Trajectories of school refusal: sequence analysis using retrospective parent reports.

School refusal (SR) is a form of school attendance problem (SAP) that requires specific mental health care. Despite improvements in the definition of SAPs, the course of SR is not well characterized. To explore three-year patterns of SR course in children, as reported by their parents, we deployed an anonymous web-based survey. We defined SR onset as the absence of ≥ 2 school weeks during one academic year, combined with emotional distress. We defined standard SR trajectories using sequence analysis of parents' recollection of three consecutive years of school attendance. We obtained 1970 responses, 1328 (67%) completed by a parent and meeting the definition of SR. Of these, 729 (55%) responses included three years of school attendance recollection. We identified five prototypical trajectories of SR: two profiles for children: beaded absences (n = 272), and rapid recovery (n = 132); and three for adolescents: prolonged recovery (n = 93), gradual decline (n = 89), and rapid decline (n = 143). We found five distinct trajectories of retrospective recall of SR course. Through pattern recognition, this typology could help with timely identification of SR and implementation of evidence-based interventions to optimize outcomes. Prospective replication of these findings and their field application is warranted.

Pathways and identity: toward qualitative research careers in child and adolescent psychiatry.

OBJECTIVE: Qualitative research methods are based on the analysis of words rather than numbers; they encourage self-reflection on the investigator's part; they are attuned to social interaction and nuance; and they incorporate their subjects' thoughts and feelings as primary sources. Despite appearing well suited for research in child and adolescent psychiatry (CAP), qualitative methods have had relatively minor uptake in the discipline. We conducted a qualitative study of CAPs involved in qualitative research to learn about these investigators' lived experiences, and to identify modifiable factors to promote qualitative methods within the field of youth mental health. METHODS: We conducted individual, semi-structured 1-h long interviews through Zoom. Using purposive sample, we selected 23 participants drawn from the US (n = 12) and from France (n = 11), and equally divided in each country across seniority level. All participants were current or aspiring CAPs and had published at least one peer-reviewed qualitative article. Ten participants were women (44%). We recorded all interviews digitally and transcribed them for analysis. We coded the transcripts according to the principles of thematic analysis and approached data analysis, interpretation, and conceptualization informed by an interpersonal phenomenological analysis (IPA) framework. RESULTS: Through iterative thematic analysis we developed a conceptual model consisting of three domains: (1) Becoming a qualitativist: embracing a different way of knowing (in turn divided into the three themes of priming factors/personal fit; discovering qualitative research; and transitioning in); (2) Being a qualitativist: immersing oneself in a different kind of research (in turn divided into quality: doing qualitative research well; and community: mentors, mentees, and teams); and (3) Nurturing: toward a higher quality future in CAP (in turn divided into current state of qualitative methods in CAP; and advocating for qualitative methods in CAP). For each domain, we go on to propose specific strategies to enhance entry into qualitative careers and research in CAP: (1) Becoming: personalizing the investigator's research focus; balancing inward and outward views; and leveraging practical advantages; (2) Being: seeking epistemological flexibility; moving beyond bibliometrics; and the potential and risks of mixing methods; and (3) Nurturing: invigorating a quality pipeline; and building communities. CONCLUSIONS: We have identified factors that can support or impede entry into qualitative research among CAPs. Based on these modifiable findings, we propose possible solutions to enhance entry into qualitative methods in CAP (pathways), and to foster longer-term commitment to this type of research (identity).

Facing the Unknown: An Inductive Analysis of the Lived Experience of Medical Residents during the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic had significant repercussions for the everyday life and public health of society. Healthcare professionals were particularly vulnerable. Here, we interviewed medical residents about their lived experiences during the pandemic to offer a phenomenological analysis. To this end, we discuss their pandemic experiences considering Jaspers' "limit situation" concept - that is, a radical shift from their everyday experiences, to one causing them to question the basis of their very existence. METHODS: We interviewed 33 medical residents from psychiatry and other specialties from the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) who either (a) worked directly with COVID-19 patients or (b) provided psychiatric care to other healthcare professionals. Semi-structured interviews were developed using the Inductive Process to Analyze the Structure of lived Experience (IPSE). RESULTS: The descriptions of the lived experiences of medical residents during the pandemic were organized into four content themes: (a) existential defense, (b) limit situations during the COVID-19 pandemic, (c) changes in lived experience, and (d) new world meanings through lived experience. CONCLUSION: During the COVID-19 pandemic, medical residents experienced what can be thought of as a "limit situation," as they encountered the healthcare delivery challenges coupled with the social isolation imposed by the COVID-19 pandemic. These challenges included fear of infection and potential death, uncertainty about the future, and the emotional overload caused by the sharp increase in patient deaths. That said, after facing such a limit situation, residents reported feeling strengthened by this experience. This is consistent with the notion that when confronted with limit situations, we draw on our resources to overcome adversity and, in turn, reap existential gains. Health care providers might use these experiences to energize their own professional approach.

"In their own words": delineating the contours of dyspnea invisibility in patients with advanced chronic obstructive pulmonary disease from quantitative discourse analysis.

BACKGROUND: Dyspnea conveys an upsetting or distressing experience of breathing awareness. It heavily weighs on chronic respiratory disease patients, particularly when it persists despite maximal treatment of causative abnormalities. The physical, psychological and social impacts of persistent dyspnea are ill-appreciated by others. This invisibility constitutes a social barrier and impedes access to care. This study aimed to better understand dyspnea invisibility in patients with chronic obstructive pulmonary disease (COPD) through quantitative discourse analysis. METHODS: We conducted a lexicometric analysis (lemmatization, descending hierarchical classification, multicomponent analysis, similarity analysis) of 11 patients' discourses (6 men, severe COPD; immediate postexacerbation rehabilitation) to identify semantic classes and communities, which we then confronted with themes previously identified using interpretative phenomenological analysis (IPA). RESULTS: Class#1 ("experience and need for better understanding"; 38.9% of semantic forms, 50% of patients) illustrates the gap that patients perceive between their experience and what others see, confirming the importance of dyspnea invisibility in patients' concerns. Class#2 ("limitations"; 28.7% of forms) and Class#3 (management"; 13.1% of forms) point to the weight of daily limitations in performing basic activities, of the need to accept or adapt to the constraints of the disease. These three classes matched previously identified IPA-derived themes. Class#4 ("hospitalization"; 18.2% of forms) points to the importance of interactions with the hospital, especially during exacerbations, which constitutes novel information. CONCLUSIONS: Lexicometry confirms the importance of dyspnea invisibility as a burden to COPD patients.

Family dyads, emotional labor, and holding environments in the simulated encounter: co-constructive patient simulation as a reflective tool in child and adolescent psychiatry training.

BACKGROUND: Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics. METHODS: We organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach. RESULTS: Based on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time. CONCLUSION: The emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor, particularly in the form of creating holding environments; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.

Somatic symptoms in school refusal: a qualitative study among children, adolescents, and their parents during the COVID-19 pandemic.

School refusal (SR) is commonly associated with somatic symptoms that are temporally related to school attendance. Abdominal pain, headache, vomiting, and musculoskeletal pain are frequently encountered and are usually not caused by a physical disease. School refusers, parents and health care workers are often puzzled by these impairing symptoms. In this qualitative study, we assessed somatic symptoms in a population encompassing both school refusers and their parents. We aimed at better understanding experiences and strategies in the management of these debilitating symptoms, while also investigating the journey of these symptoms and their behavioral consequences on the said population. We conducted qualitative interviews both within an Integrated Youth Health Care Unit in Paris and through a French parent-led support group improving care for school refusers. We interviewed 19 young persons with SR (aged 6-21 years old) and 20 parents. Using the Grounded Theory, three themes were identified: (1) somatic symptoms' journey in four phases (emergence, coping, crisis, and disappearance in the context of school dropout); (2) their deconstruction, indicating the patients' emotional state; and (3) their management through self-care practices as well as increased emotional and body awareness. Some parents, who could portray similar symptoms at a younger age, mentioned familial pattern of heightened emotional and sensorial sensitivity as a possible cause. Findings suggested that somatic symptoms in SR offer an insight into the patients' emotional state. We recommend that psychotherapies targeting somatic symptoms could be further assessed in SR, along with educational content aimed at increasing emotional literacy in schools and health care settings.

Constructing childhood depression: a qualitative study with international experts in child psychiatry.

After decades of controversy, the concept of childhood depression now seems to be part of standard medical knowledge. Yet the form and content of this nosological entity, like many psychiatric diseases, is continuously shaped by the scientific, clinical, and political communities involved in child psychiatry. In this qualitative study, we explored how the concept of childhood depression is constructed in early twenty-first century child psychiatry. We conducted a series of 18 interviews with practising child psychiatrists, international experts in the field, and interpreted them with thematic analysis informed by discourse analysis. We identified five overarching discourse themes across interviews, relating to the definition of depression, the diagnostic process, the causes of this condition, the therapeutic strategy, and the scientific role of child psychiatry. Most participants agreed that childhood depression was a mental disorder where irritability prevailed, heavily influenced by psychosocial factors, and for which psychotherapy was the ideal treatment. However, subtle points of dissent also surfaced: whether depression is primarily a mood state or psychological suffering, whether categories or dimensions are more suitable to make the diagnosis, and whether there is a genetic predisposition were some of the most controversial topics. Theoretical considerations regarding childhood depression may have significant scientific, moral, and socio-political implications beyond child psychiatry and should be addressed appropriately.

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice.

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Climate awareness, anxiety, and actions among youth: a qualitative study in a middle-income country.

OBJECTIVES: The impact of climate change on mental health is well established, but few studies have examined the perspectives of young people, especially in low- and middle-income countries (LMICs). In this qualitative study, we explored how Brazilian children and adolescents experience climate change. This approach can help inform environmental education, communication, and self-care strategies for this age group. METHODS: We conducted focus groups with 50 children and adolescents aged 5 to 18 years in three locations in Brazil. We analyzed the data using an interpretative phenomenological analysis framework. RESULTS: We identified three profiles of involvement with climate change: unaware, disengaged, and engaged. Profiles were largely related to different socioeconomic contexts. We analyzed each profile across the dimensions of space, time, emotions, and actions. Adults were portrayed by participants as stubborn deniers, as neutral influences, or as role models of knowledge and engagement. Due to their age and developmental level, young children had distinctive perceptions of climate change. CONCLUSION: Spatial and temporal perceptions of climate change are a key element for experiencing and engaging with environmental concerns and vary according to age and socioeconomic differences. Effective communication to foster climate action at individual and collective levels requires narratives that reach different ages. Replication of these findings in other LMICs is warranted.

Barriers to Identifying Learning Disabilities: A Qualitative Study of Clinicians and Educators.

OBJECTIVE: The estimated prevalence of learning disabilities (LDs) is nearly 8% of all children. Fewer than 5% of all children are diagnosed in public schools, jeopardizing remediation. We aimed to identify barriers affecting front-line child-facing professionals in detecting LDs in school-aged children. METHODS: We conducted a qualitative study with individual interviews of 40 professionals from different areas of the United States identified through theoretical sampling (20 educators, 10 pediatricians, and 10 child mental health clinicians). Clinicians represented academic and community settings, and educators represented public, private, and charter schools. Twenty had expertise in assessing LDs; 20 were generalists without specific training. We also endeavored to maximize representation across age, gender, race and ethnicity, and location. We analyzed transcripts utilizing grounded theory and identified themes reflecting barriers to detection. RESULTS: Themes and sub-themes included: 1) areas requiring improved professional education (misconceptions that may hinder detection, confounding factors that may mask LDs, and need for increasing engagement of parents or guardians in identifying LDs) and 2) systemic barriers (time constraints that limited professionals' ability to advocate for children and to delve into their emotional experiences, inconsistent guidelines across institutions and inconsistent perceptions of professional responsibility for detection, and confusion surrounding screening tools and lack of screening by some professionals in the absence of overt problems). CONCLUSIONS: Clinicians and other child-facing professionals may benefit from augmented training in screening and identification and enhanced evidence-based and institutional guidance. These efforts could increase efficiency and perceived responsibility for recognition and improve earlier detection.

Perceptions of racism in a children's psychiatric inpatient unit: A qualitative study of entrenching and uprooting factors.

WHAT IS KNOWN ON THE SUBJECT?: The impacts of racism on health are well documented and are greater for mental than for general health. Mental health professionals are well positioned to help dismantle racism and structural barriers compromising optimal patient care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it. By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our two-domain/six-theme model may serve as a rubric for individuals to engage in structured self-reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations. The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace ABSTRACT: INTRODUCTION: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. AIM/QUESTION: We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. METHODS: We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. RESULTS: We identified two countervailing processes: (1) Entrenching-factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting-factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. IMPLICATIONS FOR PRACTICE: Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two-domain/six-theme model we developed can serve as a rubric for individuals or milieu-based inpatient settings serving patients of any age to engage in structured self-reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations.

Enhancing Child and Adolescent Psychiatry Recruitment Through a Medical Student Mentorship Network: A Qualitative Study.

OBJECTIVE: There is a shortage of psychiatrists necessary to meet the clinical needs of children and adolescents. Efforts over the past decade to enhance the workforce have had a limited impact. This study sought to identify the critical components of a medical student mentorship network designed to increase recruitment into the subspecialty. METHODS: The authors conducted interviews via synchronized videoconferencing of network site leaders and medical students at 14 schools throughout the USA. In addition, they analyzed verbatim transcripts using a thematic-phenomenological qualitative approach. RESULTS: The authors interviewed thirty-eight program participants during seven focus group sessions: nine program directors and 29 medical students or graduates, a median of five participants per session. They constructed a framework consisting of two overarching domains, comprised of three themes each: (1) life cycle of a subspecialty mentorship network (Origins, Initiation, and Continuity); and (2) next steps to improve the program (Refining goals, Increasing accessibility, and Defining a path forward). CONCLUSION: Preliminary data have already documented the positive impact of participation in this mentorship program on medical student match rates into psychiatry. The qualitative model of this study provides a blueprint to develop, maintain, and optimize this and similar efforts aimed at increasing the child and adolescent psychiatry workforce.

Climate awareness, anxiety, and actions among youth: a qualitative study in a middle-income country

Objectives: The impact of climate change on mental health is well established, but few studies have examined the perspectives of young people, especially in low- and middle-income countries (LMICs). In this qualitative study, we explored how Brazilian children and adolescents experience climate change. This approach can help inform environmental education, communication, and self-care strategies for this age group. Methods: We conducted focus groups with 50 children and adolescents aged 5 to 18 years in three locations in Brazil. We analyzed the data using an interpretative phenomenological analysis framework. Results: We identified three profiles of involvement with climate change: unaware, disengaged, and engaged. Profiles were largely related to different socioeconomic contexts. We analyzed each profile across the dimensions of space, time, emotions, and actions. Adults were portrayed by participants as stubborn deniers, as neutral influences, or as role models of knowledge and engagement. Due to their age and developmental level, young children had distinctive perceptions of climate change. Conclusion: Spatial and temporal perceptions of climate change are a key element for experiencing and engaging with environmental concerns and vary according to age and socioeconomic differences. Effective communication to foster climate action at individual and collective levels requires narratives that reach different ages. Replication of these findings in other LMICs is warranted.

Understanding youths' concerns about climate change: a binational qualitative study of ecological burden and resilience.

BACKGROUND: Climate change has been shown to have long-term effects on mental health, yet, to date, there have been few studies on how children and adolescents experience and respond to ecological changes and how and why they engage in climate action. We explored empirically young people's views about climate change and how distinct cultural contexts influence individual climate action. METHODS: We invited children and adolescents (ages 7 to 18) and their caregivers from the general population in the United States and France to participate in semi-structured focus groups. We recruited 74 participants, 39 in the U.S. (33 children and adolescents, 6 parents) and 35 in France (32 children and adolescents, 3 parents). Focus groups with participants centered on their emotions, beliefs, and actions around climate change. We analyzed the focus group data and developed themes via grounded theory and symbolic interactionist approaches. RESULTS: Many participants described experiencing anger, hopelessness, guilt, and sadness in response to climate change, and a smaller number endorsed significant anxiety symptoms; many described frustration about needing to fix the mistakes of earlier generations. Younger participants frequently misunderstood the purpose of their parents' eco-conscious behaviors unless they were provided with age-appropriate explanations. Participants described a spectrum of experiences when trying to discuss climate change with peers and family, ranging from genuine support to apathy to hostility. Between the two samples, U.S. participants experienced more conflict with adults about climate change than French participants, but French participants described a greater lack of political agency compared to U.S. PARTICIPANTS: Participants in both samples expressed a relatively balanced view of climate action, recognizing the significance of individual actions while acknowledging the limits of their power in the face of systemic issues. Some found hope and empowerment through climate action and building communities around it. CONCLUSION: Discussing with children and adolescents what adults are doing to mitigate climate change can provide reassurance, model prosocial behaviors, and inspire their own investment in climate action. Adults seeking to support the psychological well-being of young people should both support their concerns and actions around climate change and create avenues for young people to meaningfully engage in climate action.

Multimodal co-therapy for unaccompanied minors: a qualitative study.

BACKGROUND: Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS: MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS: Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION: This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.

Perspectives on Climate Change and Pediatric Mental Health: a Qualitative Analysis of Interviews with Researchers in the Field.

OBJECTIVE: There is a growing appreciation that climate change is affecting pediatric mental health, yet research in this field is in its infancy. The authors aimed to interview researchers in this space to identify themes that can help shape curricula and inform mentors guiding trainees entering this research area. METHOD: A literature review was completed within PubMed, PsycINFO, and EMBASE for articles written in English and indexed between January 1, 2016, and August 1, 2021. The first and last authors of relevant articles were invited to be interviewed and to recommend other experts, from which 20 of 74 (27%) eligible participants were recruited. Standardized interviews were conducted virtually, transcribed, and qualitatively analyzed. RESULTS: Participant responses clustered into two domains, each comprising three themes: (1) current and future research: epidemiology and education, interventions, and gaps in research; and (2) barriers: limited funding, psychological resistance, and logistical impediments. Research has been primarily limited to the phenomenology of eco-anxiety, the aftermath of natural disasters, and psychoeducational interventions. Participants provided insights into how the field can become more interventional, overcome psychological resistance among colleagues through education, and improve funding through calls for grants specific to this topic. CONCLUSIONS: This study outlines perspectives on the cutting-edge directions of research in climate mental health for children and impediments to its progress. Generalizability is limited by the small sample of experts interviewed; however, these content experts' opinions can inform curriculum development and help mentors support mentees hoping to develop research careers in climate mental health.

'You can't feel what we feel': Multifaceted dyspnoea invisibility in advanced chronic obstructive pulmonary disease examined through interpretative phenomenological analysis.

BACKGROUND: More than a symptom, dyspnoea is an existential experience shaping the lives of those afflicted, particularly when its persistence despite maximal pathophysiological treatments makes it pervasive. It is, however, insufficiently appreciated by concerned people themselves, family members, healthcare professionals and the public (dyspnoea invisibility), limiting access to appropriate care and support. AIM: To provide a better understanding of dyspnoea experiences and its invisibility. DESIGN: Interpretative phenomenological analysis of data collected prospectively through in-depth semi-structured interviews. SETTING/PARTICIPANTS: Pulmonary rehabilitation facility of a tertiary care university hospital; 11 people (six men, five women) with severe chronic obstructive pulmonary disease (stages 3 and 4 of the 4-stage international GOLD classification) admitted for immediate post-exacerbation rehabilitation. RESULTS: We identified several types of dyspnoea invisibility depending on temporality and interlocutors: (1) invisibility as a symptom to oneself; (2) invisibility as a symptom to others; (3) invisibility as an experience that cannot be shared; (4) invisibility as an experience detached from objective measurements; (5) invisibility as an experience that does not generate empathic concern. The notion of invisibility was present in all the identified experiential dimensions of dyspnoea. It was seen as worsening the burden of the disease and as self-aggravating through self-isolation and self-censorship. CONCLUSIONS: The study confirmed that dyspnoea invisibility is a reality for people with advanced chronic obstructive pulmonary disease. It shows dyspnoea invisibility to be a multifaceted burden. Future research should aim at identifying individual and collective measures to overcome dyspnoea invisibility.

School Refusal in Immigrants and Ethnic Minority Groups: A Qualitative Study of Adolescents' and Young Adults' Experiences.

Background: School refusal is one cause of school absenteeism along with truancy, and the two can be difficult to distinguish. School absenteeism behaviors among students in transcultural situations (immigrants or children of immigrants) and from ethnic minority groups are subject to misdiagnosis and decreased access to care. To improve the care provided, this exploratory study addresses the experience of adolescents and young adults engaging in school refusal, from immigrant and ethnic minority groups. Methods: Sixteen participants between the ages of 16 and 20 years old presenting with school refusal were interviewed for this qualitative study. All participants were either immigrants, children of immigrants, or from an ethnic minority group. We conducted a qualitative analysis based on Interpretative Phenomenological Analysis. Results: Participants experienced school refusal as a loss of identity and as a failure to achieve what was perceived as parental expectations of success, which triggered feelings of worthlessness, shame, and guilt. The loss of a peer group, namely their classmates, as a result of school absenteeism was experienced as a marginalization from the larger society. Although participants denied having personally experienced racism, some of them recalled their parents experiencing racism at school. Conclusion: School refusal complicates identity construction, autonomy, and integration into society. For adolescents and young adults from immigrant and ethnic minority backgrounds, it also triggers guilt, transgenerational traumatic memories, and the fear of marginalization. In addition to validated therapies for school refusal, sociological, intersectional, and cross-cultural tools would be a valuable addition to treatment.