Barriers and facilitators to breast cancer screening among high-risk women: a qualitative study.

PURPOSE: Women with greater than 20-25% lifetime breast cancer risk are recommended to have breast cancer screening with annual mammogram and supplemental breast MRI. However, few women follow these screening recommendations. The objective of this study was to identify barriers and facilitators of screening among women at high risk for breast cancer, guided by the Health Services Utilization Model (HSUM). METHODS: Unaffected high-risk women (N=63) completed semi-structured qualitative interviews exploring their experiences with breast cancer screening. Interviews were audio recorded, transcribed verbatim, and analyzed using a combined deductive and inductive approach. RESULTS: Most participants (84%) had received a screening mammogram; fewer (33%) had received a screening breast MRI. Only 14% had received neither screening. In line with the HSUM, qualitative analysis identified predisposing factors, enabling factors, and need factors associated with receipt of breast cancer screening. Enabling factors - including financial burden, logistic barriers, social support, and care coordination - were most frequently discussed. Predisposing factors included knowledge, health beliefs, and self-advocacy. Need factors included healthcare provider recommendation, family history of breast cancer, and personal medical history. Although HSUM themes were consistent for both mammography and breast MRI, participants did highlight several important differences in barriers and facilitators between the two screening modalities. CONCLUSION: Barriers and enabling factors associated with supplemental screening for high-risk women represent possible intervention targets. Future research is needed to develop and test multilevel interventions targeting these factors, with the ultimate goal of increasing access to supplemental screening for high-risk women.

Children's concepts of childhood and adolescent depression.

BACKGROUND: Research on adolescent Mental Health Literacy (MHL) is rapidly increasing; however, equivalent research in children is lacking. Exploring children's mental health conceptualisations reveals how their knowledge develops and provides the evidence base for the development of mental health education for younger age groups. METHODS: A total of 105 children aged 8-9 and 11-12 years were interviewed using a vignette methodology structured according to the model of illness representations, exploring: recognition, causes, consequences, timeline and curability of depression. Age, gender and experience differences were explored. RESULTS: Children were able to identify the existence of a psychological difficulty in a depressed peer; however, they struggled to categorise depression as a mental illness or to label depression. Children referred to a variety of causal factors, primarily environmental and interpersonal rather than internal biological causes. Children considered depression to be curable within a short period of 1-2 months and anticipated negative outcomes if left untreated. Older children's concepts were more sophisticated than younger children's. Gender and experience were not associated with depression concepts in this age range. CONCLUSIONS: Age trends in children's mental health concepts are evident, in accordance with previous studies. Children from the age of 8-9 years demonstrate detailed concepts of depression. However, mental health educational interventions are needed to target specific gaps and misconceptions in children's understanding.

Effect of three group interventions on psychosocial functioning in adolescents exposed to interpersonal violence in Chile: A pilot clinical trial.

BACKGROUND: In Chile demand for specialist care following exposure to interpersonal violence (IPV) in youth far exceeds capacity. Group interventions may improve access to care for youth. OBJECTIVE: To evaluate the effectiveness and acceptability of two low-intensity group interventions: Trama Focused Cognitive Behavioral Therapy (TF-CBT); Interpersonal Psychotherapy (IPT); and treatment as usual, Art therapy-based support (ATBS). Outcomes measured were post-traumatic stress symptoms, depression, interpersonal functioning and affect regulation. PARTICIPANTS AND SETTING: Participants were 67 Chilean youth aged 13-17 years, victims of IPV on a waiting list to receive specialist individual intervention. METHODS: Using a randomised controlled trial design, participants were randomly assigned to one of the interventions. Self-report measures were completed at 5 timepoints between baseline and follow up eight weeks after intervention ended. Dropout rates and attendance were also analysed. RESULTS: TF-CBT showed significant decreases for PTSD (d = 0.91) and depression (d = 0.77) symptoms, sustained at follow-up with affect regulation problems also showing significant decrease from baseline (d = 0.43). IPT showed significant decreases in PTSD symptoms (d = 0.64) and affect regulation problems (d = 0.66), both sustained at follow-up. ATBS showed statistically significant decrease for PTSD (d = 0.79) and interpersonal problems (d = 0.65) but only change in PTSD was sustained at follow-up. There were no significant differences in dropout or attendance between the interventions. CONCLUSION: Group interventions provide a viable and effective first-phase option for reducing psychological distress in IPV-exposed youth in high-demand contexts. Effectiveness may be further improved through the more active involvement of parents and carers.

The relationship between child neglect and adolescent interpersonal functioning: A systematic review.

BACKGROUND: Neglect is a highly prevalent, yet historically understudied form of maltreatment. Recent research has revealed the far reaching and unique effects that neglect has on subsequent cognitive, behavioural and socio-emotional development, and on long-term physical and mental health outcomes. Adolescent interpersonal functioning is important to explore given the significant relational transitions that occur during this stage of development, and the known impact that these social changes can have on future life outcomes. OBJECTIVE: This systematic review synthesises the literature exploring the relationship between neglect and adolescent interpersonal functioning in peer relationships. METHODS: Seven databases and three grey literature sites were systematically searched, and identified records screened against inclusion criteria. RESULTS: Twenty-one articles were included in the final sample, exploring five different indicators of adolescent interpersonal functioning. Around half of the papers investigating quality of peer relationships found that neglect, particularly emotional neglect, is associated with reduced relationship quality, and there is consistent evidence that neglect increases the risk of gang involvement and deviant peer affiliation. CONCLUSIONS: These findings may be used to strengthen a trauma-informed approach to work with adolescents. Research on neglect and adolescent romantic relationships is sparse. Overall, the literature is varied and further research using longitudinal data and consistent measures of neglect would be of value.

Mediators of childhood trauma and suicidality in a cohort of socio-economically deprived Scottish men.

BACKGROUND: There is little research investigating the relationship between childhood abuse, including neglect, and suicidality in adult men, despite epidemiological data suggesting that they are most at risk for suicide. OBJECTIVE: To investigate the relationship between childhood abuse and neglect and suicidality, and the possible mediating roles of affect dysregulation and social inhibition. PARTICIPANTS AND SETTING: a cohort of eighty-six socio-economically deprived male Caucasian participants previously identified as suicidal, attending a non-clinical community group. METHODS: Participants completed self-report measures on childhood trauma, emotion regulation, interpersonal difficulties and suicidal behavior. RESULTS: Mediation analysis indicated that emotion dysregulation and interpersonal difficulties significantly mediated the relationship between childhood trauma and suicidality with a medium effect size (R2 = .41, p < .001). CONCLUSIONS: Study results suggest that early childhood abuse and neglect results in dysfunctional emotion regulation, which leads to suicidality in the context of impoverished social environments. The provision of psychological interventions aimed at improving social and emotional functioning may help to safeguard men who are most at risk of suicide.

An exploratory study on the factors affecting the mental health and well-being of frontline workers in homeless services.

Frontline workers in homeless services work in a high-intensity, emotionally consuming environment, with frequent exposure to traumatic material with potentially significant consequences for their own mental health. This, in turn, may have a negative impact on the quality of care provided to homeless service users. Prevention of this trajectory may be achieved through psychologically informed environments for staff. This study aimed to explore factors that may influence the development of burnout, secondary traumatic stress (STS), depression, anxiety and stress in this population. Elevated levels of burnout and STS were predicted, as was an association between the predictor variables of professional experience, educational background, continuing professional development, access to organisational support structures and the outcome measures of compassion satisfaction, burnout, STS, depression, anxiety and stress. An online cross-sectional survey design using the Professional Quality of Life Scale (Version V) and the Depression Anxiety and Stress Scale-21 and scales designed for this study capturing occupational variables were distributed via email and national networks to a wide range of services across Scotland and the rest of the UK. Over 4 months in 2017, 112 frontline homelessness workers in health, social care and third sector organisations completed the survey. Results did not indicate elevated levels of burnout or STS, though depression and stress were found to be significantly elevated compared to population norms and were associated with burnout, compassion satisfaction and secondary traumatic stress. High levels of various types of supervision support and CPD were identified. There was no association between these and burnout or stress. We highlight the elevated levels of stress and depression and make a research recommendation to parse types of supervision to assess for optimal effectiveness and efficiency in ensuring that staff working in high-stress homelessness settings receive optimal support to deliver high quality services.

Effectiveness of art therapy with pediatric populations affected by medical health conditions: a systematic review.

Background: Visual art therapy has been widely used with children with medical health conditions within various settings. However, less is known about its effectiveness. The scope of this systematic review is to shed light on what benefit art therapy may have for ill health adjustment in youth populations. Methods: Electronic databases (Psychinfo, Medline, CINAHL, ERIC, Scopus, Embase and Child and Adolescent Studies) were searched (1806-2017). Systematic methods for study selection and data extraction were used. Results: Twelve studies (N = 404 participants, 318 in the control group; aged between 2 and 19 years old, with various medical conditions) were included. Ten studies reported significant improvements concerning at least one outcome with an overall inconclusive trend toward effectiveness. Conclusions: Visual art therapy interventions were found weak in evidence quality. However, future evidence-based research designs could show the effectiveness of these interventions in health care settings.

Psychotherapy to treat consequences of interpersonal violence suffered during childhood and adolescence in Latin America: A systematic review / Psicoterapia para tratar consecuencias de la violencia interpersonal sufrida en la infancia y adolescencia en Latinoamérica: una revisión sistemática

Abstract Introduction/Objective: As in the rest of the world, in Latin America there is a high prevalence of interpersonal violence (IV) in childhood and adolescence, which is associated with psychological consequences in the short, medium and long term. At the international level, progress has been made in the recognition of evidence-based psychotherapies, but the situation in Latin America is unknown. The objective of this systematic literature review is to identify which psychotherapy models or modalities have been shown to be effective in Latin America. Methods: A systematic search of five databases was carried out with search terms relating to psychosocial interventions of people exposed to IV during childhood, based in Latin America. Studies regarding Latino populations based in United States were excluded. Results: 14 papers describing 13 studies and one follow-up were identified. Individual and group interventions (mainly cognitive-behavioural and with psychodynamic influence) were included. Although all showed clinically or statistically significant changes in symptoms of post-traumatic stress, anxiety and depression, most were pilot studies with important methodological limitations and a high risk of bias. Conclusions: It is necessary to develop clinical practice in Latin America with more robust research (i.e., controlled and randomised clinical trials) that produce more reliable evidence regarding the effectiveness of psychosocial interventions for IV involving children and adolescents in the Latin American context.

Resumen Introducción/objetivo: tal como en el resto del mundo, en Latinoamérica existe una alta prevalencia de violencia interpersonal en la infancia y adolescencia que se asocia a consecuencias psicológicas a corto, mediano y largo plazo. Internacionalmente se ha avanzado en el reconocimiento de psicoterapias basadas en la evidencia, pero se desconoce la situación de Latinoamérica. El objetivo de esta revisión sistemática es identificar cuales modelos o modalidades de psicoterapia han mostrado efectividad en Latinoamérica. Método: se realizó una búsqueda sistemática en cinco bases de datos con términos de búsqueda relacionados con intervenciones psicosociales para personas expuestos a violencia interpersonal en la infancia en Latinoamérica. Se excluyeron los estudios sobre poblaciones latinas radicadas en Estados Unidos. Resultados: se reconocieron 13 intervenciones y un estudio de seguimiento en los que se evalúa la efectividad de distintos modelos (cognitivo conductuales y con influencia psicodinámica). Aunque en todos ellos se muestran cambios clínica o estadísticamente significativos en sintomatología de estrés postraumático, ansiedad y depresión, en su gran mayoría se trata de estudios piloto con importantes limitaciones metodológicas. Conclusiones: se considera necesario avanzar en la elaboración de estudios más robustos (ej. ensayos clínicos controlados y aleatorizados) que otorguen evidencia más sólida de la efectividad de las intervenciones en el contexto cultural latinoamericano.

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review.

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children's disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.

Evaluación del efecto de intervenciones grupales basadas en TF-CBT e IPT en el funcionamiento psicosocial de adolescentes expuestos a violencia interpersonal en Chile: un protocolo de ensayo clínico piloto / TF-CBT and IPT based group intervention on psychosocial functioning in adolescents exposed to interpersonal violence in Chile: a pilot clinical trial protocol

Este artículo describe el protocolo para evaluar intervenciones con adolescentes expuestos a violencia interpersonal y sigue los lineamientos de CONSORT (Shulz et al., 2010). El objetivo es evaluar la efectividad de dos modelos de intervención grupal (Terapia Cognitivo Conductual Centrada en el Trauma, TF-CBT y Terapia Interpersonal, IPT) en la estabilización del funcionamiento psicosocial de adolescentes. Método. Este es un ensayo controlado aleatorizado con tres grupos: dos grupos de intervención (TF-CBT e IPT) y un grupo de control activo (arteterapia). Los participantes serán 84 adolescentes entre 13 a 17 años que están en lista de programas especializados. Los participantes serán asignados a uno de los tres grupos y participarán en 12 sesiones de terapia grupal. Se evaluará el progreso de los participantes en sintomatología de estrés postraumático y depresión, problemas de autorregulación e interpersonales. Las medidas se administrarán antes del inicio de la intervención, en sesiones seis, siete, doce y dos meses después de finalizada la intervención. También se evaluará la adherencia a la intervención y su aceptabilidad por parte de los participantes. Discusión. Este estudio busca contribuir al desarrollo de intervenciones basadas en evidencia en Chile para mejorar el acceso a la intervención especializada. Registro del protocolo: 19/05/2021, código ISRCTN10290141.

This paper describes the protocol developed in Chile to evaluate interventions for adolescents exposed to interpersonal violence and follows CONSORT guidelines (Shulz et al., 2010). The objective is to evaluate the effectiveness of two group intervention models (Trauma Focused Cognitive Behavioral Therapy and Interpersonal Therapy) in stabilising the psychosocial functioning of adolescent participants. Methods/Design. It is a randomised controlled trial with three groups: two intervention groups (TF-CBT and IPT) and an active control group (art therapy). The participants will be eighty-four adolescents between 13 to 17 years old on the waiting list for treatment in specialist trauma services. Participants will be assigned to one of three groups and participate in 12 group therapy sessions. Participants' progress in post-traumatic stress and depression symptomatology, self-regulation and interpersonal problems will be assessed. Measures will be administered before the start of the intervention, in sessions six, seven, twelve and two months after the end of the intervention. Adherence to the intervention and its acceptability by the participants will also be evaluated. Discussion. This study seeks to contribute to developing scalable, evidence-based interventions in the Chilean context to improve access to specialist intervention. Trial Registration. 19/05/2021, code ISRCTN10290141.

Adolescent perfectionism: Structural features of the Frost Multidimensional Perfectionism Scale and correlates with attachment and psychopathology.

OBJECTIVES: Perfectionism is recognized as a significant risk factor for psychopathology. Emerging research links attachment to perfectionism in adult and college-age samples. The Frost Multidimensional Perfectionism Scale (FMPS) has been used in adults and adolescents with a variety of factor structures found. This study sought to establish the factor structure in a general adolescent sample prior to testing for associations between perfectionism, attachment, and psychopathology in the same sample. DESIGN: A cross-sectional survey design was used. Confirmatory factor analysis, and correlational and regression analyses were employed. METHODS: A total of 290 adolescents, aged 12-18 years, were recruited from a state secondary school. All completed the FMPS along with brief measures of attachment and psychopathology. RESULT: Exploratory and confirmatory factor analyses failed to replicate previously published models, and a new six-item, 1-factor model representing perfectionism was found instead. This new variable was then used to establish a role for perfectionism and attachment anxiety in predicting internalizing problems. Perfectionism also correlated with conduct problems and hyperactivity. CONCLUSION: This study established a novel factor structure for the FMPS, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism. Caution is noted about the use of extant perfectionism measures that are not properly developmentally informed and which do not capture the dynamic nature of adolescence and adolescent perfectionism. PRACTITIONER POINTS: Perfectionism is a feature of adolescent psychopathology, including internalizing and externalizing problems. Perfectionism is associated with attachment anxiety and together contributes to internalizing problems. Current conceptualizations of perfectionism may not capture the specific developmental and dynamic aspects of adolescence and should not be regarded as a stable personality trait.

Suicidal behaviour in adolescents and young adults with ASD: findings from a systematic review.

Suicide is a major problem in Western society. However we have very little understanding of suicidal behaviour among individuals with autism spectrum disorders. The purpose of this review is to synthesise primary research on suicidal behaviour among adolescents and young adults with autism spectrum disorders in order to estimate prevalence and to identify and critically evaluate risk factors for suicidal behaviour in this population. Four primary research studies were identified for this review following a comprehensive literature search. The available research provides little empirical evidence for the processes underlying suicidal behaviour in adolescents and young adults with autism.

Design and development of a scale measuring fear of complications in type 1 diabetes.

BACKGROUND: There are many determinants of glycaemic control in patients with type 1 diabetes. Patients with type 1 diabetes and poor glycaemic control have been reported as being more likely to have a greater fear of hypoglycaemia. The relationship between fear of diabetes-related complications and glycaemic control is unclear, and therefore a brief measure of fear of diabetes complications was developed. METHODS: A questionnaire was designed, comprising items relating to general fears, specific fears (e.g. blindness, kidney problems, heart disease), lifestyle fears, fear of hypoglycaemia and weight gain. The questionnaire was piloted on 147 outpatients with type 1 diabetes, along with other measures such as the Hypoglycaemia Fear Survey, the Hospital Anxiety and Depression Scales, the Coping with Health, Injuries and Problems Scale and the Eysenck Personality Questionnaire. RESULTS: Factor analysis was carried out on the 30 items and, after rotation, 15 emerged as loading heavily on the first factor. Factor analysis was rerun on these 15 items and the first factor accounted for 56% of the total variance. This factor remained invariant when the scale was split randomly and by age and gender. The reliability of the scale (alpha) was 0.94. The scale did not correlate with any demographic variables but did with measures of negative affectivity (HADS anxiety = 0.34, p < 0.001; Depression = 0.24, p < 0.004), the Hypoglycaemia fear survey worry Scale (0.44, p < 0.001), presence of complications (0.17, p < 0.04) and number of complications (0.28, p < 0.001). CONCLUSIONS: These results indicate that the scale identifies a fear that is moderately related to the presence of complications and general negative affectivity but which is a uniquely diabetes-related emotion.