Cumulative risk and adolescent emotional distress: A longitudinal moderated mediation analysis focusing on perceived stress and social support.

This study provides insights into the roles played by perceived stress and social support in the relationship between cumulative risk exposure (CRE) and adolescent emotional distress. Preregistered longitudinal moderated mediation analyses were used to test hypotheses relating to the association between CRE and later emotional distress; the mediating role of perceived stress in the relationship between CRE and later emotional distress; and, the moderating effects of peer and adult-level family support on the relationship between CRE and later perceived stress, among N = 19,159 adolescents over three annual waves (at ages 11/12, 12/13, 13/14). Analyses revealed that CRE significantly predicted later adolescent emotional distress. This relationship was partially mediated by perceived stress. Both peer and adult-level family support significantly moderated the impact of CRE on later perceived stress (i.e., adolescents reporting higher levels of support perceived significantly lower levels of stress resulting from CRE compared to those reporting lower levels of support). These findings provide critical empirical evidence of the roles played by perceived stress and social support in the relationship between CRE and adolescent emotional distress, with consequent implications for intervention.

Latent classes of adolescent health behaviour, social covariates and mental wellbeing: a longitudinal birth cohort study.

BACKGROUND: Adolescent mental wellbeing has been declining in the United Kingdom for over a decade. Expansion of services to support the mental wellbeing of young people is a public health priority and a core component of the National Health Service's Long-Term Plan. In this paper, we leverage secondary analysis of a very large longitudinal dataset (#BeeWell) to generate insights regarding different patterns of health behaviour, their covariates, and consequences for mental wellbeing one year later. METHODS: A Latent Class Analysis was conducted using data on physical activity, sleep, and eating habits collected in 2021 from 18,478 Year 8 pupils from Greater Manchester (United Kingdom) to (1) identify distinct latent classes of adolescent health behaviour; (2) establish factors likely to be associated with latent class membership; and (3) determine whether latent class membership contributes to variance in self-reported mental wellbeing one year later. RESULTS: A three-class solution was identified as an excellent fit to the data, discriminating between: the Wellness Weary (n = 2,717; 15%); the Balanced Bunch (n = 7,377; 40%); and the Green and Dream Team (n = 8,384; 45%). Several factors significantly influenced class membership. Most notably, socio-economic disadvantage and social media use were linked with less favourable health behaviour patterns, whilst cisgender heterosexual girls were likely to endorse healthier patterns. After adjusting for covariates, the Green and Dream Team reported significantly greater mental wellbeing than the Balanced Bunch one year later. However, there was no difference between the Balanced Bunch and the Wellness Weary, signalling that health behaviours may support mental wellbeing, but only among the healthiest young people. CONCLUSIONS: Beyond advancements in fundamental understanding, our findings yield significant translation opportunities through their use and application in health, education, and allied professional settings designed to support young people.

Gender difference in the change of adolescents' mental health and subjective wellbeing trajectories.

Gender differences in adolescents' mental health problems have been extensively reported. Yet, there is limited research in exploring longitudinal trends in mental health and wellbeing between boys and girls. This study investigated any emerging developmental trends of gender differences in mental health problems and subjective wellbeing for young people from early to mid-adolescence in England. A longitudinal group of 8612 young people's mental health and subjective wellbeing trajectories were investigated between the period of ages 11/12 and 13/14. Mental health difficulties and subjective wellbeing were measured using the child self-report Strengths and Difficulties Questionnaire (SDQ) and Short Warwick and Edinburgh Wellbeing Scale (SWEMWBS), respectively. Any gender difference in the change of adolescents' mental health and subjective wellbeing over 3 year period were estimated using multi-level regression while accounting for various socio-demographic and resilience factors. Young people are at increased risk of mental health problems between the ages of 11 and 14, particularly girls. The overall difficulty levels reported by girls were significantly higher than boys across a range of mental health problems and subjective wellbeing. These developmental trends persisted after controlling for a broad range of potential confounders. Young people has shown clear signs of mental distress as they get older. This escalation was particularly evident among girls. Distress can come at the time of significant physical, emotional, and social changes in an adolescents' life, and can be heightened during secondary school transition. This evidence highlights the importance of early intervention to reduce risk of distress.

The impact of area level mental health interventions on outcomes for secondary school pupils: Evidence from the HeadStart programme in England.

In light of the dramatic rise in mental health disorders amongst adolescents seen in the past decade across the world, there is an urgent need for robust evidence on what works to combat this trend. This paper provides the first robust evaluation of the impacts on school outcomes of 6-year funding programme (HeadStart) for area-level mental health interventions for adolescents. Exploiting educational administrative data on ten cohorts of state-educated secondary school students, we use the synthetic control method to construct counterfactual outcomes for areas that received the funding. We show that the funding did not affect students' absenteeism or academic attainment, but it prevented around 800 students (c. 10% of students typically excluded yearly) from being excluded in its first year. The transient nature of this effect suggests that sustained funding for intervention may be a necessary but not sufficient condition to maintain programme effectiveness over time.

Prevalence of mental health problems in schools: poverty and other risk factors among 28 000 adolescents in England.

Current mental health provision for children is based on estimates of one in ten children experiencing mental health problems. This study analyses a large-scale community-based dataset of 28 160 adolescents to explore school-based prevalence of mental health problems and characteristics that predict increased odds of experiencing them. Findings indicate the scale of mental health problems in England is much higher than previous estimates, with two in five young people scoring above thresholds for emotional problems, conduct problems or hyperactivity. Gender, deprivation, child in need status, ethnicity and age were all associated with increased odds of experiencing mental health difficulties. DECLARATIONS OF INTEREST: None.

Mental health difficulties, attainment and attendance: a cross-sectional study.

Evidence for the association between mental health difficulties and academic outcomes is sparse and shows mixed results. The aim of this study was to investigate the association between educational attainment, absenteeism and mental health difficulties while controlling for various child characteristics such as special educational needs and socioeconomic background. 15,301 Year 7 pupils (mean age 11.91; SD = 0.28) from England completed the Strengths and Difficulties Questionnaire. Attainment, persistent absenteeism and child characteristics were derived from the National Pupil Database. Multilevel regression analysis showed that mental health difficulties were negatively associated with attainment and positively associated with persistent absenteeism. When all mental health difficulties were modelled simultaneously, behavioural difficulties, hyperactivity/attention difficulties and difficulties with peers were negatively associated with attainment. Emotional difficulties and hyperactivity/attention difficulties were positively associated with persistent absenteeism. The results of the current study highlight the importance of integration between mental health support and policy creation in relation to mental health difficulties and wellbeing in schools.

Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.

Bullying is a common childhood experience that involves repeated mistreatment to improve or maintain one's status. Victims display long-term social, psychological, and health consequences, whereas bullies display minimal ill effects. The aim of this study is to test how this adverse social experience is biologically embedded to affect short- or long-term levels of C-reactive protein (CRP), a marker of low-grade systemic inflammation. The prospective population-based Great Smoky Mountains Study (n = 1,420), with up to nine waves of data per subject, was used, covering childhood/adolescence (ages 9-16) and young adulthood (ages 19 and 21). Structured interviews were used to assess bullying involvement and relevant covariates at all childhood/adolescent observations. Blood spots were collected at each observation and assayed for CRP levels. During childhood and adolescence, the number of waves at which the child was bullied predicted increasing levels of CRP. Although CRP levels rose for all participants from childhood into adulthood, being bullied predicted greater increases in CRP levels, whereas bullying others predicted lower increases in CRP compared with those uninvolved in bullying. This pattern was robust, controlling for body mass index, substance use, physical and mental health status, and exposures to other childhood psychosocial adversities. A child's role in bullying may serve as either a risk or a protective factor for adult low-grade inflammation, independent of other factors. Inflammation is a physiological response that mediates the effects of both social adversity and dominance on decreases in health.

Survey of schools' work with child and adolescent mental health across England: a system in need of support.

BACKGROUND: With evidence of rising need around mental health in young people, cuts in specialist health provision and increasing recognition of the central role of schools in supporting young people with mental health problems, it is important to understand the provision of mental health support currently available in schools, the nature of the relationship with health and other providers of child and adolescent mental health (CAMH) services, and what are the key barriers to accessing support. METHOD: The study was a convenience sample survey of 577 school staff from 341 schools in England. Participants completed an online survey about the provision of specialist mental health support in their school, including what support is available, who provides it, and perceived barriers to supporting the mental health of young people. Data were linked to publicly available data on school characteristics. RESULTS: Over two thirds of schools reported having some specialist support available, with specialist provision more common in secondary schools. Staff training and whole-school approaches were the most frequently employed specific approaches. Support was most often provided by educational psychologists, followed by counsellors. School staff particularly valued support and feedback within the schools context. The most frequently cited barrier to mental health support was the limited capacity of specialist CAMH services. CONCLUSIONS: The results suggest a need to enhance the availability of specialist support for mental health both within schools and in CAMH services.

Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis.

OBJECTIVE: Bullying is a common childhood experience with enduring psychosocial consequences. The aim of this study was to test whether bullying increases risk for eating disorder symptoms. METHOD: Ten waves of data on 1,420 participants between ages 9 and 25 were used from the prospective population-based Great Smoky Mountains Study. Structured interviews were used to assess bullying involvement and symptoms of anorexia nervosa and bulimia nervosa as well as associated features. Bullying involvement was categorized as not involved, bully only, victim only, or both bully and victim (bully-victims). RESULTS: Within childhood/adolescence, victims of bullying were at increased risk for symptoms of anorexia nervosa and bulimia nervosa as well as associated features. These associations persisted after accounting for prior eating disorder symptom status as well as preexisting psychiatric status and family adversities. Bullies were at increased risk of symptoms of bulimia and associated features of eating disorders, and bully-victims had higher levels of anorexia symptoms. In terms of individual items, victims were at risk for binge eating, and bully-victims had more binge eating and use of vomiting as a compensatory behavior. There was little evidence in this sample that these effects differed by sex. Childhood bullying status was not associated with increased risk for persistent eating disorder symptoms into adulthood (ages 19, 21, and 25). DISCUSSION: Bullying predicts eating disorder symptoms for both bullies and victims. Bullying involvement should be a part of risk assessment and treatment planning for children with eating problems.

Bully/victims: a longitudinal, population-based cohort study of their mental health.

It has been suggested that those who both bully and are victims of bullying (bully/victims) are at the highest risk of adverse mental health outcomes. However, unknown is whether most bully/victims were bullies or victims first and whether being a bully/victim is more detrimental to mental health than being a victim. A total of 4101 children were prospectively studied from birth, and structured interviews and questionnaires were used to assess bullying involvement at 10 years (elementary school) and 13 years of age (secondary school). Mental health (anxiety, depression, psychotic experiences) was assessed at 18 years. Most bully/victims at age 13 (n = 233) had already been victims at primary school (pure victims: n = 97, 41.6 % or bully/victims: n = 47, 20.2 %). Very few of the bully/victims at 13 years had been pure bullies previously (n = 7, 3 %). After adjusting for a wide range of confounders, both bully/victims and pure victims, whether stable or not from primary to secondary school, were at increased risk of mental health problems at 18 years of age. In conclusion, children who are bully/victims at secondary school were most likely to have been already bully/victims or victims at primary school. Children who are involved in bullying behaviour as either bully/victims or victims at either primary or secondary school are at increased risk of mental health problems in late adolescence regardless of the stability of victimization. Clinicians should consider any victimization as a risk factor for mental health problems.

Body-esteem of pupils who attended single-sex versus mixed-sex schools: a cross-sectional study of intrasexual competition and peer victimization.

In intrasexual competition (competition for reproductive resources), bullying can be viewed as a tool to devalue competitors, gain a high status and a powerful, dominant position in the peer group which may lead to beneficial gains such as access to potential romantic partners. This study investigated the relationship between intrasexual competition, bullying victimization and body-esteem, in single-sex versus mixed-sex schools. 420 participants completed a body-esteem scale, a retrospective bullying questionnaire, and intrasexual competition scales. Our results showed that relational victimization was associated with low body-esteem for both females and males. Females in single-sex schools experienced higher intrasexual competition which in turn was associated with their body-esteem directly and indirectly via relational victimization. In males, intrasexual competition was indirectly associated with body-esteem via relational victimization. Interventions to improve body esteem may focus on reducing intrasexual competition and peer victimization.

Establishing Priorities for Improving Data Collection and Measurement of Mental Health and Well-Being of Adolescents With Special Educational Needs Within Nonmainstream Schools: Protocol for a Delphi Study.

BACKGROUND: There are more than 1.5 million children and young people in England with special educational needs (SEN), with over 160,000 young people in the United Kingdom attending a special school or alternative provision (AP) setting. Young people with SEN have been found to be at risk for poorer mental health and well-being than non-SEN peers. However, there is a range of both school-related and research challenges associated with identifying difficulties in a timely manner. OBJECTIVE: This Delphi study aims to determine a list of stakeholder priorities for improving school-based measurement of mental health and well-being among young people with SEN, at an aggregated level, within secondary special school or AP settings. A secondary objective is to inform the implementation of school-based well-being surveys, improve engagement in special schools or AP settings, and improve survey response rates among children and young people with SEN. METHODS: A mixed methods Delphi study will be conducted, including a scoping review and preliminary focus groups with school staff members and researchers to establish key issues. This will be followed by a 2-round Delphi survey to determine a list of stakeholder priorities for improving the measurement of mental health and well-being at an aggregate level within special schools and AP settings. A final stakeholder workshop will be held to discuss the findings. A list of recommendations will be drafted as a report for special schools and AP settings. RESULTS: The study has received ethical approval from the University College London Research Ethics Committee. The stage 1 scoping review has commenced. Recruitment for focus groups will begin in Autumn 2024. The first round of the Delphi survey will commence in early 2025, and the second round of the Delphi survey in the spring of 2025. The final workshop will commence in mid-2025 with final results expected in late 2025. CONCLUSIONS: There is a need for clear recommendations for special schools and AP settings on priorities for improving the measurement of mental health and well-being problems among young people with SEN. There is also a need for recommendations to researchers implementing school-based well-being surveys, including the #BeeWell program, to enable them to improve their engagement in special schools and AP settings and ensure surveys are accessible. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/58610.

Gender, marginalised groups, and young people's mental health: a longitudinal analysis of trajectories.

BACKGROUND: Individuals from marginalised groups experience higher levels of mental health difficulties and lower levels of wellbeing which may be due to the exposure to stress and adversity. This study explores trajectories of mental health over time for young women and girls and young people with other marginalised identities. METHODS: We conducted a secondary analysis on N = 14,215 children and young people (7,501 or 52.8% female, 6,571 or 46.2% male, and 81 or 0.6% non-binary or questioning) who completed a survey at age 11 to 12 years and at least one other annual survey aged 12 to 13 years and/or aged 13 to 14 years. We used group-based trajectory models to examine mental health difficulties. RESULTS: Except for behavioural difficulties, young women's and girls' trajectories showed that they consistently had higher levels of mental health difficulties compared to young men and boys. A similar pattern was shown for non-binary and questioning children and young people. Children and young people with economic disadvantage and/or special education needs, and/or for whom there were welfare concerns, were generally more likely to experience higher levels of mental health difficulties. CONCLUSIONS: This information could inform public policy, guidance and interventions.

Prenatal family adversity and maternal mental health and vulnerability to peer victimisation at school.

BACKGROUND: Prenatal stress has been shown to predict persistent behavioural abnormalities in offspring. Unknown is whether prenatal stress makes children more vulnerable to peer victimisation. METHODS: The current study is based on the Avon Longitudinal Study of Parents and Children, a prospective community-based study. Family adversity, maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Parenting, partner conflict and temperament were measured at preschool age. Peer victimisation was assessed using multiple informants (child, parent, teacher) at primary school age (between ages 7 and 10). RESULTS: Prenatal severe family adversity and maternal mental health directly increased the risk of victimisation at school even when controlled for postnatal family adversity and maternal mental health, parenting, partner conflict and temperament. Effects were found to be independent of sources of information of peer victimisation. Partner conflict and maladaptive parenting also independently increased the risk of peer victimisation. CONCLUSIONS: Experiences in pregnancy may affect the developing foetus and increase vulnerability to be victimised by peers. Conflict between parents and their parenting further increase the risk of being victimised by peers at school.

Predictors of mental health difficulties and subjective wellbeing in adolescents: A longitudinal study.

Background: Mental health and subjective well-being are of great interest in both health policy and research. There has been considerable debate regarding whether mental health difficulties and subjective wellbeing are two distinct domains or different ends of a single mental health spectrum. This study investigates if predictors of mental health difficulties and subjective wellbeing are the same or different in a large-scale community-based sample in the United Kingdom. Methods: 13,500 adolescents in year 7 (aged 11-12) and again in year 8 (aged 12-13) completed surveys on emotional strengths and skills, support networks, mental health difficulties and wellbeing. Socio-demographic factors were gathered from the National Pupil Database. Mental health difficulties and wellbeing scores were standardized to allow comparisons. Results: The correlation between mental health difficulties and subjective wellbeing was -0.48, indicating a moderate overlap between the two domains. Some of the predictors (e.g., gender, ethnicity, problem solving, emotion regulation) in year 7 predicted both mental health difficulties and subjective wellbeing in year 8. However, some of the predictors in year 7 only predicted mental health difficulties (e.g., special education needs, empathy) and some only subjective wellbeing (e.g., prosocial behaviour, peer support) in year 8. Conclusion: This study provides further evidence for differences in what predicts adolescents' mental health difficulties and subjective wellbeing. It highlights the importance of not only focusing on preventing or treating symptoms of mental illness but also focusing on improving children's wellbeing.

Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study.

BACKGROUND: Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact. OBJECTIVE: The aim of this research is to examine young people's experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people? METHODS: A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people's (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people. RESULTS: Overall, 398 (45.4%) of 876 young people completed the T1 questionnaire, 559 (63.8%) completed the T2 questionnaire, and 81 (9.2%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95% CI 1.72-1.95), time 2 mean=2.00 (95% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people's mental health and made them feel less isolated and alone. CONCLUSIONS: The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained.

Enduring Mental Health in Childhood and Adolescence: Learning From the Millennium Cohort Study.

OBJECTIVE: Enduring mental health (EMH) is a relatively new concept, which refers to a long-term state of not experiencing a mental illness (ie, enduring mental wellness). No analysis using this concept has been undertaken on United Kingdom data nor specifically in the childhood years. The present study seeks to consider the extent and predictors of EMH in children aged 9 months to 14 years who were part of the UK-wide Millennium Cohort Study. METHOD: Data derived from 13,310 children (49.4% girls) at ages 9 months and 3, 5, 7, 11, and 14 years were pooled into 3 categories: EMH, some instances of mental health problems (SIMHP), and many instances of mental health problems (MIMHP). RESULTS: Fewer than half of the children (41%) fell into the category of EMH; the rest had at least some periods of mental health problems. Factors associated with EMH relative to those with SIMHP or MIMHP included cognitive ability, lack of special educational needs, good emotion regulation, cooperation, and enjoyment of school. Parenting and maternal mental health were also associated with EMH but only compared with those with MIMHP. CONCLUSION: Findings suggests that EMH is not the norm during childhood. Identification of the high association between both educational well-being and emotional regulation with EMH offer the opportunity for a potentially powerful combination of community and individual initiatives. These might include supporting positive mental health of the primary care giver, systems to support early recognition, supporting positive parenting in the early years, enhancing school engagement, and strengthening the child's social and emotional skills (including cooperation) and self-regulation to prevent later mental health problems.

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence.

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [ß] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (ß =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (ß = 0.001, p = 0.018), abuse (ß = 0.015, p = 0.018), maladaptive parenting (ß = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.

The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis.

AIM: To delineate the sleep profile of Borderline Personality Disorder (BPD). METHOD: A meta-analysis to synthesise findings on the objective and subjective sleep characteristics of BPD. RESULTS: We identified 32 studies published between 1980 and December 2015. Meta-analysis indicated significant differences between BPD and healthy control groups across objective sleep continuity (sleep onset latency, total sleep time, sleep efficiency) and architecture (rapid eye movement latency/density, slow wave sleep) measures, and self-reported sleep problems (nightmares, sleep quality). Findings were independent of depression (in clinical and community populations), and concomitant psychotropic medication use. There were few significant differences between BPD and clinical (majority depressed) control groups. CONCLUSION: BPD is associated with comparable sleep disturbances to those observed in depression. These disturbances are not solely attributable to comorbid depression. Given growing evidence that sleep disturbance may exacerbate emotional dysregulation and suicide risk, treatments for BPD should explicitly address sleep problems. Future studies should utilise prospective designs to ascertain whether (and in which circumstances) sleep problems predate or follow the onset of the disorder.