Training in child and adolescent mental health for nursing, occupational therapy and social work students: does it influence career intentions?

Despite increased funding in child and adolescent mental health there remains a shortage of qualified health professionals working in this area in New Zealand. This study was designed to determine whether increasing training in child and adolescent mental health would increase undergraduate nursing, occupational therapy and social work students’ interest in working in the area. An additional aim of the study was to develop a sustainable teaching resource on child and adolescent mental health in CD-Rom format. Students participating in the study were asked to complete a questionnaire before and after attending a workshop in child and adolescent mental health and again at a follow-up point, three to 16 weeks later, to establish whether or not this had influenced their stated career intentions. To assess students’ and their educator’s perceptions of the quality and acceptability of the workshop a quality of teaching questionnaire was administered after the workshop. Three-hundred-and-seventy-three students participated in 14 workshops held in seven cities around New Zealand. The workshop had a positive impact on students’ career intentions in relation to child and adolescent mental health. A repeated measures analysis showed an overall time effect (F2,546 = 16.29, p = <0.0001). Further investigation of this difference was carried out using a multiple comparison test (Scheffe test) which showed a highly significant positive increase in career intentions between pre-workshop and post-workshop ratings (p = <0.0001), which dropped between post-workshop and follow-up (p = 0.004), with no change between pre-workshop and follow-up ratings (p = 0.43). There was no differential effect by students’ professional group (p = 0.08), ethnicity (p = 0.6), gender (p = 0.75) or age (p = 0.26). The study reflected similar career intention trends found in the literature. In particular, at base-line there were differences in profession-specific career intentions. Job attributes such as job satisfaction, personal interest, a job with supports available and being able to help people were also factors influencing students’ career intentions. The present study showed that a workshop on child and adolescent mental health had a significant immediate impact on undergraduate students’ career intentions

Evaluation of a computerised cognitive behavioural therapy (cCBT) program for depressive symptoms in sexual minority youth.

In this thesis I have described a body of work designed to address the problem of depression in sexual minority youth. I started by determining whether sexual minority youth have unique mental health and help-seeking needs. Subsequently the primary aim of my doctoral project was to design and evaluate the acceptability of a self-help program, specifically a computerised cognitive behavioural therapy (CCBT) program specially adapted for sexual minority youth with mild to moderate depressive symptoms. This thesis comprises four studies. In Study One I used multiple logistic regression to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours, in data collected from a nationally representative secondary school health and well-being survey (Youth’07). Sexual minority students consistently had higher prevalence estimates of depressive symptoms (p=<0.0001), suicide attempts (p=<0.0001) and self-harming (p=<0.0001) than students attracted to the opposite sex. Students who reported they were attracted to both sexes had the highest odds ratios for depressive symptoms (OR 3.7, 95% CI 2.8–4.7), suicide attempts (OR 7.0, 95% CI 5.2–9.4) and self-harm (OR 5.8, 95% CI 4.4–7.6). Non-heterosexual students were more likely to report having seen a health professional for an emotional worry and having difficulty accessing help for emotional concerns. For Study Two, I used thematic analysis based on the general inductive approach to analyse the results of three focus groups. In these groups nine sexual minority participants discussed the unique challenges they face and whether these challenges could usefully be addressed in a CCBT program. Participants also provided feedback on prototypes of a 3D fantasy-based role-play CCBT program (SPARX), designed for a general youth population, and made suggestions about how SPARX could be adapted for sexual minority youth. Participants reported experiencing a number of challenges in their day-to-day life including living within a homophobic and gender-stereotyped world. They highlighted issues unlikely to be experienced by their heterosexual or opposite-sex attracted peers related to discrimination and mistreatment due to their sexuality. As a result of participants’ feedback a specially modified version of SPARX, called SPARX: The Rainbow Version, was developed for sexual minority youth. In Study Three I conducted an open trial to assess the acceptability and feasibility of SPARX: The Rainbow Version (or Rainbow SPARX) amongst 21 sexual minority youth with depressive symptoms. I also collected preliminary data on the efficacy of Rainbow SPARX. The depressive symptoms of sexual minority youth (assessed using the Child Depression Rating Scale – Revised) decreased significantly post intervention (p<0.0001), with a large pre- to post-effect size (d=1.01) and this positive change was maintained at three-month follow-up. There were also significant improvements on secondary outcomes including self-rated symptoms of depression and anxiety, and a reduction in hopelessness. Over 80% of the sexual minority youth completing SPARX: The Rainbow Version thought CCBT would appeal to other young people. The results from the open trial were compared with those of a randomised controlled trial, where 154 exclusively opposite-sex attracted youth were equally randomised to SPARX and treatment as usual (TAU). With the exception of mean age of participants, open trial and RCT participants did not differ significantly in terms of baseline demographic data, baseline clinical characteristics and changes in assessment scores over time. However, open trial participants were more likely to complete treatment when compared with RCT participants (p=0.007). Study Four was a qualitative study which involved analysing the results of semi-structured interviews using the general inductive approach. Interviews were conducted with 25 youth immediately after they completed SPARX: The Rainbow Version. Twenty of these interviews were with open trial participants from Study Three. Of the remaining five interviews, four interviewees did not have depressive symptoms at baseline and one interviewee identified as being “straight”. Seventeen participants reported that SPARX: The Rainbow Version helped them feel better or less depressed and most of the participants reported that the program included useful messages or content. The majority liked the look and feel of the program. Eighteen participants highlighted minor technical issues that they thought needed to be addressed. Participants in Study Four also identified suggestions or tips that would help encourage sexual minority youth to participate in future research. I have shown that, relative to their peers, sexual minority youth are more likely to have depressive symptoms and to experience difficulty accessing appropriate healthcare. To address these issues I sought the views of sexual minority individuals and then incorporated their views into an adapted form of CCBT for sexual minority youth. Taken together the results of my open trial (Study Three) and the qualitative study (Study Four) indicate that SPARX: The Rainbow Version shows promise as an intervention for mild to moderate depressive symptoms in sexual minority youth and that this intervention was acceptable to participants and that delivery was feasible

Who is teaching the kids to cook? Results from a nationally representative survey of secondary school students in New Zealand

Learning how to cook is an important skill for developing healthy eating behaviors. Moreover, involvement in home cooking may offer young people opportunities for skill building, identity development and social engagement with their families. Recently, there have been concerns that the current generation of young people may not have the opportunities to develop sufficient cooking skills. These concerns have been addressed by the initiation of numerous, localized interventions. Yet, little is known about where the current generation of young people learn cooking skills. The objective of this study was to describe where the current generation of young people report learning to cook, drawing on nationally representative data from New Zealand. Data were collected as part of Youth2012, a nationally representative survey of secondary school students (n = 8500) in New Zealand. Almost all students reported learning to cook and from multiple sources. Almost all students reported learning to cook from a family member (mother, father, or other family member), approximately 60% of students reported that they learned to cook from certain media (cookbooks, TV, or the Internet) and half of all students reported learning to cook at school. There were numerous differences in where students learned to cook by socio-demographic characteristics. Findings from the current research highlight the important role that families play in teaching young people to cook and will be useful for those working with young people to develop these skills

Pilot testing a computerized CBT program in a remote Arctic region: Nunavut youth and youth workers reflect on SPARX

Background: Depression and suicidality amongst Inuit youth is one of the most significant health concerns in Nunavut (Canada), however access to mental health services remains limited (Kirmayer et al., 2000). It is thus crucial to explore innovative intervention modalities for this community. Evidence suggests that Computerized Cognitive Behavioural Therapy (cCBT) may be effective for depressed adolescents and young adults (Andrews et al., 2010; Richardson, Stallard, and Velleman, 2010). SPARX is a form of cCBT that has been shown to reduce symptoms of depression and anxiety in indigenous youth of New Zealand (Merry et al., 2012; Shepherd et al., 2015). This presentation presents qualitative data derived from a recently completed pilot evaluation of SPARX in 25 remote Inuit communities in Nunavut. Method: Participants: A sub-sample of youth participants from the study (12 of a total of 49), who completed the SPARX program, and 8 community workers from Nunavut who had supervised the youth during their SPARX trial. Procedure: Participants completed phone-based focus group interviews about their experiences of SPARX; whether they would recommend the program to others and why they might do so; how they would describe the program to others; any changes they would like to see made to SPARX; and how the game could be rendered more culture-specific. Analysis: Thematic analysis was used to analyze focus group data (Braun & Clarke, 2006). Results: Feedback from youth who completed SPARX, and youth workers who supervised them, was overwhelmingly positive. Five themes were identified based on youth feedback: SPARX promotes emotional regulation; SPARX skills can be applied to daily life; SPARX should be recommended to peers; SPARX should be modified to be Inuit-specific; SPARX could be improved. Four further themes were identified based on youth worker feedback: Positive changes in youth who had completed SPARX; Need for access to SPARX for all youth; SPARX should be modified to be Inuit-specific; Systemic challenges encountered when administering SPARX should be addressed. Conclusion: SPARX is a novel computer-based program designed to foster resilience and protect against depression. SPARX is showing promise among some of Canada’s most vulnerable youth. There is currently a push for the provision of culturally-sensitive, accessible mental health services. Once culturally adapted, SPARX may be a useful tool for implementation in remote, often marginalized communities

What Factors Are Related to Medical Students’ and Doctors’ Attitudes Towards Older Patients?

Background: Studies have sought to determine the possible precursors to medical students’ and doctors’ positive or negative attitudes towards older patients by examining associations with a variety of demographic, educational/training, and job/career factors. A review is now needed to explore the quality of these studies and to synthesize findings. Methods: A systematic review on the worldwide English language literature was conducted. Ten databases were explored (including Medline, PsychInfo and Science Direct) from database inception to December 2015 using a systematic search strategy. Quality was assessed and reported. Results: The search identified 2332 articles; 37 studies met the eligibility criteria. Students’ year in medical school, doctors’ years of practice or seniority, participants’ age and ethnicity did not appear to demonstrate relationships with (positive or negative) attitudes towards older patients. Ten studies reported that female medical students and/or doctors reported significantly more positive attitudes towards older patients than their male counterparts, although 18 studies found no differences. No studies reported more positive attitudes scores for males than females. Interest in working in older patient settings and reporting a high level of intrinsic motivation for choosing medicine as a career were both associated with positive attitudes towards older patients. Eight of 11 studies found more positive attitudes were reported by those who demonstrated higher levels of knowledge about ageing but this apparent relationship is questioned here due to methodological issues identified in the quality assessment stage pertaining to the knowledge measures employed. Reliability and validity of the attitude measures, that were employed, were examined. Conclusions: This article has identified factors associated with medical students’ and doctors’ positive attitudes towards older patients, as well as factors which have been extensively studied but failed to demonstrate meaningful relationships with attitudes. This is the first study to identify that the relationship between attitudes and knowledge about ageing may be a methodological artefact. Future research can build on the relationships identified here and should employ appropriate measures of attitudes with demonstrated reliability and validity

Tips for research recruitment: The views of sexual minority youth

Researchers often experience difficulties recruiting hard-to-reach populations. This is especially so for studies involving those who have been historically stigmatized, such as individuals who challenge heteronormative expectations or people who experience mental ill health. The authors aimed to obtain the views of sexual minority adolescents (n=25) about what encouraged their participation in a research project. The authors used a general inductive approach to analyze interview data. Feedback consisted of 2 main overarching themes: tips and suggestions for future research and appreciate participants’ motivation to get involved in research. Strategies for how recruitment can be optimized for studies involving sexual minority young people are discussed

'A Support Net': Evaluating a novel mental health-related online educational tool

Context: Mental ill-health affects an estimated one-in-four people over a lifetime, but members of the public can struggle to know how to help someone in need. We therefore felt it was important to create an interactive educational tool focused on mental health literacy. We developed a bespoke educational tool, called A Support Net, and evaluated its uptake in a real-world context. Methods: We captured data including: total learners; completion rates; learner country; and time spent using A Support Net. Intervention: A Support Net uses immersive video-based vignettes demonstrating realistic case studies of someone struggling with mental health problems, and learners are encouraged to reflect on how to support that person. Learners are introduced to four different scenarios and are tasked with making decisions around supporting that person, with the aim of making a positive difference (visually displayed with a ‘your impact’ scale). Results: To date there have been 8,814 users. The most frequently used vignette (‘Lily’) was accessed by 2,848 learners and had a completion rate of 62%. Most learners are from the UK, and 86% used the tool on their PC (average amount of time spent = 11 minutes). Conclusions: Overall engagement, evidenced by total learner numbers, has been encouraging which could indicate that the use of video vignettes was an engaging intervention strategy. However the completion rates for all four scenarios are low. For future interactive tools of this kind we plan to include a small number of evaluation items to measure possible improvements in mental health literacy

Abandoned to manage the post-Olympic blues: Olympians reflect on their experiences and the need for a change

The post-Olympic period is complex and distressing for many Olympic athletes; preparing for the likely impacts of the Olympic Games amongst returning athletes is fundamental in managing the negative responses articulated as the post-Olympic blues. Mindful of the need for the development of interventions that can support athletes, this study engaged Olympic athletes in: (a) discussing their experiences relating to the Olympic and post-Olympic periods and, (b) informing the researchers on Olympians’ opinions on the management of the post Olympic blues. Fourteen Olympic athletes from the United Kingdom took part in focus groups which were analysed using Thematic Analysis. The analysis produced six distinctive themes, The Olympic Dream, The Olympic Nightmare, Commodification, Perceptions of Social Support, Limited Preparation, and Managing and Overcoming. Through these themes the Olympians provided suggestions into how the content and potential facilitation of future interventions could better support athletes through their experiences. The findings were clear, Olympic athletes irrespective of whether they had previously competed in an Olympic Games expressed a desire for support in preparing for the post-Olympic experience. They expressed that this should be delivered primarily after the Olympic Games, with several athletes highlighting the value of an awareness raising session beforehand. Athletes proposed a shift away from expert sport psychology delivery of interventions in favour of a programme which was pragmatic in terms of content and delivered by former Olympians