Best practice for integrating digital interventions into clinical care for young people at risk of suicide: a Delphi study.

BACKGROUND: Digital tools have the capacity to complement and enhance clinical care for young people at risk of suicide. Despite the rapid rise of digital tools, their rate of integration into clinical practice remains low. The poor uptake of digital tools may be in part due to the lack of best-practice guidelines for clinicians and services to safely apply them with this population. METHODS: A Delphi study was conducted to produce a set of best-practice guidelines for clinicians and services on integrating digital tools into clinical care for young people at risk of suicide. First, a questionnaire was developed incorporating action items derived from peer-reviewed and grey literature, and stakeholder interviews with 17 participants. Next, two independent expert panels comprising professionals (academics and clinical staff; n = 20) and young people with lived experience of using digital technology for support with suicidal thoughts and behaviours (n = 29) rated items across two consensus rounds. Items reaching consensus (rated as "essential" or "important" by at least 80% of panel members) at the end of round two were collated into a set of guidelines. RESULTS: Out of 326 individual items rated by the panels, 188 (57.7%) reached consensus for inclusion in the guidelines. The endorsed items provide guidance on important topics when working with young people, including when and for whom digital tools should be used, how to select a digital tool and identify potentially harmful content, and identifying and managing suicide risk conveyed via digital tools. Several items directed at services (rather than individual clinicians) were also endorsed. CONCLUSIONS: This study offers world-first evidence-informed guidelines for clinicians and services to integrate digital tools into clinical care for young people at risk of suicide. Implementation of the guidelines is an important next step and will hopefully lead to improved uptake of potentially helpful digital tools in clinical practice.

"Put your personality into the call": A qualitative interview study illuminating strategies for improving men's engagement on crisis helplines.

BACKGROUND: Crisis telephone helplines are an integral part of community suicide prevention. Despite high male suicide rates, men's experiences of these services are poorly understood. The current study explored men's perspectives of their interactions with helpline counsellors to understand how their engagement on helplines can be enhanced. METHOD: Sixteen men (19-71 years) who had previously used a mental health or crisis helpline in Australia completed individual semi-structured interviews about their experiences. Data were analysed using interpretive descriptive methodologies. RESULTS: Two themes derived from the data related to how men engaged with counsellors on helpline services. First, men emphasized the importance of helpline counsellors creating and maintaining an authentic connection across the call, providing suggestions for strategies to secure connection. Second, men discussed how counsellors can facilitate outcomes through offering space for their narratives and aiding in referrals to other support services when required. CONCLUSIONS: Findings highlight the value of crisis helplines for men's suicide prevention services while identifying target areas to improve engagement. We discuss implications for the findings including suggestions for gender-sensitive care within crisis helplines.

Men's peer support for mental health challenges: future directions for research and practice.

Peer support has a long history of helping people navigate mental health challenges and is increasingly utilized within men's mental health promotion initiatives. Despite considerable research conceptualizing and evaluating peer support in various contexts, little is known about the gendered dimensions of men's peer support and mutual help for mental health. This article provides an empirically informed commentary on men's peer support and informal help-seeking preferences to make recommendations for future directions for research and practice. Research examining men's peer support is emergent and the available evidence suggests that there is potential to conceptually align with many men's values and preferences for mental health help-seeking. Peer support offers a non-clinical, strength-based adjunct to professional support that may aid men in navigating a range of mental health challenges. Consideration must be given to the influence of gender socialization and men's diverse experiences with developing and maintaining peer relationships. It should not be assumed that authentic and supportive relationships will naturally form when men congregate together. As a growing number of interventions and programs emerge targeted at boys and men, there are important opportunities to leverage these health promotion efforts to encourage and coach men to engage in mutual help. Opportunities for research and practice are discussed to better understand and harness the health-promoting potential of peer support for men's mental health.

Suicidal ideation in men during COVID-19: an examination of protective factors.

BACKGROUND: Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour. METHODS: A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis. RESULTS: Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans. CONCLUSIONS: Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

Psychic Pain Among Men: Factor Structure, Psychosocial Correlates, and Mediation of Social Connectedness and Suicidal Ideation.

ABSTRACT: The Psychic Pain Scale (PPS) measures a form of mental pain involving overwhelming negative affect and loss of self-control. Understanding psychic pain among men is needed to advance efforts for preventing male suicide. The present study examined the factor structure and psychosocial correlates of the PPS among 621 online help-seeking men. Confirmatory factor analysis indicated a higher-order factor comprising affect deluge and loss of control factors. Psychic pain evinced significant associations with general psychological distress, r = 0.64; perceived social support, r = -0.43; social connectedness, r = -0.55; and suicidal ideation, r = 0.65 (all p 's < 0.001)-the latter three remained significant after controlling for general distress. Psychic pain also mediated the association between social disconnection and suicidal ideation (standardized indirect effect = -0.14 [-0.21, -0.09]), after controlling for social support and distress. Findings support the PPS as a promising measure for investigating psychic pain among men and indicate psychic pain as a link between social disconnection and suicidal ideation.

Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety.

OBJECTIVE: Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. METHODS: Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants (N = 283) were 15-25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. RESULTS: Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. CONCLUSIONS: Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.

Young men and anxiety: Resisting, reckoning and responding.

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

Masculinities and men's emotions in and after intimate partner relationships.

Men's emotions in intimate partner relationships have received little research attention. The current interpretive descriptive study included 30 Canadian-based men to address the research question: What are the connections between masculinities and men's emotions in and after intimate partner relationships? Three inductively derived themes included emergent distressing emotions wherein participants' predominance for holding in abeyance their concerns about the relationship manifested varying levels of emotional stoicism. Within this context most men denied or downplayed and did not express their emotions. When the relationship broke, men were overwhelmed by mixed and weighty break-up emotions comprising diverse and often-times discordant emotions, including sadness, shame, anger, regret and guilt, calling into question men's rationality for deciphering and expressing what was concurrently but inexplicably felt. Shame and anger were prominent emotions demanding the participant's attention to all that happened in and at the end of the relationship. In the third theme, understanding and transitioning after-burn emotions, participant's grief levered their efforts, including soliciting professional help for deconstructing, reframing and expressing their emotions in the aftermath of the partnership ending. The findings contextualise and in some instances counter claims about the utility of men's emotional stoicism by mapping participants' feelings in and after intimate partner relationships.

A Comparative Study on the Lysosomal Cation Channel TMEM175 Using Automated Whole-Cell Patch-Clamp, Lysosomal Patch-Clamp, and Solid Supported Membrane-Based Electrophysiology: Functional Characterization and High-Throughput Screening Assay Development.

The lysosomal cation channel TMEM175 is a Parkinson's disease-related protein and a promising drug target. Unlike whole-cell automated patch-clamp (APC), lysosomal patch-clamp (LPC) facilitates physiological conditions, but is not yet suitable for high-throughput screening (HTS) applications. Here, we apply solid supported membrane-based electrophysiology (SSME), which enables both direct access to lysosomes and high-throughput electrophysiological recordings. In SSME, ion translocation mediated by TMEM175 is stimulated using a concentration gradient at a resting potential of 0 mV. The concentration-dependent K+ response exhibited an I/c curve with two distinct slopes, indicating the existence of two conducting states. We measured H+ fluxes with a permeability ratio of PH/PK = 48,500, which matches literature findings from patch-clamp studies, validating the SSME approach. Additionally, TMEM175 displayed a high pH dependence. Decreasing cytosolic pH inhibited both K+ and H+ conductivity of TMEM175. Conversely, lysosomal pH and pH gradients did not have major effects on TMEM175. Finally, we developed HTS assays for drug screening and evaluated tool compounds (4-AP, Zn as inhibitors; DCPIB, arachidonic acid, SC-79 as enhancers) using SSME and APC. Additionally, we recorded EC50 data for eight blinded TMEM175 enhancers and compared the results across all three assay technologies, including LPC, discussing their advantages and disadvantages.

Mental health symptoms and correlates among amateur football players: a cross-sectional study.

The objective of this study was to evaluate mental health problems reported by Turkish amateur football players. A total of 4516 Turkish amateur football players were invited to complete an anonymous online survey including demographic and COVID-19 pandemic related questions, the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, and Athlete Psychological Strain Questionnaire. A total of 1263 players participated in the study (27.9% response rate). Single players reported higher depression and anxiety scores than married players. Higher depression, anxiety, and athletes-specific stress scores were reported by players with an annual income <$5,000 and those reporting an income loss >75% during the COVID-19 pandemic. Players with a sports injury history, psychiatric illness, sleep problems, and perceived inadequate social and/or organizational support reported poorer indices relative to their counterparts. Implementation of mental health screening among amateur football players may assist in detecting vulnerabilities and initiating appropriate timely intervention.

Suicidal ideation among men during COVID-19: Examining the roles of loneliness, thwarted belongingness, and personality impairment.

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self-functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self-report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self-functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self-functioning. The findings are important to consider within the COVID-19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI.

Characteristics and clinical needs of young tertiary students attending a specialist mood disorders clinic.

OBJECTIVE: To investigate the clinical characteristics of tertiary students and non-students attending a specialist clinic for severe mood disorders. METHOD: Medical record audit of clients discharged from the Youth Mood Clinic (YMC). Data extracted included depressive symptomatology, suicidal ideation, self-harm, suicide attempt, tertiary education engagement, drop-out and deferral. RESULTS: Data from 131 clients (M age = 19.58 years, SD = 2.66) were analysed, including 46 tertiary students. Relative to non-students, at intake, tertiary students reported more severe depressive symptomatology (d = 0.43). They were more likely to experience suicidal ideation at intake (V = 0.23), and during treatment (V = 0.18). Tertiary students were also more likely to be living separately to their family of origin (V = 0.20) but were less likely to have experienced parental separation (V = 0.19). 21.73% of tertiary students dropped out or deferred study during care. CONCLUSION: In this cohort, those engaged in tertiary education experience more severe depression and more commonly experienced suicidal ideation. These young people require targeted support for their mental health while they undertake tertiary education.

Translation and Validation of the Arabic Version of the Athlete Psychological Strain Questionnaire.

CONTEXT: The international sports community is becoming more proactive in clinical mental health practice and research. An athlete-specific psychological distress screening tool can identify potential mental health illness. DESIGN: The Athlete Psychological Strain Questionnaire (APSQ) is a simple screening tool for detecting early signs of athlete-specific strain and related mental health concerns. METHODS: We evaluated the internal consistency and reliability of the translated and culturally adjusted Arabic version of the APSQ (APSQ-Ar) with Arabic-speaking elite athletes. The final translation underwent standard forward and backward translation, an inspection by a team of experts, and then preliminary testing. The APSQ-Ar was cross-culturally validated and then assessed for internal consistency and reliability among (n = 98) Arabic-speaking athletes. RESULTS: There were no problems with the patients' understanding or interpretation of the items on the APSQ-Ar translation. The intraclass correlation value was .93 (95% confidence interval, .89-.95), and the mean difference was 2.4 with a minimal detectable change of 5.12, demonstrating strong test-retest reliability. Moreover, Cronbach alpha showed excellent internal consistency (.76). CONCLUSIONS: The APSQ-Ar was demonstrated to be good, reliable, and internally consistent. With APSQ-Ar, sports medicine professionals in Arabic-speaking countries will be able to identify psychological distress and symptoms in athletes and, as a result, provide them with mental health support.

The team behind the team: prevalence and correlates of mental health problems among professional football team medical and allied staff?

This study aimed to evaluate depression, anxiety, and stress prevalence and correlates among professional football team medical and allied health staff (MAHS) in Turkey. An online survey was sent to all MAHS (n = 865) attending the professional development accreditation course organized at the end of the 2021-2022 football season in Turkey. Three standardized scales assessed depression, anxiety, and stress. A total of 573 staff participated (response rate = 66.2%). 36.7% of MAHS reported at least moderate severity depression, 25% anxiety, and 80.5% stress. Younger (26-33 years) and less experienced (6-10 years) MAHS reported higher stress scores than their older (50-57 years) and more experienced (>15 years) counterparts (p = 0.02 and p = 0.03, respectively). Masseurs (compared to team doctors) and staff without a second job (compared to those with a second job) reported higher depression and anxiety scores (p = 0.02, p = 0.03, p = 0.03, p = 0.02, respectively). Depression, anxiety, and stress scores of MAHS whose monthly income was less than $519 were higher than those whose income was more than $1036 (all p < 0.01). Findings demonstrated that professional football team MAHS suffer from symptoms of mental-ill-health at substantial rates. In light of these results, organizational policies should be implemented to proactively support the mental health of MAHS working in professional football.

Conditional Process Modeling of the Relationship Among Self-Reliance, Loneliness, and Depressive Symptoms, and the Moderating Effect of Feeling Understood.

ABSTRACT: Self-reliance features as one of the notable male norms espoused by traditional masculine socialization. Strict adherence to a self-reliant attitude has been found to confer risk for depression and suicidality among men. Yet, little research has investigated the factors that may contribute to self-reliance having a negative impact for men. Using data from a large sample of Canadian men (N = 530), the present study examined the association between self-reliance and depression, while also assessing the roles of loneliness and not feeling understood as contributing factors in this process. Findings indicated that the moderated mediation model was significant, pointing to loneliness as a significant mediator in the association between self-reliance and depression. Furthermore, the findings revealed that not feeling understood moderated the relationship between self-reliance and loneliness, indicating that this association applies mainly to those men who do not feel understood by at least one important person in their life.

Anxiety and Depressive Symptoms During the COVID-19 Emergency Period: A Comparative Cross-Sectional Study in Professional Football.

OBJECTIVE: The primary objective of our study was to establish the prevalence of anxiety and depressive symptoms among professional football (ie, soccer; hereinafter "football") players during the COVID-19 emergency period, drawing comparisons with players assessed before exposure to the COVID-19 emergency period. DESIGN: Observational comparative cross-sectional study by means of electronic questionnaire. SETTING: Professional football. PARTICIPANTS: A total of 468 female (mean age: 22.8 years) and 1134 male (mean age: 26.0 years) players participated. The non-COVID-19 comparison group consisted of 132 female (mean age: 23.1 years) and 175 male (mean age: 24.8 years) professional footballers. INTERVENTION: N/A. MAIN OUTCOME MEASURES: Anxiety symptoms were measured with the validated Generalized Anxiety Disorder 7 and depressive symptoms with the validated Patient Health Questionnaire 9. Both instruments have been widely used in both clinical and research settings among different populations, showing excellent psychometric properties. RESULTS: During the COVID-19 emergency period, the 2-week prevalence of symptoms consistent with a diagnosis of generalized anxiety disorder and depression was 18.2% and 21.6%, respectively, among female professional footballers and 15.5% and 12.9%, respectively, among male players. The 2-week prevalence of anxiety and depressive symptoms among professional footballers was significantly higher during the COVID-19 emergency period than before the global pandemic (P < 0.01). Differences were most pronounced for those worried about the playing future. CONCLUSIONS: The COVID-19 emergency period is associated with increased symptoms of anxiety and depression in professional footballers, especially among those worried about their future as players.

Extending the Male Depression Risk Scale for use with older men: the effect of age on factor structure and associations with psychological distress and history of depression.

OBJECTIVES: The Male Depression Risk Scale (MDRS-22) is a self-report scale that assesses externalising and male-typical depression symptoms with promising psychometric properties reported in young-to-middle aged men. However, studies are yet to consider the psychometric properties of the MDRS-22 in older men. This study examined the psychometric properties of the MDRS-22 in both younger and older males and its relationship to prototypic depression symptoms and self-reported depression history. METHOD: A community sample of younger (n = 510; 18-64 years) and older (n = 439; 65-93 years) males completed the original 82 MDRS items from which the MDRS-22 was derived, the Patient Health Questionnaire (PHQ-9), and provided information regarding previous depression diagnoses. Exploratory and confirmatory factor analyses were used to examine factor structure. Generalised linear models examined the relationship between externalised and male-typical symptoms with prototypic depression symptoms in younger and older men. RESULTS: Model fit indices demonstrated that the MDRS-22 performs well in older males. Results also revealed that the MDRS-22 is associated with prototypic depression symptoms and a previous depression diagnosis in both age groups. CONCLUSION: Results support the psychometric validity of the MDRS-22 as a measure of externalising and male-typical depression symptoms in older men. Use of scales such as the MDRS-22 may help to improve the detection of depression in men across the lifespan and may also identify factors that put men at risk of poor physical and mental health outcomes.

Operationalizing positive masculinity: a theoretical synthesis and school-based framework to engage boys and young men.

Scholars have consistently documented the relationship between conformity to traditional masculine norms and maladaptive psychosocial outcomes among boys and young men. Given current social commentary, including debate around 'toxic masculinity', intervention is needed to encourage boys to embody healthy expressions and identities of masculinity. Whilst new approaches grounded in positive masculinity show promise, the construct requires further definition and phenomenological clarity. Here we review divergent perspectives on positive masculinity, and forward a refined definition, specific to psychosocial health promotion among boys and young men. We then outline the theoretical basis of a positive masculinity framework to guide the content of future interventions, aiming to achieve positive identity development among boys and young men for the good of all. This framework represents a necessary unification of scholarship around male adolescent development, education and health. Future health promotion interventions may benefit from applying the framework to support a positive psychosocial trajectory among boys and young men, with a focus on connection, motivation and authenticity.

Mapping Men's Mental Health Help-Seeking After an Intimate Partner Relationship Break-Up.

Deleterious effects of separation and divorce on men's mental health are well-documented; however, little is known about their help-seeking when adjusting to these all-too-common life transitions. Employing interpretive descriptive methods, interviews with 47 men exploring their mental health help-seeking after a relationship break-up were analyzed in deriving three themes: (1) Solitary work and tapping established connections, (2) Reaching out to make new connections, and (3) Engaging professional mental health care. Men relying on solitary work and established connections accessed relationship-focused self-help books, online resources, and confided in friends and/or family. Some participants supplemented solitary work by reaching out to make new connections including peer-based men's groups and education and social activities. Comprising first-time, returning, and continuing users, many men responded to relationship break-up crises by engaging professional mental health care. The findings challenge longstanding commentaries that men actively avoid mental health promotion by illuminating wide-ranging help resources.

Shame and guilt as mediators between dispositional optimism and symptom severity among mental health outpatients.

Dispositional optimism is robustly associated with psychological wellbeing, and individuals with lower optimism tend to experience more depressive and anxiety symptoms. While mechanisms in this relationship such as coping and social integration have been explored, limited research has examined whether the self-conscious emotions of shame and guilt account for the association between dispositional optimism and psychological distress. The present study examined shame and guilt as mediators in the relation between dispositional optimism and depressive and anxiety symptom severity among 137 patients (M age = 33.5, SD = 12.08 years) seeking community-based mental health care. Mediation analyses using bootstrap 99% confidence intervals indicated significant mediation by guilt--but not shame--in the model predicting depressive symptoms, and significant mediation by shame--but not guilt--in the model predicting anxiety symptoms. These findings suggest differential effects of dispositional optimism on depressive and anxiety symptoms according to the predominance of shame- or guilt-related affects. Interventions seeking to reduce distress through promoting optimism may be enhanced by considering patients' experiences of shame and guilt.