Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

The science of child and adolescent mental health in Greece: a nationwide systematic review.

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Health-Related Quality of Life and Behavioral Difficulties in Greek Preschool Children with Developmental Language Disorder.

Developmental language disorder (DLD) has a great impact on language skills as well as on a wide range of functioning areas, such as social and school functioning. In the present study, we aim to explore the Health-Related Quality of Life (HRQoL) of preschool children with DLD, compared to children with no language difficulties, using a self and proxy report method. A total of 230 parents of preschool children with DLD and 146 parents of children without language difficulties completed the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Generic Core Module and the Strengths and Difficulties Questionnaire (SDQ). Additionally, 71 children with DLD and 55 peers without DLD completed the self-reported PedsQLTM module. The parents of kindergarten children (5-6 years old) with DLD reported that their kids experience worse social and school functioning compared to the control group. In addition, the children with DLD self-reported lower physical and social functioning. The parents of children with DLD reported that their children experience higher hyperactivity/inattention problems than the parents of the control group. Kindergarten children with DLD have a poorer HRQoL compared to their peers, as perceived by themselves and their parents. Moreover, children with DLD present with higher hyperactivity and inattention symptoms. Health professionals working with children who have DLD need to consider not only the language difficulties but also the children's wellbeing and symptoms of hyperactivity and inattention.

Experience of Service Questionnaire (ESQ) in children and adolescents: factor structure, reliability, validity, item parameters and interpretability of the parent version for practical use in Greece.

Background: Health systems need tools to assess patient's experience of service, but existing tools lack reliability and validity assessment. Our aim is to investigate the factor structure, reliability, validity, item parameters and interpretability of the parent version of the Experience of Service Questionnaire (ESQ) for practical use in Greece. Methods: A total of 265 caregivers that were using mental health services in Greece participated in this study as part of the Nationwide cross-sectional survey from the Child and Adolescent Mental Health Initiative (CAMHI). Confirmatory Factor Analysis was used to test factor structure. Reliability of all models were measured with omega coefficients. Tobit regression analysis was used to test for convergent and discriminant validity with specifically designed questions. Item parameters were assessed via Item Response Theory. Interpretability was assessed by means of IRT-based scores. Results: We found that ESQ is best represented and scored as a unidimensional construct, given potential subscales would not have enough reliability apart from a general factor. Convergent and discriminant validity was demonstrated, as caregivers who perceived that their child benefited from the received mental health care had 6.50 higher summed scores (SMD=1.14, p<0.001); while those who believed that their child needed additional help had 5.08 lower summed scores on the ESQ (SMD=-0.89, p<0.001). Average z-scores provided five meaningful categories of services, in terms of user satisfaction, compared to the national average. Conclusions: Our study presents evidence for the reliability and validity of the ESQ and provides recommendations for its practical use in Greece. ESQ can be used to measure experience of service and might help drive improvements in service delivery in the Greek mental health sector.

Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece.

BACKGROUND: In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS: This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS: A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION: A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.

Health-Related Quality of Life in Kindergarten Children with Developmental Language Disorder: Child-Mother Agreement.

Language disorders are associated with difficulties in various aspects of life, such as academic and social functioning, resulting in impaired health-related quality of life (HRQoL). Most studies use a parent proxy method to assess HRQoL. Since HRQoL refers to the subjective experience of an individual, it is necessary to assess children's perspectives along with their mothers'. The aim of the current study is to explore HRQoL rating agreement between children and their mothers, since the literature on other conditions suggests that discrepancies seem to reflect their different perspectives. Thus, 53 Greek-speaking children diagnosed with DLD attending kindergarten and their mothers completed, respectively, self-report and parent proxy PedsQLTM questionnaires. Mothers reported significantly better HRQoL than their children with developmental language disorder (DLD) in all HRQoL domains (p < 0.001). Poor agreement was revealed after comparing the scores from both responders, both in abstract domains, such as emotional functioning, as well as in more observable ones, such as physical health (ICC ranged from -0.05 to 0.07). Bland-Altman plots also showed poor agreement on HRQoL. Our results expand on the already known, from other conditions, importance of evaluating children's subjective experience of their HRQoL in kindergarten children with DLD. A multi-informant approach is ideal, and clinicians should prioritize children's view about their lives even when they are kindergarten-age. This approach could inform interventions focusing not only on language skills but also on other areas where it is necessary, depending on the child's subjective experience combined with the maternal perspective.