The Conceptualization of the Positive Cognitive Triad and Associations with Depressive Symptoms in Adolescents.

The positive cognitive triad (positive cognitions about the self, world, and future) has been considered a protective factor against depressive symptoms. This study examines three conceptualizations of the positive cognitive triad and their relation to depressive symptoms. Analyses were replicated in two samples in order to provide evidence for the validity of findings. Two samples (n1 = 2982, Mage = 13.04, Rangeage = 11-15 years; n2 = 2540, Mage = 13.11, Rangeage = 11-16 years) of Australian adolescents completed the Positive Cognitive Triad Inventory and Center for Epidemiological Studies Depression Scale. Findings supported the notion that the overall positive cognitive triad is a protective factor for depressive symptoms, and specifically, the role of positive cognitions about the self in this protection. After future studies examine the directionality of the relation between positive cognitions and depressive symptoms, mental health providers using cognitive behavioral approaches may consider examining positive cognitions with patients.

Evaluating the "possums" health professional training in parent-infant sleep.

Infant sleep problems are among the most common issues reported by parents in the postnatal period. Yet, infant sleep and infant sleep interventions remain controversial. This study evaluated health professional training in a novel approach to parent-infant sleep: the Possums Sleep Intervention. Health professionals (n = 144) completed a short survey before and after the training, which focused on the sleep component. The Possums Sleep Intervention training included the following topics: sleep science, cued care, sleep hygiene, relaxation for parents and babies, problem solving, and acceptance and commitment therapy (ACT). Health professionals reported: improvements in knowledge on infant sleep regulation, the mother-infant relationship and ACT; improvements in health professionals' own sleep quality; improvements in psychological flexibility; and a reduction in professional burnout and secondary traumatic stress. Moreover, the health professional training was received positively. Overall, this study is supportive of the Possums Sleep Intervention health professional training.

Los problemas infantiles para dormir están entre los asuntos más comúnmente reportados por los padres en el período postnatal. Aun así, el dormir del infante y las intervenciones en el caso del dormir del infante se mantienen controversiales. Este estudio evaluó el entrenamiento de profesionales de la salud a través de un acercamiento novedoso al dormir de progenitor-infante: la Intervención 'Possums' (Zarigüeyas) del Dormir. Los profesionales de la salud (n = 144) completaron una encuesta corta antes y después del entrenamiento, el cual se enfocó en el componente de dormir. El entrenamiento de la Intervención 'Possums' del Dormir incluyó los siguientes temas: la ciencia del dormir; el cuidado señalado; la higiene de dormir; la relajación para padres y bebés; el resolver problemas; y la terapia de aceptación y compromiso (ACT). Los profesionales de la salud reportaron: mejoras en el conocimiento acerca de la regulación del dormir del infante, la relación madre-infante y ACT; mejoras en la calidad del propio dormir de los profesionales de la salud; mejoras en la flexibilidad sicológica; y una reducción en el agotamiento profesional y el estrés traumático secundario (STS). Es más, se recibió positivamente el entrenamiento a los profesionales de la salud. En general, este estudio apoya el entrenamiento de profesionales de la salud en la Intervención 'Possums' del Dormir. Palabras claves: dormir, infancia, postnatal, terapia de aceptación y compromiso, profesionales de la salud.

Les problèmes de sommeil du nourrisson se trouvent parmi les problèmes les plus fréquents dont font état les parents durant la période postnatale. Cependant le sommeil du nourrisson et les interventions en sommeil du nourrisson demeurent à controverse. Cette étude a évalué la formation de professionnels de la santé dans une nouvelle approche du sommeil parent-nourrisson: l'Intervention Sommeil Possums. Des professionnels de la santé (n = 144) ont rempli un questionnaire court avant et après la formation, portant sur l'aspect du sommeil. La formation de l'Intervention Sommeil Possums a inclus les sujets suivants: science du sommeil; soin déclenché; hygiène du sommeil; relaxation pour les parents et les bébés; résolution de problèmes; et la Thérapie d'Acceptation et d'Engagement (ACT). Les professionnels de la santé ont fait état d'améliorations des connaissances sur la régulation du sommeil du bébé, la relation mère-bébé et l'ACT; améliorations dans leur propre qualité de sommeil; amélioration dans la flexibilité psychologique; et une réduction du burnout professionnel et du stress traumatique secondaire (STS). De plus la formation des professionnels de la santé a été reçu de manière positive. Dans l'ensemble cette étude soutient la formation des professionnels de la santé de l'Intervention Sommeil Possums. Mots clés: sommeil, nourrisson, postnatal, thérapie d'acceptation et d'engagement, professionnels de la santé.

Efficacy of interventions to improve psychological adjustment for parents of infants with or at risk of neurodevelopmental disability: A systematic review.

BACKGROUND: Supportive and targeted interventions for families are required to optimize parental adjustment and the parent-infant relationship in line with earlier diagnosis of neurodevelopmental risk for infants. AIMS: The purpose of this systematic review was to determine the efficacy of interventions in improving psychological adjustment and well-being for parents who have an infant diagnosed with or at risk of neurodevelopmental disability. METHODS: The Cochrane Review Group search strategy was followed with search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL, PsycINFO, and Embase between July and December 2017. Methodological quality of included articles was assessed using the Physiotherapy Evidence Database (PEDro) Scale by two independent reviewers. RESULTS: Twelve studies met the inclusion criteria. A small number of high-quality trials demonstrated moderate to large effectiveness of reducing adverse parent psychological symptoms of trauma and stress. Significant improvements in depression and anxiety symptoms emerged at longer-term (6 months to 8 years) follow-up postinterventions. CONCLUSIONS: There is promising support for the effectiveness of some interventions to reduce maladaptive psychological symptoms in parents with infants diagnosed at risk of neurodevelopmental disability. Further quality RCTs of psychological interventions addressing broader neurodevelopmental risk conditions for infants are required.

The Effectiveness of Enhanced Cognitive Behavioural Therapy (CBT-E): A Naturalistic Study within an Out-Patient Eating Disorder Service.

BACKGROUND: The effectiveness of enhanced cognitive behavioural Therapy (CBT-E) for adults with a range of eating disorder presentations within routine clinical settings has been examined in only two known published studies, neither of which included a follow-up assessment period. AIM: The current study aimed to evaluate the effectiveness of CBT-E within an out-patient eating disorder service in Brisbane, Queensland, Australia, and incorporated a follow-up assessment period of approximately 20 weeks post-treatment. METHOD: The study involved 114 adult females with a diagnosed eating disorder, who attended an average of 20-40 individual CBT-E sessions with a psychologist or a psychiatry registrar between 2009 and 2013. RESULTS: Of those who began treatment, 50% did not complete treatment, and the presence of psychosocial and environmental problems predicted drop-out. Amongst treatment completers, statistically and clinically significant improvements in eating disorder and general psychopathology were observed at post-treatment, which were generally maintained at the 20-week follow-up. Statistically significant improvements in eating disorder and general psychopathology were observed amongst the total sample. CONCLUSIONS: The findings, which were comparable to the previous Australian effectiveness study of CBT-E, indicate that CBT-E is an effective treatment for adults with all eating disorders within out-patient settings. Given the high attrition rate, however, minimizing drop-out appears to be an important consideration when implementing CBT-E within clinical settings.

Associations between Social Support from Family, Friends, and Teachers and depressive Symptoms in Adolescents.

Approximately 20% of adolescents develop depressive symptoms. Family, friends, and teachers are crucial sources of social support for adolescents, but it is unclear whether social support impacts adolescents directly (principle-effect model) or by moderating the effect of stress (stress-buffer model) and whether each source of social support remains meaningful when their influence is studied simultaneously. To help fill this gap, we followed 1452 Australian students (average age at enrollment = 13.1, SD = 0.5; range: 11-16 years; 51.9% female) for 5 years. Based on our findings, each source of support is negatively related to depressive symptoms one year later when studied independently but when combined, only family and teacher support predicted depressive symptoms. Family support in all grades and teacher support in grade 8 to 10 but not in grade 11 directly impacted adolescent depressive symptoms 1 year later. Family support in grades 8 and 11 also buffered against the negative impact of stress on depressive symptoms one year later. Based on the unexpected findings, the most important limitations seem to be that the used instruments do not allow for a separation of different groups of friends (e.g., classmates, same-gender peers, romantic partners), types of social support, and stress. In addition, the high, nonrandom attrition rate with adolescents reporting less social support, more stressful events, a higher frequency of depressive symptoms, and/or being of Torres Strait Islander or Aboriginal background limits the generalizability of our findings. Summarized, our findings demonstrate that adolescents facing stress might benefit more from family support compared to their peers without stressful life events and that friends may have a weaker presence in adolescent lives than expected.

Eating disorder mental health literacy: What do psychologists, naturopaths, and fitness instructors know?

At present, there are no known studies investigating the eating disorder mental health literacy (ED-MHL) of common frontline health providers such as psychologists, naturopaths, and fitness instructors. Little research also exists around practitioner knowledge for the spectrum of eating disorders. The current study sought to fill these research gaps and comprised 115 health practitioners who completed an online survey. A fictional vignette describing a female (Sarah) experiencing a subthreshold bulimic variant without purging was presented alongside common ED-MHL items. Almost 4 in 10 psychologists, 7 in 10 natural therapists, and 8 in 10 fitness instructors failed to detect a general eating disorder, with the latter two groups more likely to believe the problem was a self-esteem issue. Perceived helpfulness of people and interventions varied from best practice clinical guidelines, with physical/medical risk management not prioritized, pharmacotherapy viewed poorly, and doctors seen as one of the least helpful people. Although Sarah's problem was seen as severe and highly common (which may speak to the volume of undetected eating disorders), alarmingly 36.7% of fitness instructors viewed her predicament as desirable given weight lost. This novel study highlights the need for specific training interventions to improve health practitioners' ED-MHL, particularly around atypical eating disorder presentations, which may facilitate earlier detection and help-seeking for evidence-based interventions rather than expenditure on unhelpful or even harmful treatments, leading to improved community health and lives saved.

A child chronic cough-specific quality of life measure: development and validation.

BACKGROUND: Quality of life (QoL) measures are an important patient-relevant outcome measure for clinical studies. Cough is the most common symptom that results in new medical consultations. Although adult and parent-proxy cough-specific QoL instruments have been shown to be a useful cough outcome measure, no suitable cough-specific QoL measure for children with chronic cough exists. We report on the statistical properties of a chronic cough-specific QoL (CC-QoL) questionnaire for children. METHOD: 130 children (median age 10 years, IQR 8-12 years; 65 girls) participated. A preliminary 37-item version was developed from conversations with children with chronic cough (>4 weeks). Children also completed generic QoL questionnaires (Pediatric QoL Inventory 4.0 (PedsQL4.0), Spence Children's Anxiety Scale (SCAS)) and cough diary scores. RESULTS: The clinical impact method of item reduction resulted in 16 items that had excellent internal consistency (Cronbach's α=0.94) among these items and also within each domain. Evidence for construct and criterion validity was established with significant correlations between CC-QoL subscales with cough scores, PedsQL and SCAS scores. CC-QoL scores were sensitive to change following an intervention and significant differences were noted between those children coughing and those who had ceased coughing. Minimum important difference (MID) for overall and domain CC-QoL ranged from 0.37-1.36 (distribution-based approach) to 1.11-1.58 (anchor-based approach). CONCLUSIONS: Chronic cough significantly impacts the QoL of children. The CC-QoL is a reliable, valid and sensitive to change outcome measure that assesses QoL from the child's perspective. Pending data from a confirmatory cohort, a MID for the CC-QoL of 1.1 is recommended when evaluating health status change.

Self-stigma of seeking treatment and being male predict an increased likelihood of having an undiagnosed eating disorder.

OBJECTIVE: To examine whether self-stigma of seeking psychological help and being male would be associated with an increased likelihood of having an undiagnosed eating disorder. METHOD: A multi-national sample of 360 individuals with diagnosed eating disorders and 125 individuals with undiagnosed eating disorders were recruited. Logistic regression was used to identify variables affecting the likelihood of having an undiagnosed eating disorder, including sex, self-stigma of seeking psychological help, and perceived stigma of having a mental illness, controlling for a broad range of covariates. RESULTS: Being male and reporting greater self-stigma of seeking psychological help was independently associated with an increased likelihood of being undiagnosed. Further, the association between self-stigma of seeking psychological help and increased likelihood of being undiagnosed was significantly stronger for males than for females. DISCUSSION: Perceived stigma associated with help-seeking may be a salient barrier to treatment for eating disorders-particularly among male sufferers.

Parent cough-specific quality of life: development and validation of a short form.

BACKGROUND: Cough is a distressing symptom and has a significant effect on many children and their families. Quality-of-life (QOL) measures provide important outcome indicators for clinicians and aid in evaluating the efficacy of interventions. OBJECTIVE: The aim of this study was to develop and validate a short cough-specific QOL questionnaire for pediatric use. METHOD: Two sources provided data to establish a shortened version of the Parent Cough-specific Quality of Life (PC-QOL) questionnaire. The first (n=240, 137 boys; median age, 29 months [interquartile range, 14-64 months]) was used for development and cross-validation. Stepwise regression was used to select the reduced set of items, and analyses of reliability, validity, and minimally important differences determined psychometric strength and sensitivity to change. The second independent dataset (n=320, 190 boys; median age, 39.5 months [interquartile range, 16-77 months]) was used as a confirmatory sample. RESULTS: Forward-step regression identified 8 items that accounted for 95% of the variance in the full-scale PC-QOL questionnaire. This shortened version (PC-QOL-8) was internally consistent (Cronbach α=0.84), had good test-retest reliability (intraclass correlation coefficient=0.66), and demonstrated strong validity (significant correlations with a cough verbal category descriptor score, cough visual analog scale, and subscales of the Short Form-12 General Health scale, the Pediatric Quality of Life Inventory, and the Depression, Anxiety, and Stress Scale). The reduced scale was responsive to change, and a minimally important difference of 0.9 was suggested. These findings were confirmed with the second dataset. CONCLUSION: The PC-QOL-8 questionnaire is a short, reliable, and valid instrument for assessing the effect of a child's chronic cough. It demonstrated sensitivity to change, and its length and psychometric properties should enhance its potential uptake and routine use in clinical practice and research.

When a baby is diagnosed at high risk of cerebral palsy: understanding and meeting parent need.

PURPOSE: To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment Therapy; PACT). MATERIALS AND METHODS: Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10-24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews. RESULTS: Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery. CONCLUSIONS: Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care.IMPLICATIONS FOR REHABILITATIONParents want clinicians to be honest, supportive and to normalise their griefClinicians in rehabilitation would benefit from up-skilling in grief supportParental support should be built into systems of care for children with cerebral palsy.

Breathe Easier Online: evaluation of a randomized controlled pilot trial of an Internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition.

BACKGROUND: Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. OBJECTIVE: To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. METHODS: We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). RESULTS: The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. CONCLUSIONS: Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033; http://www.anzctr.org.au/trial_view.aspx?ID=308074 (Archived by WebCite at http://www.webcitation.org/63BL55mXH).

Co-occurring anger in young people with Asperger's syndrome.

OBJECTIVES: The co-occurrence of anger in young people with Asperger's syndrome (AS) has received little attention despite aggression, agitation, and tantrums frequently being identified as issues of concern in this population. The present study investigated the occurrence of anger in young people with AS and explores its relationship with anxiety and depression. METHOD: Sixty-two young people (12-23 years old) diagnosed with AS were assessed using the Beck Anger Inventory for Youth, Spence Children's Anxiety Scale, and Reynolds Adolescent Depression Scale. RESULTS: Among young people with AS who participated in this study, 41% of participants reported clinically significant levels of anger (17%), anxiety (25.8%) and/or depression (11.5%). Anger, anxiety, and depression were positively correlated with each other. Depression, however, was the only significant predictor of anger. CONCLUSION: Anger is commonly experienced by young people with AS and is correlated with anxiety and depression. These findings suggest that the emotional and behavioral presentation of anger could serve as a cue for further assessment, and facilitate earlier identification and intervention for anger, as well as other mental health problems.

Parenting Acceptance and Commitment Therapy: An RCT of an online course with families of children with CP.

AIM: To test an online course Parenting Acceptance and Commitment Therapy (PACT) in an RCT with families of children with cerebral palsy (CP), predicting improvements in emotional availability and parent and child adjustment. METHOD: 67 families of children (2-10 years) with CP participated. Families were randomly assigned to waitlist control or PACT. Assessments at baseline, post-intervention and at six-month follow up (durability of intervention effects) focussed on emotional availability, adjustment and quality of life. Analysis consisted of repeated measure linear regression models. RESULTS: At postintervention (T2), an intervention effect was demonstrated for two aspects of observed emotional availability: parental non-intrusiveness MD = 0.68 (-0.56 to 1.92), p = 0.050 and child involvement, MD = 0.91 (-0.36 to 2.18), p = 0.011. An intervention effect was also found for the parent-reported emotional availability in terms of child involvement. Further intervention effects were found in parent-report measures of child quality of life (social wellbeing and acceptance, participation and physical health), parental mindfulness, parental acceptance, support, social connection, and meaning. No effects were found on parent or child adjustment. Analyses focussed on durability of intervention effect, collapsed across groups, indicated that effects persisted at 6 month follow up (T4). INTERPRETATION: PACT demonstrated an intervention effect for two aspects of emotional availability-parental non-intrusiveness and child involvement-as well as parental mindfulness and child quality of life. Parents reported increased comfort with the CP diagnosis, higher likelihood to seek support, higher likelihood to stay connected to others and greater meaningful living. PACT is an effective online/telehealth parenting support intervention for parents of children with CP.

Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study.

BACKGROUND: The gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed. OBJECTIVE: The aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison. METHODS: Dual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73%) during the study period were invited to participate. RESULTS: Owing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization. CONCLUSIONS: The Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison.

Practitioner eating disorder detection: The influence of health mindset, thin-ideal internalization, orthorexia and gender role.

AIMS: The current study sought to determine what factors inhibited psychologists, naturopaths and fitness instructors from detecting an eating disorder (ED), and the discipline differences across these factors. METHODS: Participants of the online study were 115 health practitioners who consisted of 35 psychologists, 50 naturopathic and 30 fitness practitioners. A vignette describing a female experiencing a sub-threshold bulimic variant without purging was presented alongside ED mental health literacy items such as assessing one's ability to detect a problem. Additional items examined factors that may inhibit detection, including practitioners' level of: thin-ideal internalization, orthorexia, health or fitness mindset (a newly developed scale measuring health and fitness obsessiveness) and gender role identity. RESULTS: A significant number of naturopaths and fitness instructors (20% and 33.3%, respectively) were found to have elevated orthorexia scores. Similarly, psychologists had the greatest tendency to internalize the thin-ideal (M = 3.60), which was comparable to levels seen in recent research for 20- to 21-year-old females with EDs. The two largest factors inhibiting ED detection were the strength of a health mindset and gender role identity. Practitioners who had higher health mindset scores or who associated with gender identities higher in masculinity traits (ie, either androgynous or masculine gender roles) were more likely to miss detecting an ED. CONCLUSIONS: While many present ED studies focus upon assessing and changing client cognitions, this study emphasizes the need for further research regarding training interventions to address practitioner cognitions and gender role biases, which may in turn improve ED detection.

Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial.

LAY ABSTRACT: Children on the autism spectrum may experience difficulties with the regulation of attention, thoughts, emotions, and behavior, understanding, and expressing their emotions appropriately, as well as anxiety, and sleep. In autism research, contemplative practices that work through both body and mind have shown tentatively promising results. However, there are limited studies on this topic, and the use of yoga to facilitate executive control has not been researched yet. The Incredible Explorers (6-week program), a yoga-informed intervention program for children (8-12 years), was developed to understand whether, for children on the autism spectrum, the training could improve the ability to self-regulate, reduce anxiety and sleep problems, and increase awareness of emotions. In our sample, 61 children with one of their parents completed the program. Half of the group received the intervention, and the other half had to wait until the yoga group completed their trial. The participants were asked to give their feedback immediately after program completion and at 6-week follow-up. Compared to the group that was waiting to receive the intervention, parents in the yoga group reported significant gains for their children in regulating their overall executive control immediately after the session and again at follow-up. The parents reported a reduction in some of the sleep problems post-treatment. Children indicated an improved ability to communicate their feelings and willingness to analyze their emotions post-intervention. However, the study had several shortcomings and given that this was the first trial of the program, the results need to be interpreted with caution. Further research is recommended.

Development and validation of a parent-proxy health-related quality of life survey for Australian First Nations children.

OBJECTIVE: Within Australia, Aboriginal and Torres Strait Islander (First Nations) populations perceive health and well-being differently to non-Indigenous Australians. Existing health-related quality of life (HR-QoL) measurement tools do not account for these differences. The objective of this study was to develop and validate a culturally specific parent-proxy HR-QoL measurement tool for First Nations children. DESIGN: Scale development was informed by parents/carers of children with a chronic illness and an expert panel. The preliminary 39-item survey was reviewed (n=12) and tested (n=163) with parents/carers of First Nations children aged 0-12 years at baseline with comparative scales: the Kessler Psychological Distress Scale, generic HR-QoL (Paediatric QoL Inventory 4.0, PedsQL4.0) and Spence Children's Anxiety Scale, and repeated (n=46) 4 weeks later. Exploratory Factor Analysis was used for scale reduction. Reliability and validity were assessed by internal consistency, test-retest, and correlations with comparison scales. RESULTS: Items within our First Nations-Child Quality of Life (FirstNations-CQoL) were internally consistent with Cronbach's alpha coefficients of ≥0.7 (quality of life, 0.808; patient experience, 0.880; patient support, 0.768) and overall test-retest reliability was good (r=0.75; 95% CI 0.593 to 0.856). Convergent validity was observed with the PedsQL4.0 with Pearson's coefficients of r=0.681 (ages 2-4 years); r=0.651 (ages 5-12 years) and with the Kessler Psychological Distress scale (r=-0.513). Divergent validity against the Spence Anxiety Scale was not demonstrated. CONCLUSIONS: The FirstNations-CQoL scale was accepted by the participants, reliable and demonstrated convergent validity with comparison measures. This tool requires further evaluation to determine responsiveness, its minimal important difference and clinical utility.

Validation of a parent-proxy quality of life questionnaire for paediatric chronic cough (PC-QOL).

BACKGROUND: Quality of life (QOL) measures are an important patient-relevant outcome measure for clinical studies. Currently there is no fully validated cough-specific QOL measure for paediatrics. The objective of this study was to validate a cough-specific QOL questionnaire for paediatric use. METHOD: 43 children (28 males, 15 females; median age 29 months, IQR 20-41 months) newly referred for chronic cough participated. One parent of each child completed the 27-item Parent Cough-Specific QOL questionnaire (PC-QOL), and the generic child (Pediatric QOL Inventory 4.0 (PedsQL)) and parent QOL questionnaires (SF-12) and two cough-related measures (visual analogue score and verbal category descriptive score) on two occasions separated by 2-3 weeks. Cough counts were also objectively measured on both occasions. RESULTS: Internal consistency for both the domains and total PC-QOL at both test times was excellent (Cronbach alpha range 0.70-0.97). Evidence for repeatability and criterion validity was established, with significant correlations over time and significant relationships with the cough measures. The PC-QOL was sensitive to change across the test times and these changes were significantly related to changes in cough measures (PC-QOL with: verbal category descriptive score, r(s)=-0.37, p=0.016; visual analogue score, r(s)=-0.47, p=0.003). Significant correlations of the difference scores for the social domain of the PC-QOL and the domain and total scores of the PedsQL were also noted (r(s)=0.46, p=0.034). CONCLUSION: The PC-QOL is a reliable and valid outcome measure that assesses QOL related to childhood cough at a given time point and measures changes in cough-specific QOL over time.

School-based prevention of depression: a randomised controlled study of the beyondblue schools research initiative.

BACKGROUND: Depressive disorders are experienced by 3-5% of the adolescent population at any point of time. They adversely affect adolescent development in a range of areas and greatly increase risk for suicide. The present study investigated the effectiveness of a universal intervention designed to reduce depressive symptoms among students commencing high school. METHODS: Twenty-five pairs of secondary schools matched on socio-economic status were randomly assigned to either an intervention or a comparison group (n = 5,634 Year 8 students). The intervention extended over a 3-year period and utilised a comprehensive classroom curriculum programme, enhancements to the school climate, improvements in care pathways, and community forums. A range of measures completed by students, average age at baseline = 13.1 years (SD = .5), and teachers was used to assess changes in depressive symptoms, risk and protective factors relevant to depression, and the quality of the school environment. RESULTS: Changes in the level of depressive symptoms and in the levels of risk and protective factors experienced by students in the two groups did not differ significantly over the 3 years of the study. Furthermore, statistically significant differences in the ratings of school climate across this time period were found only for staff-rated assessments. CONCLUSIONS: Despite using an extensive, structured programme, based on best evidence to increase protective factors and reduce risk factors at the individual and school levels, the intervention did not reduce levels of depressive symptoms among participating adolescents. The results draw attention to the difficulties faced when implementing large-scale, school-based, universal preventive interventions. These include the need to develop methods to effectively train teachers across large geographical regions to deliver new interventions with fidelity, the difficulty of engaging young adolescents with prevention programmes, and the long period of time required to implement policy and practice changes at 'whole-school' levels.

Exploring Mental Health Professionals' Perspectives of Text-Based Online Counseling Effectiveness With Young People: Mixed Methods Pilot Study.

BACKGROUND: Population-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups. OBJECTIVE: This pilot study aimed to explore and confirm e-mental health professional's perspectives about various domains and themes related to young service users' (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities. METHODS: Participants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness. RESULTS: A total of 4 domains and various subthemes were confirmed and identified to be related to YSUs' characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors). CONCLUSIONS: Participants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor's interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation.