The extent and specificity of relative age effects on mental health and functioning in early adolescence

BACKGROUND: Although extensive evidence indicates that being younger within a school cohort is associated with poorer academic functioning, much less is known about such relative-age effects (RAEs) for mental health. METHODS: Data from 23,378 11-13 year olds attending state-maintained secondary schools in England were analysed to investigate RAEs on mental health measured using the Strengths and Difficulties Questionnaire. Participants were grouped into oldest, middle and youngest thirds of their academic year based on their month of birth relative to their cohort. Hierarchical linear regression analysis evaluated RAEs and gender- or deprivation-related moderation of such effects. RESULTS: Relatively younger adolescents had significantly more emotional symptoms and peer problems compared to relatively older individuals in a year group, though effect sizes were small. These effects were not moderated by gender or deprivation. Impact of mental health difficulties on other aspects of functioning were also greater among relatively younger children. Larger RAEs are observed in the younger cohort (11-12 years) compared to in the 12-13 year olds, thereby indicating that RAEs might attenuate with age. CONCLUSION: Being relatively younger than classmates is associated with increased internalising symptoms, poorer peer relationships, and higher impact of mental health difficulties on functioning at school and home. The findings support wider inclusion of relative age in understanding mental health difficulties and its inclusion as a potential risk factor in studies investigating the development of psychopathology, especially for internalising symptoms. Possible mechanisms of the effects detected are discussed

A sequence analysis of patterns in self-harm in young people with and without experience of being looked-after in care

Objectives: Young people in the public care system (‘looked-after’ young people) have high levels of self-harm. Design: This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). Methods: Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across six months. Results: Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence six months prior to most recent self-harm. Conclusions: Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode is needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Background Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. Methods Forty-five young people (aged 13–21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). Results A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. Limitations Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. Conclusions The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions

A qualitative exploration of how adopted children and their parents conceptualise mental health difficulties.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Adopted children tend to have high levels of emotional, behavioural and developmental need and are more likely to present to a range of services, including Child and Adolescent Mental Health Services (CAMHS). Although research exploring adopted children’s’ perspectives is growing, it remains limited. Furthermore, there has been little work t0 engage adopted children in research. Our project aimed to examine adopted children’s viewpoints of mental health and services alongside those of their adoptive carers. Results indicated that, although there were some similarities between carer and child perspectives, they also frequently differed. They provided different constructions of the problem but agreed that family relationships were strained. Some acknowledgement of the role of the school was offered and other external sources of support cited. Coping was considered to be complex and, while some issues were analogous to ‘normal’ family life, much was inherent to the adoption status

Youth and professional perspectives of mental health resources across eight countries

Introduction: Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. Methods: The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14–24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. Results: Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. Conclusion: The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring

International youth mental health case study of peer researchers’ experiences

BACKGROUND: The involvement of young people as peer researchers, especially with lived experience, is increasingly considered important in youth mental health research. Yet, there is variation in the understanding of the role, and limited evidence on its implementation across different research systems. This case study focusses on the barriers and enablers of implementing peer researcher roles within and across majority world countries contexts. METHODS: Based on an international youth mental health project involving different levels of peer researchers and participants from eight countries, peer researchers and a co-ordinating career researcher reflect on lessons regarding enabling and challenging factors. These reflections are captured and integrated by a systematic insight analysis process. RESULTS: Building on existing international networks, it was feasible to actively involve peer researchers with lived experience in a multi-country mental health study, who in turn recruited and engaged young participants. Identified challenges include the terminology and definition of the role, cultural differences in mental health concepts, and consistency across countries and sites. DISCUSSION: Peer researchers’ role could be strengthened and mainstreamed in the future through ongoing international networks, training, sufficient planning, and active influence throughout the research process. TRIAL REGISTRATION: Not applicable

Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors, and service providers on number of appointments

BACKGROUND: Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS). AIM: To develop a case mix classification for CAMHS that is clinically meaningful and predictive of number of appointments attended, and to investigate the influence of presenting problems, context and complexity factors, and provider variation. METHOD: We analysed 4573 completed episodes of outpatient care from 11 English CAMHS. Cluster analysis, regression trees, and a conceptual classification based on clinical best practice guidelines were compared regarding their ability to predict number of appointments, using mixed effects negative binomial regression. RESULTS: The conceptual classification is clinically meaningful and did as well as data-driven classifications in accounting for number of appointments. There was little evidence for effects of complexity or context factors, with the possible exception of school attendance problems. Substantial variation in resource provision between providers was not explained well by case mix. CONCLUSION: The conceptually-derived classification merits further testing and development in the context of collaborative decision making

An evaluation of the implementation and impact of England's mandated school-based mental health initiative

We report on a large, randomized controlled trial of a nationally-mandated, school-based mental health program in England: Targeted Mental Health in Schools (TaMHS). TaMHS aimed to improve mental health for students with, or at risk of, behavioral and emotional difficulties, by provision of evidence-informed interventions relating to closer working between health and education services. Our study involved 8,480 children (aged 8-9 years) from 266 elementary schools. Students in intervention schools with, or at risk of, behavioral difficulties reported significant reductions in behavioral difficulties compared to control school students, but no such difference was found for students with, or at risk of, emotional difficulties. Implementation of TaMHS was associated with increased school provision of a range of interventions and enhanced collaboration between schools and local specialist mental health providers. The implications of these findings are discussed, in addition to the strengths and limitations of the stud

Experience of self-harm and its treatment in looked-after young people: an interpretative phenomenological analysis

Objectives: We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Methods: Qualitative interviews with 24 looked-after young people. Results: Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronised, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Conclusions: Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation and increasing support during placement changes