Making cities mental health friendly for adolescents and young adults.

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.

National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020.

Importance: There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective: To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants: Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures: Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results: From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance: Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019.

Importance: Approximately 1 in 6 youth in the US have a mental health condition, and suicide is a leading cause of death among this population. Recent national statistics describing acute care hospitalizations for mental health conditions are lacking. Objectives: To describe national trends in pediatric mental health hospitalizations between 2009 and 2019, to compare utilization among mental health and non-mental health hospitalizations, and to characterize variation in utilization across hospitals. Design, Setting, and Participants: Retrospective analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative database of US acute care hospital discharges. Analysis included 4 767 840 weighted hospitalizations among children 3 to 17 years of age. Exposures: Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified mental health diagnoses into 30 mutually exclusive disorder types. Main Outcomes and Measures: Measures included number and proportion of hospitalizations with a primary mental health diagnosis and with attempted suicide, suicidal ideation, or self-injury; number and proportion of hospital days and interfacility transfers attributable to mental health hospitalizations; mean lengths of stay (days) and transfer rates among mental health and non-mental health hospitalizations; and variation in these measures across hospitals. Results: Of 201 932 pediatric mental health hospitalizations in 2019, 123 342 (61.1% [95% CI, 60.3%-61.9%]) were in females, 100 038 (49.5% [95% CI, 48.3%-50.7%]) were in adolescents aged 15 to 17 years, and 103 456 (51.3% [95% CI, 48.6%-53.9%]) were covered by Medicaid. Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8%, and these hospitalizations accounted for a significantly higher proportion of pediatric hospitalizations (11.5% [95% CI, 10.2%-12.8%] vs 19.8% [95% CI, 17.7%-21.9%]), hospital days (22.2% [95% CI, 19.1%-25.3%] vs 28.7% [95% CI, 24.4%-33.0%]), and interfacility transfers (36.9% [95% CI, 33.2%-40.5%] vs 49.3% [95% CI, 45.9%-52.7%]). The percentage of mental health hospitalizations with attempted suicide, suicidal ideation, or self-injury diagnoses increased significantly from 30.7% (95% CI, 28.6%-32.8%) in 2009 to 64.2% (95% CI, 62.3%-66.2%) in 2019. Length of stay and interfacility transfer rates varied significantly across hospitals. Across all years, mental health hospitalizations had significantly longer mean lengths of stay and higher transfer rates compared with non-mental health hospitalizations. Conclusions and Relevance: Between 2009 and 2019, the number and proportion of pediatric acute care hospitalizations due to mental health diagnoses increased significantly. The majority of mental health hospitalizations in 2019 included a diagnosis of attempted suicide, suicidal ideation, or self-injury, underscoring the increasing importance of this concern.

Crisis y encrucijadas de una psiquiatría en busca de futuro / The crisis and crossroads experienced by a psychiatry in search of the future

Asumiendo la metáfora de la encrucijada, propuesta por Santiago Levín, en la que estaría situada la psiquiatría en la actualidad, el presente artículo pretende reflexionar sobre algunos aspectos de una crisis paradigmática de la medicina mental que ha hecho a algunos temer por su futuro. Se abordan algunas cuestiones epistemológicas de cierto calado, como el régimen de "verdad" en el que supuestamente deben manejarse los expertos, así como los dilemas planteados en los dos elementos clave del encuentro clínico: el diagnóstico y el tratamiento. Finalmente, se insiste en la importancia de lo ético, lo social, y lo político a la hora de replantear saberes y prácticas. (AU)

On the understanding we accept where psychiatry would today be located in the metaphor of the crossroads, as proposed by Santiago Levín, the purpose of this article is to explore certain aspects of a paradigmatic crisis in mental medicine that has raised some concerns as to its future. Certain deep epistemological questions are addressed, such as the schema of "truth", where experts should supposedly manage themselves, and the dilemmas raised from the two key elements of a clinical session: diagnosis and treatment. Finally, the study emphasises the importance of the ethical, social, and political aspects of rethinking knowledge and practices. (AU)

Virtual reality in Metaverse for future mental health-helping profession: an alternative solution to the mental health challenges of the COVID-19 pandemic.

Currently, Metaverse has become a hot topic of conversation everywhere. Therefore, this can also be an accurate solution to the mental health challenges of the COVID-19 pandemic. Hopefully in the future, mental health workers can make the best use of it.

Salud Mental Colectiva y Determinación Social: Posibilidades Paradigmáticas / Collective Mental Healthand Social Determination: Paradigmatic Possibilities

En la presente revisión teórica exploro posibilidades para la construcción de un paradigma de salud mental colectiva. Lo hago tomando distancia de miradas positivistas, funcionalistas, bio-médicas e individualistas, y subrayando el rol fundamental de procesos de determinación social comprendidos de forma crítica, intercultural y transdisciplinaria. El procedimiento supuso una revisión exploratoria de fuentes tituladas “salud mental colectiva” (2016-2021) y la inclusión de publicaciones clave adicionales. Losresultados señalan la importancia de teorizar la salud mental de forma compleja y dialéctica, contextualizar ecológicamente los sufrimientos, accio-nar estrategias de bienestar y procurar reflexividad permanente en torno a la interculturalidad y las relaciones de poder. Las posibilidades exploradas resaltan el aporte esencial de la epide-miología crítica latinoamericana, en diálogo constante con otros valiosos saberes. Desde dicha construcción dialógica, un paradigma de salud mental colectiva emerge como unapotente al-ternativa para abordar sufrimientos mentales en el contexto de sistemas sociales que nos en-ferman. (AU)

In this theoretical review, I explore possibilities for the construction of a collective mental health paradigm. I conduct such review by distancing myself from positivist, functionalist, bi-omedical and individualist perspectives, while emphasizing the fundamental role of social de-termination processes conceived from a critical, intercultural and transdisciplinary stand-point. The procedure involved an exploratory review of sources entitled “collective mental health” (2016-2021) and the inclusion of additional key publications. Results indicate the im-portance of theorizing mental health in ways that are complex and dialectical; conducting an ecological contextualization of suffering; activating wellness strategies; and making perma-nent efforts towards reflexivity around interculturality and power relations. Explored possibil-ities highlight the essential contribution of Latin American critical epidemiology, in constant dialogue with other valuable knowledge. From such dialogic construction, a collective mental health paradigm emerges as a powerful alternative to address mental suffering in the context of social systems that make us ill. (AU)

Reflexões sobre a construção de uma pesquisa qualitativa em psicoterapia on-line / Reflexiones sobre la construcción de una investigación cualitativa en psicoterapia online / Reflections on the construction of a qualitative research in online psychotherapy

RESUMO. Os serviços mediados pela internet oferecem uma diversidade de formas de conexão e interatividade e, em decorrência, surgem novas intervenções em saúde mental, exigindo pesquisas que fundamentem e avaliem tais práticas. Entretanto, os estudos na área são escassos, especialmente diretrizes que auxiliem na condução de pesquisas que envolvam as intervenções baseadas na internet. Nesse sentido, o objetivo deste artigo é indicar orientações para o desenho de pesquisas de intervenção psicológica na internet, tendo como ilustração a construção de uma pesquisa interventiva em psicoterapia on-line, qualitativa, descritiva e longitudinal. São abordados seis aspectos significativos para pesquisas em intervenção digital, incluindo contato com colaboradores, critérios de participação, alcances da pesquisa, monitoramento e avaliação das intervenções, critérios tecnológicos e aspectos éticos no campo digital. São levantados aspectos técnicos, qualitativos e de cuidados necessários para manter a qualidade dos atendimentos e das pesquisas mediadas pelas tecnologias digitais. É urgente à psicologia consolidar um campo de saber que se ocupe tanto das influências das tecnologias nas subjetividades, também, delinear estudos que avaliem com rigor científico o uso da internet para o tratamento e cuidado em saúde mental.

RESUMEN. Los servicios mediados por Internet ofrecen una diversidad de formas de conexión e interactividad y, como resultado, surgen nuevas intervenciones en salud mental, que requieren investigaciones que corroboren y evalúen dichas prácticas. Sin embargo, los estudios en el área son escasos, especialmente las directrices que ayudan a realizar investigaciones que involucran intervenciones basadas en Internet. En este sentido, el objetivo de este artículo es indicar directrices para el diseño de investigación de intervención psicológica en Internet, teniendo como ilustración la construcción de una investigación intervencionista en psicoterapia online, cualitativa, descriptiva y longitudinal. Se abordan seis aspectos significativos para la investigación en intervención digital, incluyendo el contacto con colaboradores, los criterios de participación, el alcance de la investigación, el seguimiento y evaluación de las intervenciones, los criterios tecnológicos y los aspectos éticos en el campo digital. Se plantean aspectos técnicos, cualitativos y asistenciales necesarios para mantener la calidad asistencial y la investigación mediada por las tecnologías digitales. Es urgente que la Psicología consolide un campo de conocimiento que se ocupe tanto de las influencias de las tecnologías en las subjetividades como de esbozar estudios que evalúen con rigor científico el uso de Internet para el tratamiento y cuidado en salud mental.

ABSTRACT Internet-mediated services offer a variety form of connection and interactivity, from this, new mental health interventions emerge, requiring research to validate and evaluate such practices. However, studies in the area are scarce, especially guidelines that assist in conducting research involving Internet-based interventions. The purpose of this study was to indicate guidelines for the design of psychological intervention research mediated by the Internet, based on the construction of an interventional research in online, qualitative, descriptive and longitudinal psychotherapy. Six significant aspects for digital intervention. Six significant aspects for research in digital intervention are addressed, including contact with collaborators, criteria for participation, scope of research, monitoring and evaluation of interventions, technological criteria and ethical aspects in the digital field. Technical, qualitative and care aspects necessary to maintain the quality of care and research mediated by digital technologies are raised. It is urgent for Psychology to consolidate a field of knowledge that deals with the influence of technologies on subjectivities, as well as to design studies that scientifically assess the use of the internet for treatment and care in mental health.

El principio vulnerabilidad: definición y alcance en el ámbito de la investigación con personas / O princípio da vulnerabilidade: definição e alcance no campo da pesquisa com pessoas / The principle of vulnerability: definition and scope in the field of research with people

The principle of vulnerability has an ontological and a circumstantial approach, althoughit is not exempt from criticism. Despite this, historically this principle has been recognized in thedifferent legal and ethical standards that guide research with people. In mental health, due to itspeculiarities, it acquires a fundamental role. Methodology: we use a theoretical reflection on thesubject, using the relevant and updated bibliography extracted from the Pubmed search engine. Thefollowing keywords are used in English: vulnerability, ethics, research, nursing, mental health, using the boolean operator “AND” to detect the underlying ethical problems. On the other hand, weuse the terms vulnerability, mental capacity, confidentiality, and research, together with “AND”,for its conceptual analysis. Results: We provide an anthropological and ethical theoretical framework so that the Nursing team can more rigorously understand and justify the issue of vulnerabilitywhen researching people with mental health problems. This allows care that is more appropriate tohuman nature and external conditioning factors. Conclusions: The principle of vulnerability is keyin the field of research with people. A respect for the vulnerability when these people are includedin the experiments, necessarily goes through making "tailor-made suits" that guarantee adequateprotection, which must always be made compatible with free participation and with respect for the privacy and confidentiality of the people. participant people. (AU)

El principio de vulnerabilidad tiene un enfoque ontológico y otro circunstancial, aunqueno está exento de críticas. Pese a ello, históricamente se ha ido reconociendo este principio en lasdistintas normas legales y deontológicas que orientan las investigaciones con personas. En salud mental, por la sus peculiariadades, adquiere un papel fundamental. Metodología: Reflexión teóricasobre la temática, utilizando la bibliografía relevante y actualizada extraída del buscador Pubmed.Se utilizan las siguientes palabras clave en inglés: Vulnerability, ethics, research, nursing, mentalhealth, utilizando el opreador boleano “AND” para detectar cuáles son los problemas éticos subyacentes. Por otro lado, usamos los términos vulnerability, mental capacity, confidentiality, y research,junto con “AND”, para su análisis conceptual. Resultados: Aportamos un marco teórico antropológico y ético para que el equipo de Enfermería sepa comprender y justificar con más rigor la temáticade la vulnerabilidad cuando se investiga con personas con problemas de salud mental. Esto permitecuidados más apropiados a la naturaleza humana y a los condicionantes externos. Conclusiones: Elprincipio de vulnerabilidad es clave en el ámbito de la investigación con personas. Un respeto porla vulnerabilidad cuando estas personas son incluidas en los experimentos, pasa necesariamentepor hacer “trajes a medida” que garanticen una adecuada protección, que ha de hacerse siemprecompatible con una libre participación y con el respeto a la intimidad y confidencialidad de laspersonas participante. (AU)

O princípio da vulnerabilidade tem uma abordagem ontológica e circunstancial, emboranão seja isento de críticas. Apesar disso, historicamente esse princípio tem sido reconhecido nasdiferentes normas legais e éticas que orientam a pesquisa com pessoas. Na saúde mental, pelas suaspeculiaridades, adquire um papel fundamental. Método: Reflexão teórica sobre o tema, utilizandoa bibliografia relevante e atualizada extraída do motor de busca Pubmed. As seguintes palavraschave são usadas em inglês: vulnerabilidade, ética, pesquisa, enfermagem, saúde mental, usando ooperador booleano “AND” para detectar os problemas éticos subjacentes. Por outro lado, utilizamosos termos vulnerabilidade, capacidade mental, confidencialidade e pesquisa, juntamente com“AND”, para sua análise conceitual. Resultados: Fornecemos um referencial teórico antropológicoe ético para que a equipe de Enfermagem possa compreender e justificar com mais rigor a questãoda vulnerabilidade ao pesquisar pessoas com problemas de saúde mental. Isso permite um cuidadomais adequado à natureza humana e aos fatores condicionantes externos. Conclusões: O princípioda vulnerabilidade é fundamental no campo da pesquisa com pessoas. O respeito à vulnerabilidadequando essas pessoas são incluídas nos experimentos passa necessariamente pela confecção de "trajes sob medida" que garantam a proteção adequada, que deve ser sempre compatibilizada com alivre participação e com o respeito à privacidade e confidencialidade das pessoas. pessoas participantes. (AU)

Assessing the Effect of the COVID-19 Outbreak on Didactic Education and Mental Health of Physician Assistant Students in the New York City Region.

INTRODUCTION: COVID-19 has profoundly affected life throughout the world, and it greatly impacted physician assistant (PA) education programs when the virus spread across the New York region 2 years ago. PA programs at Stony Brook University, Hofstra University, and the New York Institute of Technology were located in the epicenter of the pandemic and were forced to transition to online learning during the spring of 2020. The purpose of this study was to explore didactic PA students' perceptions of virtual learning, their mental health status, and the challenges and unexpected benefits they have faced during this historic time. METHODS: A consent form that linked to an 11-question electronic Qualtrics survey was emailed to all didactic students enrolled in the 3 participating PA programs. The survey data were used to conduct a descriptive analysis and a Spearman's ρ correlation analysis using SPSS 24 software. RESULTS: The survey response rate was 39% (89/229). The students perceived it to be more challenging to maintain the same level of academic achievement with virtual learning, although they felt they were able to meet learning objectives and be prepared for clinical clerkships. They reported experiencing greater stress, anxiety, and depression related to decreased socialization and isolation. However, the students said that their PA program provided enough support to assist with student needs, and they noted unexpected benefits of remote learning, including more time to spend with family members, increased schedule flexibility, and lower commuting costs. DISCUSSION: The PA students' education and mental health were negatively affected because of the abrupt transition from in-person to virtual learning. At the height of the COVID-19 pandemic, most of the students in the 3 participating PA programs in New York were affected by the change to remote learning and the subsequent lack of socialization. PA students experienced both challenges and benefits during this unscheduled virtual learning period. While students noted increases in mental health issues, they felt supported by faculty members and prepared to start clinical rotations.

Validación y adaptación española de la Escala de Actitudes Estigmatizadoras hacia la Salud Mental entre Iguales (Peer Mental Health Stigmatization Scale, PMHSS-24) / Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24)

Introducción: En la actualidad, existe un creciente interés por las intervenciones con adolescentes encaminadas a la reducción del estigma hacia las personas con problemas de salud mental. Desafortunadamente, el número de escalas disponibles en castellano para evaluar el estigma en estas edades es reducido. El presente trabajo tiene por objetivo adaptar y validar en población española la Escala de Actitudes Estigmatizadoras hacia la Salud Mental entre Iguales (PMHSS-24). Material y métodos: Participaron 443 adolescentes (46,6% mujeres y 53,7% hombres) de entre 13 y 17 años (Medad=14,64; DE=0,83) alumnos de 3.° y 4.° de Educación Secundaria Obligatoria. Se calculó la consistencia interna de la prueba, se realizó un análisis factorial exploratorio (AFE) con la mitad de la muestra y otro confirmatorio (AFC) con la otra mitad, y se halló la invarianza de medición de la escala a través del sexo. Resultados: El AFE arrojó una estructura de 2factores para la escala negativa (53% de la varianza explicada) y otros 2para la positiva (62% de la varianza explicada). El AFC corroboró la estructura factorial con adecuados indicadores de bondad de ajuste (CFI>0,95; NNFI>0,95; SRMR <0,08; RMSEA <0,08). Las cargas factoriales oscilaron entre 0,49 y 0,89, con una correlación entre factores r=0,53 y 0,45. Ambas subescalas exhibieron valores de αóptimos (negativa 0,94 y positiva 0,81). La escala fue invariante entre sexos. Conclusiones: El PMHSS-24 puede ser un instrumento útil para el cribado inicial de los estereotipos que exhiben los adolescentes hacia las personas con dificultades emocionales. (AU)

Introduction: There is currently a growing interest in interventions aimed at the reduction of stigma towards people with emotional difficulties in adolescents. Unfortunately, the number of scales available in Spanish to assess stigma at these ages is limited. This paper aims to adapt and validate the scale of stigmatizing attitudes towards mental health among peers (Peer Mental Health Stigmatization Scale PMHSS-24). Material and methods: A total of 443 adolescents (46.6% female and 53.7% male) between 13 and 17 years of age participated (Mage=14.64; SD=.83) in the 3rd and 4th grades of Obligatory Secondary Education. The internal consistency of the test was calculated, an exploratory factorial analysis (EFA) was performed with half of the sample and a confirmatory one (CFA) with the other half, and the invariance of measurement of the scale through sex was found. Results: The EFA showed a two-factor structure for the negative scale (53% of the variance explained) and another 2for the positive scale (62% of the variance explained). The CFA corroborated the factor structure with appropriate goodness-of-fit indicators (CFI>.95; NNFI>.95, SRMR<.08, RMSEA<.08). Factor loads ranged from .49 to .89, with α factor correlation between r=.53 and .45. Both subscales exhibited optimal alpha values (negative .94 and positive .81). The scale was invariant between the sexes. Conclusions: The data suggest that PMHSS-24 may be a useful scale for the initial screening of the stereotypes exhibited by adolescents toward people with mental illness. (AU)