep disturbances who had been offered treatment for depression through a large, multi-centre, randomised controlled trial. Semi-structured interviews conducted after treatment and 1-year post treatment were analysed using thematic analysis. Two main themes were identified. Both themes demonstrated how an overarching desire to escape impacted the adolescents’ sleep in distinct ways; ‘thinking about the ‘bad stuff’’ was characterised by ruminative thinking, which prevented sleep, whereas ‘sleep as an escape’ indicated a desire to sleep excessively due to feelings of helplessness. Overall, the findings demonstrate a nuanced relationship between sleep and depression in adolescence, and imply that the underlying meaning of the sleep difficulties for each young person should be considered in the delivery of therapy for adolescent depression

Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents

Background It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). Aims To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Methods Data was gathered from 179 participants with an anxiety disorder (11-17 years) who had previously engaged with the outpatient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset [n = 73] had outcome data, which was used to examine changes in sleep following CBT. Results At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents’ weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. Conclusions The study relied upon subjective measurement of sleep and there was no control group, however the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.</p

Characteristics of young people referred for treatment of depression and anxiety in a school-based mental health service

Objectives: The aim of the paper was to describe referrals to a UK school-based mental health service for children and adolescents. Methods: Children and young people (CYP) (N = 485, aged 4–18) were referred to two Mental Health Support Team sites in the South of England in 2021, for CBT-informed interventions for mild-to-moderate anxiety and depression. Child and parent reported outcome measures were completed pre-intervention, including measures of symptom severity and impact. Results: Referrals consisted of 61% female, 57% secondary school age (12–18 years old) and 81% White British. Children of secondary school age self-reported significantly higher levels of anxiety (p =.003) and depression (p Conclusions: The findings have direct relevance to the transformation and delivery of school-based public mental health services for children and adolescents. There is a need to collect routine data from other services to assess the broader needs of CYP referred for low intensity early interventions across regions.</p

Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study

Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11–17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents’ parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents’ dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people