“Five hours to sort out your life”: A qualitative study of university students experience of mental health support

Background: Previous qualitative research suggests that university students feel that current service provision does not meet their needs. Exploring the reasons for this may help to promote service change, encourage the uptake of care, improve outcomes and increase satisfaction within university services. Aims: This study aimed to improve the understanding of how students experience the process of accessing and using mental health support, barriers and facilitators to treatment, and how students would adapt provision to improve experiences. Method: Semi-structured interviews were conducted with 16 full-time students who had used mental health services at university. Data were analysed using thematic analysis. Results: Five higher-order themes were identified: personalisation and informed choice, simplifying the process, feeling abandoned ignored or invisible, stigma, and superiority of private and external services. Sixteen subthemes were identified within these themes. Conclusions: Findings indicate that access to mental health support should be simplified, with collaboration across university and external health and care services, to prevent students feeling lost or abandoned when seeking care. An inclusive approach to support access and provision of services for all presentations of mental health problems should be developed

The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology.

This review assessed the efficacy of adapted psychological interventions for Black and minority ethnic (BME) groups. A conceptual typology was developed based on adaptations reported in the literature, drawing on the common factors model, competence frameworks and distinctions between types of cultural adaptations. These distinctions were used to explore the efficacy of different adaptations in improving symptoms of a range of mental health problems for minority groups. Bibliographic searches of MEDLINE, Embase, PsycINFO, HMIC, ASSIA, CENTRAL, CDSR and CINAHL spanned the period from 1965 to December 2020. Adaptations to interventions were categorised: i) treatment specific: therapist-related, ii) treatment-specific: content-related and iii) organisation-specific. Meta-analyses of RCTs found a significant effect on symptom reduction when adapted interventions were compared to non-adapted active treatments (K = 30, Hedge's g = -0.43 [95% CI: -0.61, -0.25], p < .001). Studies often incorporated multiple adaptations, limiting the exploration of the comparative effectiveness of different adaptation types, although inclusion of organisation-specific adaptations may be associated with greater benefits. Future research, practitioner training and treatment and service development pertaining to adapted care for minority groups may benefit from adopting the conceptual typology described

The efficacy of psychological interventions for the prevention and treatment of mental health disorders in university students: A systematic review and meta-analysis

Background: Mental health problems are becoming increasingly prevalent among students and adequate support should be provided to prevent and treat mental health disorders in those at risk. / Methods: This systematic review and meta-analysis examined the efficacy of psychological interventions for students, with consideration of how adaptions to intervention content and delivery could improve outcomes. We searched for randomised controlled trials (RCTs) of interventions in students with or at risk of mental health problems and extracted data for study characteristics, symptom severity, wellbeing, educational outcomes, and attrition. Eighty-four studies were included. / Results: Promising effects were found for indicated and selective interventions to treat anxiety disorders, depression and eating disorders. PTSD and self-harm data was limited, and did not demonstrate significant effects. Relatively few trials adapted intervention delivery to student-specific concerns, and overall adapted interventions showed no benefit over non-adapted interventions. There was some suggestion that adaptions based on empirical evidence and provision of additional sessions, and transdiagnostic models may yield some benefits. / Limitations: The review is limited by the often poor quality of the literature and exclusion of non-published data. / Conclusions: Interventions for students show benefit though uncertainty remains around how best to optimise treatment delivery and content for students. Additional research into content targeting specific underlying mechanisms of problems and transdiagnostic approaches to provision could be promising avenues for further research

Social ecological factors associated with physical activity and screen time amongst mothers from disadvantaged neighbourhoods over three years

Background: Mothers from socioeconomically disadvantaged neighbourhoods are at elevated risk of physical inactivity and high levels of screen time. Yet, little is known regarding the social ecological factors that are longitudinally associated with physical activity and screen time in this target group, and whether the age of their children impacts these relationships. This study aimed to longitudinally examine the social ecological factors associated with physical activity and screen time amongst mothers living in socioeconomically disadvantaged neighbourhoods, and whether these differed according to their child's age. Methods: Data were from 895 mothers living in socioeconomically disadvantaged neighbourhoods (mean age 36.7 years) at baseline and three-year follow-up. Mothers self-reported weekly discretionary physical activity (leisure-time, LTPA; transport-related, TRPA) and screen time durations. Linear regression models assessed associations between five intrapersonal, three social and five physical environmental factors and LTPA, TRPA and screen time, adjusting for confounding factors, clustering by neighbourhood and baseline variables. Interaction analysis was conducted for age of children (younger and older children (n = 442) and mothers with older children (aged 5-12 years) only (n = 453). Results: In adjusted models, all intrapersonal factors (self-efficacy, enjoyment, outcome expectations, behavioural intentions and behavioural skill), social support from friends, neighbourhood cohesion and number of televisions were longitudinally associated with LTPA amongst all mothers. Interaction models showed that findings were generally consistent across groups (i.e., those with both younger and older children compared to those with older children only), with three exceptions. Physical activity enjoyment and social support from family were associated with LTPA only among mothers with older children. Neighbourhood cohesion was associated with screen time only amongst mothers with both younger and older children. No associations were detected for TRPA. Conclusion: Intrapersonal, social and physical environmental factors were longitudinally associated with mother's LTPA, whilst neighbourhood cohesion was longitudinally associated with screen time behaviours amongst mothers. Interventions aimed at increasing LTPA amongst mothers (particularly those from socioeconomically disadvantaged neighbourhoods) may need to target all domains of the social ecological model and may require some tailoring according to the age of children. Further work is needed to identify longitudinal associations with screen time and TRPA in this population group

Parents’ engagement in an Australian school- and home-based group RCT to reduce children’s sitting time and promote physical activity: Transform-Us!

Session - S34 Involvement of parents in multicomponent school-based interventions targeting energy balance related behaviours among children and adolescents: Lessons learned from process evaluation: abstract S34.2Conference Theme: Promoting Healthy Eating and Activity WorldwidePURPOSE: Transform-Us! was a 3-year group RCT aiming to determine the effectiveness of strategies to reduce 8-year old Australian children’s sedentary behaviour (SB) or promote their physical activity (PA), or both (PA+SB) compared with usual practice (C) at school and home. METHOD: Process evaluation data were collected at post--‐intervention (T3) Nov/Dec 2011. Nine newsletters per year were …postprin

Strategies to promote children\u27s school based physical activity : Transform-Us! Mid-intervention findings

Session 202 - School based interventions: paper 276This journal suppl. entitled: Be Avtive 2012Many children engage in suboptimal levels of PA despite the associated health risks. Schools (n=20) in the Transform-Us! program were randomized to one of four intervention arms that target increases in children’s PA (PA), reductions in sedentary behavior (SB), both behaviors (SB+PA) or control current practice (C). This examination focuses on the PA promotion strategies employed in the PA and SB+PA arms compared with the C arm. To promote children’s PA each PA and SB+PA class was provided with sporting and circus equipment; asphalt line markings were installed at the school; and teachers were asked to encourage PA. Grade 3 children at participating schools were invited to take part in evaluation assessments including the completion of a self-report survey. Findings from the PA promotion strategy questions at baseline (Feb–June 2010), and T2 (Nov/Dec) are reported here. Children (n=425, 55% female) were asked to respond (yes/no) to five items asking about social support for PA from their class teacher, which were then summed to create a ‘teacher social support’ scale. Children were also asked to indicate if ‘there are markings on the walls or on the school playground to help us play games’ (perceived availability of line markings); if they are ‘allowed to use school sports equipment during recess and lunch breaks’ (perceived accessibility of sports equipment); and how much they like ‘the areas to play in at school’ using a 5-point Likert scale (perceived school environment). Between baseline and T2, teacher social support increased in both PA (1.7[1.4] vs 2.1[1.4]) and SB arms (1.9[1.4] vs 2.4[1.4) but declined in C (2.0[1.4] vs 1.7[1.5]). For all three arms, increases were seen in perceived availability of line markings (PA: 53.2% vs 69.4%; SB+PA: 59.3% vs 71.4%; C: 60.0% vs 69.8%); perceived accessibility of sport equipment (PA: 87.7% vs 97.2%: SB+PA: 80.7 vs 94%; C: 85.4% vs 97.6%); and perceived school environment (PA: 1.44[0.9] vs 1.42[0.8]; SB+PA: 1.5[0.8] vs 1.6[0.7]; C: 1.4[0.9] vs 1.5[0.7]) between baseline and T2. All findings were significant at a 1% probability level. At the mid-intervention time point, findings suggest that PA strategies have increased perceived availability of line markings, accessibility of sport equipment, and perceived school environment in children allocated to the PA and SB+PA arms. However, there were also unexpected increases in the C arm for three out of four items. Post-intervention findings will add to these preliminary findings

Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis

Objective: To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. // Methods: Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. // Results: Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3–4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4–43.3)). // Conclusions: Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important

Children\u27s perceptions of the factors helping them to be resilient to sedentary lifestyles

Despite the increased risk of sedentary lifestyles associated with socioeconomic disadvantage, some children living in disadvantaged areas display 'resilience' to unhealthy behaviours whereby they manage to engage in regular physical activity and avoid high levels of screen time. It is important to understand what is helping these children to do well. This qualitative study explored the perceptions of 'resilient' children regarding factors that assist them to engage in high levels of physical activity and low screen time. In-depth face-to-face interviews were conducted with 38 children (7-13 years) living in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. Themes that emerged relating to physical activity included: parental support and encouragement of physical activity, having a supportive physical environment and having friends to be active with. Themes relating to screen time included: individual preferences to be active, knowledge of health risks associated with sedentary behaviour, having a home environment supportive of physical activity and parental rules. The results provide valuable insights regarding factors that may help children living in disadvantaged neighbourhoods to be physically active and reduce their screen time and may inform future studies targeting this important population group.Jenny Veitch, Lauren Arundell, Clare Hume and Kylie Bal

Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children

OBJECTIVE: Investigate associations of TV viewing time and accelerometry-derived sedentary time with inflammatory and endothelial function biomarkers in children. METHODS: Cross-sectional analysis of 164 7-10-year-old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C-reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin-2, -6, -8, -10, tumour necrosis factor alpha, adiponectin, resistin, brain-derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E-selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate- to vigorous-intensity physical activity and diet density. RESULTS: Each additional h&thinsp;week(-1) of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM-1 in the fully adjusted model. The association between frequency and duration of 5-10&thinsp;min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density. CONCLUSIONS: This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10&thinsp;min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health