Evaluating the effectiveness of a universal eHealth school-based prevention programme for depression and anxiety, and the moderating role of friendship network characteristics.

BACKGROUND: Lifetime trajectories of mental ill-health are often established during adolescence. Effective interventions to prevent the emergence of mental health problems are needed. In the current study we assessed the efficacy of the cognitive behavioural therapy (CBT)-informed Climate Schools universal eHealth preventive mental health programme, relative to a control. We also explored whether the intervention had differential effects on students with varying degrees of social connectedness. METHOD: We evaluated the efficacy of the Climate Schools mental health programme (19 participating schools; average age at baseline was 13.6) v. a control group (18 participating schools; average age at baseline was 13.5) which formed part of a large cluster randomised controlled trial in Australian schools. Measures of internalising problems, depression and anxiety were collected at baseline, immediately following the intervention and at 6-, 12- and 18-months post intervention. Immediately following the intervention, 2539 students provided data on at least one outcome of interest (2065 students at 18 months post intervention). RESULTS: Compared to controls, we found evidence that the standalone mental health intervention improved knowledge of mental health, however there was no evidence that the intervention improved other mental health outcomes, relative to a control. Student's social connectedness did not influence intervention outcomes. CONCLUSION: These results are consistent with recent findings that universal school-based, CBT-informed, preventive interventions for mental health have limited efficacy in improving symptoms of anxiety and depression when delivered alone. We highlight the potential for combined intervention approaches, and more targeted interventions, to better improve mental health outcomes.

The relationship between perceived income inequality, adverse mental health and interpersonal difficulties in UK adolescents.

BACKGROUND: Adolescence is a period of life when young people increasingly define themselves through peer comparison and are vulnerable to developing mental health problems. In the current study, we investigated whether the subjective experience of economic disadvantage among friends is associated with social difficulties and poorer mental health in early adolescence. METHODS: We used latent change score modelling (LCSM) on data from the UK Millennium Cohort Study, collected at ages 11 and 14 (N = 12,995). Each LCSM modelled the mean of an outcome related to mental health and interpersonal difficulties at age 11 (including self-esteem, well-being, emotional difficulties, peer problems, bullying, victimisation and externalising difficulties), the change of the outcome from ages 11 to 14 and its predictors, including perceived income inequality among friends (i.e. perceiving oneself as belonging to a poorer family than the families of one's friends). RESULTS: Perceived income inequality predicted adverse mental health and a range of interpersonal difficulties during adolescence, even when controlling for objective family income. Follow-up analyses highlighted that, at 11 years, young people who perceived themselves as belonging to poorer families than their friends reported worse well-being, self-esteem, internalising problems, externalising problems and victimisation at the same age (relative to those who perceived themselves as richer than or equal to their friends, or who did not know). Longitudinal analyses suggested that victimisation decreased from ages 11 to 14 to a greater extent for adolescents who perceived themselves as poorer than other adolescents. CONCLUSIONS: The salience of economic inequalities in proximal social environments (e.g. among friends) in early adolescence could further amplify the negative effects of economic disadvantage on mental health and behavioural difficulties during this period.

The effect of intolerance of uncertainty on anxiety and depression, and their symptom networks, during the COVID-19 pandemic.

Individuals vary in their ability to tolerate uncertainty. High intolerance of uncertainty (the tendency to react negatively to uncertain situations) is a known risk factor for mental health problems. In the current study we examined the degree to which intolerance of uncertainty predicted depression and anxiety symptoms and their interrelations across the first year of the COVID-19 pandemic. We examined these associations across three time points (May 2020 - April 2021) in an international sample of adults (N = 2087, Mean age = 41.13) from three countries (UK, USA, Australia) with varying degrees of COVID-19 risk. We found that individuals with high and moderate levels of intolerance of uncertainty reported reductions in depression and anxiety symptoms over time. However, symptom levels remained significantly elevated compared to individuals with low intolerance of uncertainty. Individuals with low intolerance of uncertainty had low and stable levels of depression and anxiety across the course of the study. Network analyses further revealed that the relationships between depression and anxiety symptoms became stronger over time among individuals with high intolerance of uncertainty and identified that feeling afraid showed the strongest association with intolerance of uncertainty. Our findings are consistent with previous work identifying intolerance of uncertainty as an important risk factor for mental health problems, especially in times marked by actual health, economic and social uncertainty. The results highlight the need to explore ways to foster resilience among individuals who struggle to tolerate uncertainty, as ongoing and future geopolitical, climate and health threats will likely lead to continued exposure to significant uncertainty.

Expectations of Social Consequences Impact Anticipated Involvement in Health-Risk Behavior During Adolescence.

This study examined how individual differences in expectations of social consequences relate to individuals' expected involvement in health-risk behaviors (HRBs). A total of 122 adolescents (aged 11-17) reported their expected involvement in a number of risk behaviors and whether or not they expect to be liked more or less by engaging in the behavior: the expected social benefit. Higher perceived social benefit was associated with higher anticipated involvement in said behavior. This relationship was stronger for adolescents who reported a higher degree of peer victimization, supporting the hypothesis that experiencing victimization increases the social value of peer interactions. Findings suggest that adolescents incorporate expectations of social consequences when making decisions regarding their involvement in HRBs.

Association of Antenatal COVID-19-Related Stress With Postpartum Maternal Mental Health and Negative Affectivity in Infants.

Importance: Antenatal stress is a significant risk factor for poor postpartum mental health. The association of pandemic-related stress with postpartum outcomes among mothers and infants is, however, less well understood. Objective: To examine the association of antenatal COVID-19-related stress with postpartum maternal mental health and infant outcomes. Design, Setting, and Participants: This cohort study was conducted among 318 participants in the COVID-19 Risks Across the Lifespan study, which took place in Australia, the UK, and the US. Eligible participants reported being pregnant at the first assessment wave between May 5 and September 30, 2020, and completed a follow-up assessment between October 28, 2021, and April 24, 2022. Main Outcomes and Measures: COVID-19-related stress was assessed with the Pandemic Anxiety Scale (score range, 0-4, with higher scores indicating greater COVID-19-related stress). The 8-item Patient Health Questionnaire (score range, 0-3, with higher scores indicating more frequent symptoms of depression) was used to measure maternal depression at each time point, and the 7-item General Anxiety Disorder scale (score range, 0-3, with higher scores indicating more frequent symptoms of anxiety) was used to measure generalized anxiety at each time point. At follow-up, postpartum distress was assessed with the 10-item Postpartum Distress Measure (score range, 0-3, with higher scores indicating greater postpartum distress), and infant outcomes (negative and positive affectivity and orienting behavior) were captured with the Infant Behavior Questionnaire (score range, 1-7, with higher scores indicating that the infant exhibited that affect/behavior more frequently). Results: The study included 318 women (mean [SD] age, 32.0 [4.6] years) from Australia (88 [28%]), the US (94 [30%]), and the UK (136 [43%]). Antenatal COVID-19-related stress was significantly associated with maternal postpartum distress (ß = 0.40 [95% CI, 0.28-0.53]), depression (ß = 0.32 [95% CI, 0.23-0.41]), and generalized anxiety (ß = 0.35 [95% CI, 0.26-0.44]), as well as infant negative affectivity (ß = 0.45 [95% CI, 0.14-0.76]). The findings remained consistent across a range of sensitivity analyses. Conclusions and Relevance: The findings of this cohort study suggest that targeting pandemic-related stressors in the antenatal period may improve maternal and infant outcomes. Pregnant individuals should be classified as a vulnerable group during pandemics and should be considered a public health priority, not only in terms of physical health but also mental health.

Reappraisal capacity is unrelated to depressive and anxiety symptoms.

Research suggests affective symptoms are associated with reduced habitual use of reappraisal as an emotion regulation strategy in individuals with mental health problems. Less is known, however, about whether mental health problems are related to reduced reappraisal capacity per se. The current study investigates this question using a film-based emotion regulation task that required participants to use reappraisal to downregulate their emotional response to highly evocative real-life film footage. We pooled data (N = 512, age: 18-89 years, 54% female) from 6 independent studies using this task. In contrast to our predictions, symptoms of depression and anxiety were unrelated to self-reported negative affect after reappraisal or to emotional reactivity to negative films. Implications for the measurement of reappraisal as well as future directions for research in the field of emotion regulation are discussed.

Measuring online and offline social rejection sensitivity in the digital age.

Social rejection sensitivity has been proposed as a central risk factor for depression. Yet, its assessment has typically been limited to offline contexts. Many of today's social interactions, however, take place online. Here, we developed a measure to assess social rejection sensitivity in both online and offline environments. Across four separate samples including a total of 2381 individuals (12-89 years), the Online and Offline Social Sensitivity Scale was shown to offer a reliable measure of social rejection sensitivity. The study provides evidence that rejection sensitivity across online and offline social environments shows a moderate to strong association with depressive symptoms and maladaptive ruminative brooding. We also found age-related differences in social rejection sensitivity in online and offline contexts with rejection sensitivity decreasing from early adolescence to older age. The scale has the potential to advance future research on the role of social rejection sensitivity in mental health in a digital age. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Navigating the Social Environment in Adolescence: The Role of Social Brain Development.

Successful navigation of the social environment is dependent on a number of social cognitive processes, including mentalizing and resistance to peer influence. These processes continue to develop during adolescence, a time of significant social change, and are underpinned by regions of the social brain that continue to mature structurally and functionally into adulthood. In this review, we describe how mentalizing, peer influence, and emotion regulation capacities develop to aid the navigation of the social environment during adolescence. Heightened susceptibility to peer influence and hypersensitivity to social rejection in adolescence increase the likelihood of both risky and prosocial behavior in the presence of peers. Developmental differences in mentalizing and emotion regulation, and the corticosubcortical circuits that underpin these processes, might put adolescents at risk for developing mental health problems. We suggest how interventions aimed at improving prosocial behavior and emotion regulation abilities hold promise in reducing the risk of poor mental health as adolescents navigate the changes in their social environment.

Peer Influence in Adolescence: Public-Health Implications for COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in the widespread implementation of social distancing measures. Adhering to social distancing may be particularly challenging for adolescents, for whom interaction with peers is especially important. We argue that young people's capacity to encourage each other to observe social distancing rules should be harnessed.

Amplified Concern for Social Risk in Adolescence: Development and Validation of a New Measure.

In adolescence, there is a heightened propensity to take health risks such as smoking, drinking or driving too fast. Another facet of risk taking, social risk, has largely been neglected. A social risk can be defined as any decision or action that could lead to an individual being excluded by their peers, such as appearing different to one's friends. In the current study, we developed and validated a measure of concern for health and social risk for use in individuals of 11 years and over (N = 1399). Concerns for both health and social risk declined with age, challenging the commonly held stereotype that adolescents are less worried about engaging in risk behaviours, compared with adults. The rate of decline was steeper for social versus health risk behaviours, suggesting that adolescence is a period of heightened concern for social risk. We validated our measure against measures of rejection sensitivity, depression and risk-taking behaviour. Greater concern for social risk was associated with increased sensitivity to rejection and greater depressed mood, and this association was stronger for adolescents compared with adults. We conclude that social risks should be incorporated into future models of risk-taking behaviour, especially when they are pitted against health risks.

The Need for Functional Assessments in School-Based Mental Health Intervention Research.

This Viewpoint discusses the need to study functional impairment in addition to symptoms in school-based mental health intervention research.

Are We There Yet? Exploring the Impact of Translating Cognitive Tests for Dementia Using Mobile Technology in an Aging Population.

This study examines implications of the expanded use of mobile platforms in testing cognitive function, and generates evidence on the impact utilizing mobile platforms for dementia screen. The Saint Louis University Mental State examination (SLUMS) was ported onto a computerized mobile application named the Cambridge University Pen to Digital Equivalence assessment (CUPDE). CUPDE was piloted and compared to the traditional pen and paper version, with a common comparator test for both groups. Sixty healthy participants (aged 50-79) completed both measurements. Differences were tested between overall outcomes, individual items, and relationship with the comparator. Significant differences in the overall scores between the two testing versions as well as within individual items were observed. Even when groups were matched by cognitive function and age, scores on SLUMS original version (M = 19.75, SD = 3) were significantly higher than those on CUPDE (M = 15.88, SD = 3.5), t (15) = 3.02, p < 0.01. Mobile platforms require the development of new normative standards, even when items can be directly translated. Furthermore, these must fit aging populations with significant variance in familiarity with mobile technology. Greater understanding of the interplay and related mechanisms between auditory and visual systems, which are not well understood yet in the context of mobile technologies, is mandatory.