Distinct profiles of mental health need and high need overall among New Zealand adolescents - Cluster analysis of population survey data.

OBJECTIVE: The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students. METHODS: We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey (n = 7721, ages 13-18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples. RESULTS: We identified five clusters (n = 7083). The healthy cluster (n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster (n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster (n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster (n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster (n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Maori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity. CONCLUSION: We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not 'one size fits all'. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster.

Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys.

OBJECTIVE: To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students. METHODS: Representative cross-sectional youth health surveys with 2-4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548). RESULTS: In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale-Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Maori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students. CONCLUSION: Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Maori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened.

Technology Matters: SPARX - computerised cognitive behavioural therapy for adolescent depression in a game format.

Adolescent depression is common, and its prevalence is thought to be increasing in many high income nations. Addressing adolescent depression has proven challenging using traditional face-to-face psychotherapies, with major barriers including workforce shortages internationally and reluctance to seek help among some adolescents. There is substantial evidence to support the use of digital tools to treat mental health problems, with the National Institute for Health and Care Excellence (NICE) now recommending such tools as a first-line treatment. In this article, we outline the evidence base for SPARX, a digital tool named specifically in NICE guideline NG134, and discuss its use in clinical settings. We also consider implementation issues and future research directions.

Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019.

Background: Rangatahi Maori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pakeha (NZ European /other European/"White") adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access. Methods: Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Maori and Pakeha adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001-2019 and 2012-2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA). Findings: Rangatahi Maori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65-2.46]). Compared to Pakeha youth there was a pattern of persistent Maori disadvantage, particularly for racism (RR 2.27 [2.08-2.47]), depressive symptoms (RR 1.42 [1.27-1.59]) and forgone healthcare (RR 1.63 [1.45-1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12-3.02] in 2007 to RR 1.55 [1.25-1.93] in 2019). CTA reveals rangatahi Maori-specific policies, Maori leadership, and political support aligned with improved outcomes and narrowing inequities. Interpretation: Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Maori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation. Funding: Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris-John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whanau contributors to rangatahi wellbeing (HRC ref: 17/315).

New Zealand Youth19 survey: vaping has wider appeal than smoking in secondary school students, and most use nicotine-containing e-cigarettes.

OBJECTIVE: To investigate smoking and vaping in secondary school students (aged 13-18 years) in New Zealand (NZ) following the introduction of 'pod' e-cigarettes, which have been associated with the rapid escalation of youth vaping elsewhere. METHODS: Data on smoking and vaping were collected in 2019 as part of a comprehensive youth health survey (N=7,721). RESULTS: Vaping was 2-3 times more prevalent than smoking, with 10% of students vaping regularly (monthly or more often), and 6% weekly or more often, compared with 4% and 2%, respectively, for tobacco smoking. Nicotine-containing e-cigarettes were sometimes or always used by 80% of regular and 90% of weekly vapers. Regular and weekly smoking was rare in low deprivation (affluent) areas, whereas regular and weekly vaping prevalence was similar across the socioeconomic spectrum. More than 80% of ever-vapers (N=2732) reported they were non-smokers when they first vaped, and 49% of regular vapers (N=718) had never smoked. CONCLUSIONS: A significant proportion of New Zealand adolescents, many of whom have never smoked, use nicotine-containing e-cigarettes regularly. Implications for public health: Vaping is less harmful than smoking, but it is not harmless. Public health action is needed to support young non-smokers to remain smokefree and vape-free.

Young adolescents' interest in a mental health casual video game.

BACKGROUND: Mental distress and disorders among adolescents are well documented. Despite the array of treatments available, many mental health issues remain untreated and often undiagnosed. In an attempt to narrow the treatment gap, researchers have adapted existing mental health interventions into digital formats. Despite their efficacy in trial settings, however, real-world uptake of digital mental health interventions is typically low. Casual video games (CVGs) are popular among adolescents and may be a promising tool to reduce stress, anxiety and depression. AIM: We set out to explore young adolescents' views of CVGs and their opinions of mental health CVG prototypes, to help determine whether this idea warrants further investigation. METHODS: Pen and paper feedback forms following a brief presentation to 13-15-year-old adolescents in seven high schools (n = 207) followed by more detailed focus groups (n = 42) and workshops (n = 21) with interested students. FINDINGS: Across all three methods, participants reported playing CVGs several times a week or day to help relieve stress, feel more relaxed and relieve boredom. Most were also interested in the idea of a mental health CVG. Participants in focus groups and workshops confirmed that playing CVGs was common among themselves and their peers, and that the idea of a CVG with subtle and brief mental health content such as game-linked 'micro messages' was appealing. Participants recommended that the game should have an engaging interface and subtle mental health skills and information. CONCLUSIONS: Findings from this exploratory study suggest that the concept of a mental health CVG appears to be appealing to adolescents. This novel approach should be tested.

The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review.

Background: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered. Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood. Method: A systematic search was conducted, using the terms (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health or anx* or depress* or stress or mood) and (study or trial or treatment or prescribed or prevention) as "Title," "Abstracts," "Keywords," or "Topic" words across all years. A Google search was also completed to check for articles that may have been missed. Results: N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified. Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood.

Co-creating a large-scale adolescent health survey integrated with access to digital health interventions.

AIM: This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. METHODS: We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. RESULTS: Students' perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. CONCLUSION: The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.