ToyBox Study Malaysia: improving healthy energy balance and obesity-related behaviours among pre-schoolers in Malaysia

The prevalence of childhood overweight and obesity is increasing in Malaysia and currently nearly 10% of children aged between 6 months and 12 years are overweight and almost 12% are obese. Early interventions to prevent excess weight gain are needed. ToyBox Study Malaysia is a feasibility project, funded by the Medical Research Council Newton-Ungku Omar Fund, to assess the practicalities of adapting the existing European ToyBox Study intervention programme to the Malaysian kindergarten setting. The main aims of all ToyBox programmes are related to improving four key energy balance-related behaviours, namely drinking water, eating healthy snacks and meals, reducing sedentary behaviour and increasing physical activity. Using stratified sampling, the ToyBox Study Malaysia intervention will be delivered and compared to usual practice by assessing behaviour, physical activity and health-related outcomes as measured by questionnaires, accelerometry and anthropometry. It is hoped that the evidence-based ToyBox Study Malaysia will help to achieve healthier energy balance-related behaviours in the children and their families and provide lifelong benefits to health. This article provides information on the dietary patterns, physical activity levels and prevalence of overweight and obesity in Malaysian children, and the approach of the ToyBox Study Malaysia

Process evaluation of a kindergarten-based intervention for obesity prevention in early childhood: the Toybox study Malaysia

BackgroundToybox is a kindergarten-based intervention program that targets sedentary behavior, snacking and drinking habits, as well as promoting physical activity in an effort to improve healthy energy balance-related behaviors among children attending kindergartens in Malaysia. The pilot of this program was conducted as a randomized controlled trial (RCT) involving 837 children from 22 intervention kindergartens and 26 control kindergartens respectively. This paper outlines the process evaluation of this intervention.MethodsWe assessed five process indicators: recruitment, retention, dosage, fidelity, and satisfaction for the Toybox program. Data collection was conducted via teachers’ monthly logbooks, post-intervention feedback through questionnaires, and focus group discussions (FGD) with teachers, parents, and children. Data were analyzed using quantitative and qualitative data analysis methods.ResultsA total of 1072 children were invited. Out of the 1001 children whose parents consented to join, only 837 completed the program (Retention rate: 88.4%). As high as 91% of the 44 teachers and their assistants engaged positively in one or more of the process evaluation data collection methods. In terms of dosage and fidelity, 76% of parents had received newsletters, tip cards, and posters at the appropriate times. All teachers and their assistants felt satisfied with the intervention program. However, they also mentioned some barriers to its implementation, including the lack of suitable indoor environments to conduct activities and the need to make kangaroo stories more interesting to captivate the children’s attention. As for parents, 88% of them were satisfied with the family-based activities and enjoyed them. They also felt that the materials provided were easy to understand and managed to improve their knowledge. Lastly, the children showed positive behaviors in consuming more water, fruits, and vegetables.ConclusionsThe Toybox program was deemed acceptable and feasible to implement by the parents and teachers. However, several factors need to be improved before it can be expanded and embedded as a routine practice across Malaysia

The course of mental health problems in children presenting with abdominal pain in general practice

Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months' follow-up. Design. A prospective cohort study with one-year follow-up. Setting. 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects. 281 children aged 4-17 years. Main outcome measures. The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up. Results. A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3-44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2-46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7-51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months' follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple nonspecific somatic symptoms at follow-up. Conclusions. In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain

“Just keep pushing”: parents’ experiences of accessing child and adolescent mental health services for child anxiety problems

Background:Anxiety disorders are among the most common psychopathologies in childhood, however a high proportion of children with anxiety disorders do not access effective treatments.The aim of the present qualitative study was to understand families’ experiences of seeking help and accessing specialist treatment for difficulties with childhood anxiety.Methods:Parents of 16 children (aged 7-12 years) referred to a child mental health service for difficulties with anxiety, were interviewed about their experiences of seeking and accessing treatment within CAMHS. All interviews were transcribed verbatim and thematically analysed for similarities and differences in families’ experiences. Results:Factors that helped and/or hindered families accessing treatment related to: i) parental recognition, ii) contact with professionals, iii) reaching CAMHS, iv) parental effort, and v) parental knowledge and concerns. High demands on services and parents’ uncertainty surrounding the help-seeking process presented key hurdles for families. The critical role of parental persistence and support from GPs and school staff was evident across interviews.Conclusions:Findings highlighted the need for information and guidance on identifying child anxiety difficulties and professional, peer and self-help support; and ensuring sufficient provision is available to allow families prompt access to support

Axis I comorbidity in adolescent inpatients referred for treatment of substance use disorders

<p>Abstract</p> <p>Background</p> <p>To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders.</p> <p>Methods</p> <p>151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL).</p> <p>Results</p> <p>128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once.</p> <p>Conclusions</p> <p>The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial impairment.</p

Improving mental health literacy in year 9 high school children across Wales: a protocol for a randomised control treatment trial (RCT) of a mental health literacy programme across an entire country

Background: Adolescence is a crucial period for developing and maintaining good habits for mental health and well-being. This is important for future mental health, as most mental health problems manifest during adolescence. Mental health literacy is the foundation for mental health prevention, stigma reduction, and increased help-seeking efficacy particularly among adolescents. The mental health literacy programme “The Guide”, which was developed in Canada, has shown success in increasing mental health literacy in North American 16-17 year olds. “The Guide Cymru” is an adaptation of The Guide designed for a younger age group (13-14 year olds) and for the Welsh culture and context and is being offered to all state schools in Wales. Methods: This two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of The Guide Cymru. All 205 secondary schools in Wales will be invited to take part, involving up to 30,000 year 9 pupils. Schools will be randomised to either the immediate implementation of The Guide Cymru or to a wait-list control. The wait-list control will receive The Guide Cymru around 12 weeks later. Measures of mental health literacy (assessed via the Knowledge and Attitudes to Mental Health scale) and mental health problems (via the PedsQL and Strengths and Difficulties Questionnaire) will be taken at baseline (pre-intervention), 12 weeks later (after the active group has received The Guide Cymru), and 24 weeks later (after the wait-list control has received The Guide Cymru).Discussion: The trial aims to evaluate if The Guide Cymru increases mental health literacy, including reduced stigma to others and to the self, and increased levels of good mental health behaviours and help-seeking for mental health problems. Trial Registration: ISRCTN15462041. Registered 03/10/2019. https://doi.org/10.1186/ISRCTN15462041Keywords: Mental health literacy, Randomised Control Trial, Early intervention, Self-stigma, Stigma, Education, Adolescence, Help-seeking efficacy, School-based intervention

Specific phobia predicts psychopathology in young women

Contains fulltext : 90255.pdf (publisher's version ) (Closed access)Although specific phobia is characterized by an early age at onset and by high rates of comorbidity, few studies have examined comorbid relationships prospectively. The present study investigated the association between specific phobia and the risk of a broad range of psychopathology among young women in the community. Data came from the Dresden Predictor Study in which 1,538 German women (18-25 years) completed a diagnostic interview at two time points. Women with specific phobia had a twofold increase in odds of developing any anxiety disorder, generalized anxiety disorder, depression, and any somatoform disorder during 17 months, compared to women without specific phobia. Except for depression, these associations persisted after adjustment for all comorbid mental disorders. Specific phobia thus appears to be a risk factor for a variety of problems. The result further underpins the necessity for early intervention for specific phobia to prevent later mental health problems

Observing interactions between children and adolescents and their parents: the effects of anxiety disorder and age

Parental behaviors, most notably overcontrol, lack of warmth and expressed anxiety, have been implicated in models of the development and maintenance of anxiety disorders in children and young people. Theories of normative development have proposed that different parental responses are required to support emotional development in childhood and adolescence, yet age has not typically been taken into account in studies of parenting and anxiety disorders. In order to identify whether associations between anxiety disorder status and parenting differ in children and adolescents, we compared observed behaviors of parents of children (7–10 years) and adolescents (13–16 years) with and without anxiety disorders (n=120), while they undertook a series of mildly anxiety-provoking tasks. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warm engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviors. Specifically, parents of adolescents with anxiety disorders showed higher intrusiveness and lower warm engagement than parents of non-anxious adolescents. A similar relationship between these parenting behaviors and anxiety disorder status was not observed among parents of children. The findings suggest that theoretical accounts of the role of parental behaviors in anxiety disorders in children and adolescents should distinguish between these different developmental periods. Further experimental research to establish causality, however, would be required before committing additional resources to targeting parenting factors within treatment

Person-Related Protective and Vulnerability Factors of Psychopathology Symptoms in Non-Clinical Adolescents

Psychopathology in youths is thought to originate from a dynamic interplay of a variety of protective and vulnerability factors. In this study, a large multi-ethnic sample of non-clinical adolescents (N = 376) completed questionnaires for measuring a wide range of person-related protective and vulnerability factors as well as psychopathology symptoms, in order to explore (a) the relations among various protective and vulnerability factors, and (b) the unique contributions of these protective and vulnerability factors to different types of psychological problems. Results indicated that the overlap among protective and vulnerability factors was quite modest. Further, it was found that factors clustered in theoretically meaningful components reflecting protection, vulnerability, and more specific aspects of coping and social support. Finally, data indicated that each type of psychopathology symptoms was associated with a typical set of protective and vulnerability factors. Although these results should be interpreted with caution because of the cross-sectional nature of the study, they may nevertheless guide future research exploring multifactorial models of psychopathology in youths