A rapid review of guidelines on the involvement of adolescents in health research.

BACKGROUND: Meaningful involvement of adolescents in health research is their fundamental human right and has many benefits. A lack of awareness among researchers on how to meaningfully involve adolescents in health research has been linked to adolescent under involvement in health research. To address this barrier, studies have reported the need for more guidance. To inform the development of better guidelines on adolescent involvement, there is a need to first consolidate the currently available guidance on adolescent involvement in health research and to identify the gaps in these guidelines. This review aims to systematically identify all the currently available guidelines on adolescent involvement in health research and evaluate their scope, content, context, and quality. METHODS: This rapid review was pre-registered with PROSPERO #CRD42021293586. It included documents that incorporated tangible recommendations on the involvement of adolescents in health research. We searched six databases for peer-reviewed literature: MEDLINE, CINAHL, Embase, Scopus, Web of Science, and ERIC. We conducted a grey literature search in Google Scholar, Google, websites of 472 relevant organisations and sought expert input. The quality of the guidelines was assessed using the Appraisal of Guidelines for REsearch & Evaluation (AGREE-II) Instrument. Data was analysed using descriptive analyses and narrative synthesis. RESULTS: We found that the current guidelines on adolescent involvement in health research are often narrow in scope, targeting specific users and populations while focusing on limited research areas. The guidelines individually fail to provide comprehensive coverage of recommendations across all topics related to adolescent research involvement, that are collectively addressed across all included guidelines. Furthermore, these guidelines tend to be context-specific and are generally of low quality, often due to inadequate stakeholder involvement and a lack of rigorous development methods. CONCLUSION: This review provides a consolidated list of guidelines on adolescent involvement in health research along with their quality scores as a resource for researchers to select the guidelines suitable for their research topic, context, and scope for adolescent involvement. There is a need to develop a set of guidelines on adolescent involvement in research, which are comprehensive in scope, cover all key aspects of adolescent involvement in health research, can be adapted for different contexts, and which are based on rigorous and systematic methods. PATIENT AND PUBLIC INVOLVEMENT: Adolescent co-researchers D. B. and C. W. were involved at different stages of the review process. D. B. screened 25% of the peer-reviewed articles at the title and abstract screening stage and 10% at full-text screening stage. C. W. extracted data from 10% of the included guidelines. Both co-researchers reviewed and shared their feedback on the article and are co-authors on this paper. They will also be invited to contribute to further dissemination of the findings from this review.

An umbrella review of reviews on challenges to meaningful adolescent involvement in health research.

BACKGROUND: Less than 1% of studies on child and adolescent health report the involvement of adolescents in health research. This is attributed to barriers experienced by researchers and adolescents in the engagement process. To address this under-involvement of adolescents, we first need a better understanding of the factors that hinder adolescent involvement in health research. OBJECTIVE: We conducted an umbrella review of reviews to consolidate the review-level evidence on the barriers to meaningful involvement of adolescents in health research. METHODS: We preregistered this umbrella review of reviews with PROSPERO (CRD42021287467). We searched 11 databases; Google Scholar; and PROSPERO; supplemented by a hand search of the reference lists of eligible reviews, relevant journals, websites of 472 organisations, and input from experts. This resulted in the inclusion of 99 review articles exploring adolescent involvement in studies on adolescent physical or mental health, which were narratively synthesised. Adolescent coresearchers were engaged at all stages of the review. RESULTS: We found that adolescent involvement in health research is impeded by several challenges experienced by researchers and adolescents. Some challenges experienced by researchers were organisational issues which included limited resources, gatekeeping and paying adolescents. Some barriers were related to a lack of preparedness among researchers and included a lack of awareness of adolescent involvement, the need for training and guidance, and negative attitudes towards participatory research. There were also barriers around how adolescents can be involved, such as researchers finding it challenging to adapt to new methods, issues with recruitment and retention of adolescents, inclusiveness and accessibility. There were also challenges specific to adolescents, such as adolescents' skills and expertise, training, motivations and study goals. Finally, barriers related to the ethical involvement of adolescents included issues with power dynamics, confidentiality, safety and protection of adolescents. Some of the barriers reported by adolescents included tokenistic involvement, inaccessibility of adolescent involvement, and their competing demands. CONCLUSION: Researchers may find this review useful in understanding and planning for potential challenges of involving adolescents in research. Despite many identified barriers to adolescent engagement, few mitigation strategies were identified to address these barriers. There is a clear need to establish best practices for meaningful adolescent involvement in health research. PUBLIC AND PATIENT INVOLVEMENT IN THE REVIEW: Adolescents were involved at multiple stages of this umbrella review of reviews. They reviewed the protocol, screened 25% of the articles at title and abstract screening stage, screened 10% of full-text articles, and worked on data analysis. They also helped plan and conduct a participatory workshop with an adolescent advisory group to discuss the challenges experienced by adolescents in health research.

War-related trauma linked to increased sustained attention to threat in children.

Experiences of war and displacement can have profound effects on children's affective development and mental health, although the mechanism(s) underlying these effects remain unknown. This study investigated the link between early adversity and attention to affective stimuli using a free-viewing eye-tracking paradigm with Syrian refugee (n = 31, Mage  = 9.55, 12 female) and Jordanian non-refugee (n = 55, Mage  = 9.98, 30 female) children living in Jordan (March 2020). Questionnaires assessed PTSD, anxiety/depression, insecurity, distress, and trauma. Refugee children showed greater initial avoidance of angry and happy faces compared to non-refugee children, and higher trauma exposure was linked to increased sustained attention to angry stimuli. These findings suggest that war-related trauma may have differential effects on the early and later stages of affective processing in refugee children.

Measurement of pregnancy-related anxiety worldwide: a systematic review.

BACKGROUND: The perinatal period is often characterized by specific fear, worry, and anxiety concerning the pregnancy and its outcomes, referred to as pregnancy-related anxiety. Pregnancy-related anxiety is uniquely associated with negative maternal and child health outcomes during pregnancy, at birth, and early childhood; as such, it is increasingly studied. We examined how pregnancy-related anxiety is measured, where measures were developed and validated, and where pregnancy-related anxiety has been assessed. We will use these factors to identify potential issues in measurement of pregnancy-related anxiety and the geographic gaps in this area of research. METHODS: We searched the Africa-Wide, CINAHL, MEDLINE, PsycARTICLES, PsycINFO; PubMed, Scopus, Web of Science Core Collection, SciELO Citation Index, and ERIC databases for studies published at any point up to 01 August 2020 that assessed pregnancy-related anxiety. Search terms included pregnancy-related anxiety, pregnancy-related worry, prenatal anxiety, anxiety during pregnancy, and pregnancy-specific anxiety, among others. Inclusion criteria included: empirical research, published in English, and the inclusion of any assessment of pregnancy-related anxiety in a sample of pregnant women. This review is registered on PROSPERO (CRD42020189938). RESULTS: The search identified 2904 records; after screening, we retained 352 full-text articles for consideration, ultimately including 269 studies in the review based on the inclusion and exclusion criteria. In total, 39 measures of pregnancy-related anxiety were used in these 269 papers, with 18 used in two or more studies. Less than 20% of the included studies (n = 44) reported research conducted in low- and middle-income country contexts. With one exception, all measures of pregnancy-related anxiety used in more than one study were developed in high-income country contexts. Only 13.8% validated the measures for use with a low- or middle-income country population. CONCLUSIONS: Together, these results suggest that pregnancy-related anxiety is being assessed frequently among pregnant people and in many countries, but often using tools that were developed in a context dissimilar to the participants' context and which have not been validated for the target population. Culturally relevant measures of pregnancy-related anxiety which are developed and validated in low-income countries are urgently needed.

Promoting well-being in refugee children: An exploratory controlled trial of a positive psychology intervention delivered in Greek refugee camps.

Rigorously evaluated interventions that target protective factors and positive resources rather than ameliorating negative outcomes in child refugees are rare. To address this, we developed and evaluated a short, group-based resilience-building intervention called Strengths for the Journey (SFJ), which was designed for war-affected children. We conducted a quasi-randomized pilot study of the SFJ intervention with 72 7- to 14-year-old forcibly displaced children (Mage = 10.76, 64.8% female) in three refugee camps in Lesvos, Greece. Intervention effectiveness was assessed by measuring pre-post changes in well-being, self-esteem, optimism, and depressive symptoms from before (T1) to immediately after the intervention/wait-list task (T2). Four focus group interviews were conducted with 31 of the participants to discuss their views on the effects of the intervention and the continued use of the skills that were learned. Using repeated-measures ANOVAs, we found improvements in well-being, F (1, 46) = 42.99, ηp2 = .48, self-esteem, F (1, 56) = 29.11, ηp2 = .40, optimism, F (1, 53) = 27.16, ηp2 = .34, and depressive symptoms, F (1, 31) = 62.14, ηp2 = .67, in the intervention group compared with the wait-listed group (p < .05). Focus group participants highlighted the importance of SFJ in developing a sense of togetherness and building their strengths. Child refugees in low-resource settings may benefit from brief, first-line interventions that target protective factors such as well-being, hope, self-esteem, and belonging.

C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomized controlled trial.

Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B =  -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement.

Minds Under Siege: Cognitive Signatures of Poverty and Trauma in Refugee and Non-Refugee Adolescents.

The impacts of war and displacement on executive function (EF)-what we might call the cognitive signatures of minds under siege-are little known. We surveyed a gender-balanced sample of 12- to 18-year-old Syrian refugees (n = 240) and Jordanian non-refugees (n = 210) living in Jordan. We examined the relative contributions of poverty, trauma exposure, posttraumatic stress, and insecurity to variance in inhibitory control and working memory. We observed associations between poverty and WM, suggesting that, even in populations exposed to substantial violence and fear, poverty is a specific pathway to WM deficit. We did not, however, find associations between EFs and exposures to trauma. Careful distinction between childhood adversities may illuminate which neurocognitive pathways matter for measures of cognitive function.

Resilience in Context: A Brief and Culturally Grounded Measure for Syrian Refugee and Jordanian Host-Community Adolescents.

Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11-18 years). Confirmatory factor analyses tested three-factor structures for 28- and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92-.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.

Overcoming socioeconomic adversity: Academic resilience in mathematics achievement among children and adolescents in Ireland.

Although socioeconomic disadvantage is linked with academic underachievement, many children from low-income backgrounds perform well in school. Which modifiable factors predict this academic resilience? We examine between- and within-person predictors of one important academic metric - mathematics performance - across adolescence in 1715 (796 male, 919 female) youth living in poverty in Ireland, using data from three waves (9, 13, and 17/18 years) of the Growing Up in Ireland study. Using linear mixed models, math performance was worse when adolescents had more socioemotional and behavioural difficulties, more child-parent relationship conflict, parents had lower expectations of the adolescent's educational achievement, and when primary caregivers had less education. Adolescents who had better intellectual self-concept and attended a non-disadvantaged school had greater math performance. This research adds to the growing body of work suggesting academic resilience is dynamic and multisystemic; it provides potential targets at multiple levels to promote such resilience.

Facial emotion recognition in refugee children with a history of war trauma.

Over 36 million children are currently displaced due to war, yet we know little about how these experiences of war and displacement affect their socioemotional development-notably how they perceive facial expressions. Across three different experiments, we investigated the effects of war trauma exposure on facial emotion recognition in Syrian refugee (n = 130, Mage = 9.3 years, 63 female) and Jordanian nonrefugee children (n = 148, Mage = 9.4 years, 66 female) living in Jordan (data collected 2019-2020). Children in the two groups differed in trauma exposure, but not on any of our measures of mental health. In Experiment 1, we measured children's biases to perceive an emotion using morphed facial expressions and found no evidence that biases differed between refugees and nonrefugees. In Experiment 2, we adapted a novel perceptual scaling task that bypasses semantic knowledge, and again found no differences between the two group's discrimination of facial expressions. Finally, in Experiment 3, we recorded children's eye movements as they identified Middle Eastern actors' facial expressions, and again found no differences between the groups in either their identification accuracies or scanning strategies. Taken together, our results suggest that exposure to war-related trauma and displacement during early development, when reported by the caregiver but not always recollected by the child, does not appear to alter emotion recognition of facial expressions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Can large language models replace humans in systematic reviews? Evaluating GPT-4's efficacy in screening and extracting data from peer-reviewed and grey literature in multiple languages.

Systematic reviews are vital for guiding practice, research and policy, although they are often slow and labour-intensive. Large language models (LLMs) could speed up and automate systematic reviews, but their performance in such tasks has yet to be comprehensively evaluated against humans, and no study has tested Generative Pre-Trained Transformer (GPT)-4, the biggest LLM so far. This pre-registered study uses a "human-out-of-the-loop" approach to evaluate GPT-4's capability in title/abstract screening, full-text review and data extraction across various literature types and languages. Although GPT-4 had accuracy on par with human performance in some tasks, results were skewed by chance agreement and dataset imbalance. Adjusting for these caused performance scores to drop across all stages: for data extraction, performance was moderate, and for screening, it ranged from none in highly balanced literature datasets (~1:1) to moderate in those datasets where the ratio of inclusion to exclusion in studies was imbalanced (~1:3). When screening full-text literature using highly reliable prompts, GPT-4's performance was more robust, reaching "human-like" levels. Although our findings indicate that, currently, substantial caution should be exercised if LLMs are being used to conduct systematic reviews, they also offer preliminary evidence that, for certain review tasks delivered under specific conditions, LLMs can rival human performance.

The use of creative art therapy to address the mental health of refugee adolescents: a systematic review.

INTRODUCTION: Creative art therapy (CAT) has become increasingly popular as a means of promoting positive mental health among adolescent refugees when accompanied by interdisciplinary interventions that engage families and communities. In this pre-registered systematic review (PROSPERO: CRD42022372538), we evaluated and synthesized the available literature reporting the use of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years. METHODOLOGY: We conducted a systematic search of the grey and black literature published in English and Arabic between 2012 to 2022 on 10 databases. RESULTS: Systematic database searches revealed 397 articles but only 5 met our inclusion criteria. These studies reported some positive outcomes but the evidence supporting the effectiveness of CAT as a diagnostic, treatment and mental health promotion intervention with adolescent refugees, aged 10-24 years is inconclusive. CONCLUSION: The findings of this review point to the need for more methodologically robust studies that describe the intervention, implementation, and therapeutic approaches in greater detail to strengthen the evidence for the use of CAT with adolescent refugees.

Positive Impacts of Adolescent Involvement in Health Research: An Umbrella Review.

Despite an increased recognition of the right of adolescents to be involved in decisions that affect them, young people continue to be under-involved in health research. One of the reasons is a lack of awareness among researchers on the current evidence base around the benefits of involving adolescents. To address this, we conducted an umbrella review to synthesize the evidence on the positive impacts of adolescent involvement in health research. This umbrella review was preregistered with PROSPERO (CRD42021287467). We searched 11 databases, Google Scholar, PROSPERO, reference lists, 10 journals, websites of 472 organizations, and sought input from experts. Ultimately, we included 99 review articles. We found that adolescent involvement has many positive impacts on young people, including increased knowledge and skills; personal development; financial benefits; career and academic growth; enhanced relationships; and valuing their experience. The positive impacts of adolescent involvement on the research itself include increased relevance of the study to adolescents, improved recruitment, development of more adolescent-friendly materials, enhanced data collection and analysis, and more effective dissemination. Researchers also benefited from adolescents' involvement through increased knowledge, skills, and a shift in their attitudes. The evidence supporting the positive impacts of adolescent involvement in research is substantial but limited by a lack of rigorous evaluation, inconsistent reporting, and unclear evaluation methods.

Maternal Trauma and Psychopathology Symptoms Affect Refugee Children's Mental Health But Not Their Emotion Processing.

Refugee children's development may be affected by their parents' war-related trauma exposure and psychopathology symptoms across a range of cognitive and affective domains, but the processes involved in this transmission are poorly understood. Here, we investigated the impact of refugee mothers' trauma exposure and mental health on their children's mental health and attention biases to emotional expressions. In our sample of 324 Syrian refugee mother-child dyads living in Jordan (children's Mage=6.32, SD = 1.18; 50% female), mothers reported on their symptoms of anxiety and depression, and on their children's internalising, externalising, and attention problems. A subset of mothers reported their trauma exposure (n = 133) and PTSD symptoms (n = 124). We examined emotion processing in the dyads using a standard dot-probe task measuring their attention allocation to facial expressions of anger and sadness. Maternal trauma and PTSD symptoms were linked to child internalising and attention problems, while maternal anxiety and depression symptoms were associated with child internalising, externalising, and attention problems. Mothers and children were hypervigilant towards expressions of anger, but surprisingly, mother and child biases were not correlated with each other. The attentional biases to emotional faces were also not linked to psychopathology risk in the dyads. Our findings highlight the importance of refugee mothers' trauma exposure and psychopathology on their children's wellbeing. The results also suggest a dissociation between the mechanisms underlying mental health and those involved in attention to emotional faces, and that intergenerational transmission of mental health problems might involve mechanisms other than attentional processes relating to emotional expressions.

Coparenting, mental health, and the pursuit of dignity: A systems-level analysis of refugee father-mother narratives.

Research on coparenting is virtually absent from the refugee literature, despite its importance for family systems, children's bio-behavioural and emotional development, and intergenerational responses to social change. In 2022, we conducted 30 semi-structured interviews with Syrian refugees in Jordan and used thematic analysis to examine how fathers and mothers (n = 15 dyads) enacted parenting together. We identified four approaches characterising how couples navigated coparenting interactions, family cohesion, and intergenerational change. These were negotiation, mirroring, anchoring, and transformation. Specifically, Syrian couples negotiated how to balance responsibilities, sought emotions and behaviours that reflected calm and respect, prioritised family togetherness over education or resettlement opportunities, and, strikingly, adopted gentler parenting approaches to transform intergenerational experiences. Underpinning these four themes were efforts to uphold family dignity. Syrians described themselves as ordinary parents, eschewing the label of refugee parents and building a normal life for their families after war and displacement. Our thematic analysis offers methodological and conceptual advances in exemplifying how to capture a dyadic understanding of coparenting and why refugees strive to parent in ways that sustain mental health and dignity. This systems-level analysis of coparenting in dignity is specifically relevant to strengthening the processes of family-level communication and to designing integrated programs that support caregiving, wellness, and family unity. Our findings lay the groundwork for developing a relational, agentic model of family caregiving systems in the context of precarity and forced displacement.

A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana.

INTRODUCTION: Despite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana. METHODS: We conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data. RESULTS: At the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges. CONCLUSION: Pregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.

Effectiveness of a community-led shared book reading intervention in Syrian refugee children: a randomised controlled trial.

Community-led, shared book reading programs may help improve refugee children's reading abilities and attitudes towards reading. We Love Reading (WLR)-a light-touch, community-led, shared book reading program-was evaluated in a pre-registered, wait-listed, randomised controlled trial (AEARCTR-0006523). 322 Syrian refugee mother-child dyads (children: 4-8-year-olds, 50.0% female) in Jordan were tested at two timepoints, 15 weeks apart. WLR did not significantly affect child literacy or child-reported child attitudes toward reading (ps > 0.05). Mothers did report improved child attitudes toward reading from WLR (p = 0.046, η2 = 0.013). The intervention did not lead to improvements in family relationships (ps > 0.05). WLR may have promise in improving attitudes toward reading in forcibly displaced children but did not affect literacy or child-reported attitudes toward reading; these results provide insight into what changes are needed for effective shared book reading interventions in this population.

Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting.

BACKGROUND: Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting. METHODS: An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephone-delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon. Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8-17 years) and their caregivers (N = 11, 100% female, age 29-56 years) (N = 25 interviews). Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized. RESULTS: Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family's attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone. CONCLUSIONS: Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed. Trial Registration ClinicalTrials.gov ID: NCT03887312; registered 22nd March 2019.

A test of the instability hypothesis in low- and middle-income countries.

The instability hypothesis proposes that family structure transitions lead to negative child outcomes through the pathway of stress. However, in many cases, family structure transitions are not associated with stress or negative child outcomes, suggesting that there are specific circumstances under which transitions are more or less stressful. Using five rounds of data (ages 1-15) from the Young Lives study (N = 8,062) which follows children and their caregivers in Ethiopia, India, Peru, and Vietnam, we had two aims: (a) to test the instability hypothesis, and (b) to examine the specific circumstances under which family structure transitions lead to stress and worsened child physical health. First, we used multilevel mediation to assess whether financial stress mediated the link between family structure transitions and children's physical health. We then added household size, multigenerational household, and horizontally extended kin household as moderators to the family structure transition-financial stress relationship. We found that financial stress did not mediate the link between family structure transitions and children's physical health in any of the Young Lives countries. We found some moderated mediation effects for household size and multigenerational households in Peru and Vietnam, but effect sizes were small. These findings highlight the need to further unpack the instability hypothesis to understand the specific circumstances under which family structure transitions lead to stress and worsened child outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).