Factors that influence mental health and well-being of high-performance athletes from Olympic or Paralympic sport who have transitioned out of national-level or international-level sport: a mixed methods approach.

Transitioning out of elite sports can be a challenging time for athletes. To illuminate the gaps and opportunities in existing support systems and better understand which initiatives may have the greatest benefit in supporting athletes to transition out of elite sport, this study examined the lived experience of retired elite Australian athletes. Using a sequential mixed-methods approach, quantitative data were collected via a self-report online survey, while qualitative data were collected via semistructured interviews. In total 102 retired high-performance athletes (M=27.35, SD=7.25 years) who competed in an Olympic or Paralympic recognised sport at the national and/or international-level participated in the online survey, providing data across domains of well-being and athletic retirement. Eleven survey respondents opted in for the semistructured interview (M=28.9, SD=6.9 years) providing in-depth responses on their retirement experiences. Using partial least squares structural equation modelling (PLS-SEM), latent variables were identified from the survey data and associations between retirement support, retirement difficulties, retirement experiences, well-being and mental health were determined. Interview data were thematically analysed. The structural model had good predictive validity for all nine latent variables, describing positive and negative associations of retirement experiences, mental health and well-being. Building an identity outside of sport, planning for retirement, and having adaptive coping strategies positively impacted retirement experiences. Feeling behind in a life stage and an abrupt loss of athletic identity had a negative impact on retirement experiences. Implications for sports policymakers are discussed, including support strategies that could better assist athletes in successfully transitioning from elite sports.

Resistance training and combined resistance and aerobic training as a treatment of depression and anxiety symptoms in young people: A systematic review and meta-analysis.

AIM: To determine the treatment effect of resistance training in reducing symptoms of anxiety and depression in young people. METHODS: We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to September 2023 for randomized controlled trials (RCT) that included at least 4 weeks of resistance training, with participants aged 26 years or younger with clinically elevated anxiety and depression symptoms. A random-effects meta-analysis was used to calculate a pooled effect size of resistance training pre-and post-intervention compared to control groups. The quality of evidence was assessed using the Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: Ten RCTs involving 376 participants (209 females and 127 males) across educational, clinical, and community based setting were eligible for inclusion in the analysis. Resistance training was associated with a significant reduction in depressive (Hedge's g = -1.06, 95% CI -1.61 to -0.51, p < .001) and anxiety (Hedge's g = -1.02, 95% CI -1.50 to -0.54, p < .001) symptoms. Substantial heterogeneity was observed in the analysis of depression symptoms (I2 = 79%) and anxiety symptoms (I2 = 66%). Six trials had a low risk of bias, four trials showed some concerns. The GRADE analysis demonstrated a high level of certainty for depressive symptoms and a moderate level for anxiety symptoms. CONCLUSION: Resistance training is an effective intervention in reducing depression and anxiety symptoms in young people, delivered across a range of settings. Future trials exploring the effect resistance training interventions with long-term follow up are warranted to understand the outcomes.

A Prototype Software Framework for Transferable Computational Health Economic Models and Its Early Application in Youth Mental Health.

We are developing an economic model to explore multiple topics in Australian youth mental health policy. To help make that model more readily transferable to other jurisdictions, we developed a software framework for authoring modular computational health economic models (CHEMs) (the software files that implement health economic models). We specified framework user requirements for: a simple programming syntax; a template CHEM module; tools for authoring new CHEM modules; search tools for finding existing CHEM modules; tools for supplying CHEM modules with data; reproducible analysis and reporting tools; and tools to help maintain a CHEM project website. We implemented the framework as six development version code libraries in the programming language R that integrate with online services for software development and research data archiving. We used the framework to author five development version R libraries of CHEM modules focussed on utility mapping in youth mental health. These modules provide tools for variable validation, dataset description, multi-attribute instrument scoring, construction of mapping models, reporting of mapping studies and making out of sample predictions. We assessed these CHEM module libraries as mostly meeting transparency, reusability and updatability criteria that we have previously developed, but requiring more detailed documentation and unit testing of individual modules. Our software framework has potential value as a prototype for future tools to support the development of transferable CHEMs.Code: Visit https://www.ready4-dev.com for more information about how to find, install and apply the prototype software framework.

Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report.

BACKGROUND: Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting. METHODS: Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy. RESULTS: Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%). CONCLUSIONS: Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.

The Addition of Fish Oil to Cognitive Behavioral Case Management for Youth Depression: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial.

BACKGROUND: Clinical trials suggest that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) may reduce depressive symptoms in adults with major depressive disorder. Therefore, n-3 PUFAs may be a potential treatment for depression in youth. METHODS: Participants were 15- to-25 year-old individuals with major depressive disorder who sought care in one of three government-funded mental health services for young people in metropolitan Melbourne, Perth, or Sydney, Australia. Participants were randomly assigned in a double-blind, parallel-arm design to receive either fish oil (840 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid) or placebo capsules as adjunct to cognitive behavioral case management. All participants were offered 50-minute cognitive behavioral case management sessions every 2 weeks delivered by qualified therapists (treatment as usual) at the study sites during the intervention period. The primary outcome was change in the interviewer-rated Quick Inventory of Depressive Symptomatology, Adolescent Version, score at 12 weeks. Erythrocyte n-3 PUFA levels were assessed pre-post intervention. RESULTS: A total of 233 young people were randomized to the treatment arms: 115 participants to the n-3 PUFA group and 118 to the placebo group. Mean change from baseline in the Quick Inventory of Depressive Symptomatology score was -5.8 in the n-3 PUFA group and -5.6 in the placebo group (mean difference, 0.2; 95% CI, -1.1 to 1.5; p = .75). Erythrocyte PUFA levels were not associated with depression severity at any time point. The incidence and severity of adverse events were similar in the two groups. CONCLUSIONS: This placebo-controlled trial and biomarker analysis found no evidence to support the use of fish oil for treatment in young people with major depressive disorder.

Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study.

BACKGROUND: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. OBJECTIVE: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. METHODS: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. RESULTS: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. CONCLUSIONS: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis.

AIM: This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. METHODS: Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). RESULTS: Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. CONCLUSION: The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.

Longitudinal affective response to high-intensity interval training and moderate-intensity continuous training in overweight women with polycystic ovary syndrome: A randomised trial.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) experience general and PCOS-specific barriers that limit their engagement with exercise and contribute to high attrition from exercise programs, hindering the potential benefits of exercise to address their increased cardio-metabolic risk. A positive remembered affective response can predict future intentions and adherence to exercise prescription. OBJECTIVES: To compare the longitudinal changes in remembered affect to high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in women with PCOS and to determine whether longitudinal changes in remembered affect are correlated with changes in fitness, body mass index, adherence and exercise enjoyment. METHODS: Physically inactive, overweight women with PCOS were randomly assigned to 12 weeks of either HIIT (n = 15) or MICT (n = 14) (3 sessions per week). Remembered affective valence (Feeling Scale) was collected after each exercise session. Cardiorespiratory fitness (VO2peak) was assessed at baseline and post-intervention. Exercise enjoyment was assessed post-intervention. RESULTS: The longitudinal changes in the remembered affect were more positive in the HIIT group compared to MICT (ß = 0.017, p = 0.047). HIIT was also considered more enjoyable than MICT (p = 0.002). Adherence was high in both groups (>90%). We found a moderate correlation with longitudinal changes between the remembered affect and change in fitness (rs = 0.398) and exercise enjoyment (rs = 0.376) using the combined group, however, these were not statistically significant (p = 0.054 and p = 0.064, respectively). CONCLUSIONS: HIIT demonstrated a more positive longitudinal remembered affective response and greater exercise enjoyment compared to MICT in overweight women with PCOS.

Prevalence of diagnosable depression in patients awaiting orthopaedic specialist consultation: a cross-sectional analysis.

BACKGROUND: Musculoskeletal conditions, including osteoarthritis (OA), are a leading cause of disability and chronic pain, and are associated with high rates of comorbid depression. However, signs of depression are often masked by pain. The aim of this study was to determine the prevalence and severity of depression and pain in individuals awaiting specialist orthopaedic consultation. A secondary objective was to determine the relationship between pain and depression, irrespective of demographic factors and clinical diagnosis. METHODS: Cross-sectional analysis of individuals awaiting orthopaedic consultation at a public hospital in Melbourne, Australia. Relevant data were extracted from medical records and questionnaires. Descriptive statistics were used to summarise participant characteristics. The patient health questionnaire (PHQ-9) was used to assess depression and a numerical rating scale (NRS) was used to assess pain severity. Multiple linear regression analyses were used to establish the relationship between pain and depression. RESULTS: Nine hundred and eighty-six adults (mean ± standard deviation, age = 54.1 ± 15.7 years, 53.2% women) participated in the study. OA was present in 56% of the population and 34% of the entire population had moderate depression or greater, 19% of which met the criteria for major depressive disorder. Moderate-to-severe pain was present in 79% of individuals with OA and 55% of individuals with other musculoskeletal complaints. Pain was significantly associated with depression scores (ß = 0.84, adjusted R2 = 0.13, P < 0.001), and this relationship remained significant after accounting for gender, age, education and employment status, OA status, number of joints affected and waiting time (ß = 0.91, adjusted R2 = 0.19, P < 0.001). CONCLUSIONS: Depression affects one-third of individuals on an orthopaedic waitlist. A strong link between pain and depression in patients awaiting specialist orthopaedic consultation exists, indicating a need for an integrated approach in addressing pain management and depression to manage this complex and comorbid presentation.

Elevated nest temperature has opposing effects on host species infested with parasitic nest flies.

Environmental factors, such as elevated temperature, can have varying effects on hosts and their parasites, which can have consequences for the net outcome of this relationship. The individual direct effects of temperature must be disentangled to determine the net-effect in host-parasite relationships, yet few studies have determined the net-effects in a multi-host system. To address this gap, we experimentally manipulated temperature and parasite presence in the nests of two host species infested by parasitic blowflies (Protocalliphora sialia). We conducted a factorial experiment by increasing temperature (or not) and removing all parasites (or not) in the nests of eastern bluebirds (Sialia sialis) and tree swallows (Tachycineta bicolor). We then measured nestling morphometrics, blood loss, and survival and quantified parasite abundance. We predicted that if temperature had a direct effect on parasite abundance, then elevated temperature would cause similar directional effects on parasite abundance across host species. If temperature had a direct effect on hosts, and therefore an indirect effect on the parasite, parasite abundance would differ across host species. Swallow nests with elevated temperature had fewer parasites compared to nests without temperature manipulation. In contrast, bluebird nests with elevated temperatures had more parasites compared to nests without temperature manipulation. The results of our study demonstrate that elevated temperature can have differential effects on host species, which can impact infestation susceptibility. Furthermore, changing climates could have complex net-effects on parasite fitness and host health across multi-host-parasite interactions.

Understanding the complexity, patterns, and correlates of alcohol and other substance use among young people seeking help for mental ill-health.

PURPOSE: Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. METHODS: Young people (12-25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. RESULTS: 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. CONCLUSIONS: Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.

Efficacy of high-intensity interval training for improving mental health and health-related quality of life in women with polycystic ovary syndrome.

Women with PCOS have substantially greater symptoms of depression and anxiety, and a lower health-related quality of life (HRQoL) compared to women without PCOS. The aim of this study was to determine if high-intensity interval training (HIIT) could provide greater improvements in mental health outcomes than standard moderate-intensity continuous training (MICT). Twenty-nine overweight women with PCOS aged 18-45 years were randomly assigned to 12 weeks of either MICT (60-75% HRpeak, N = 15) or HIIT (> 90% HRpeak, N = 14). Outcome measures included symptoms of depression, anxiety and stress (DASS-21), general HRQoL (SF-36) and PCOS specific HRQoL (PCOSQ) collected at baseline and post-intervention. Reductions in depression (Δ - 1.7, P = 0.005), anxiety (Δ - 3.4, P < 0.001) and stress (Δ - 2.4, P = 0.003) scores were observed in the HIIT group, while MICT only resulted in a reduction in stress scores (Δ - 2.9, P = 0.001). Reductions in anxiety scores were significantly higher in the HIIT group compared to the MICT group (ß = - 2.24, P = 0.020). Both HIIT and MICT significantly improved multiple domain scores from the SF-36 and PCOSQ. This study highlights the potential of HIIT for improving mental health and HRQoL in overweight women with PCOS. HIIT may be a viable strategy to reduce symptoms of depression and anxiety in women with PCOS, however, large-scale studies are required to confirm these findings.Trial registration number: ACTRN12615000242527.

Prevalence and Correlates of Tobacco Use in Young People Presenting to Australian Primary Mental Health Services.

INTRODUCTION: In Australian youth primary mental health settings it is unclear as to the rates and correlates of tobacco use at service entry. AIMS AND METHODS: We aimed to delineate the prevalence and correlates of recent tobacco use (eg, cigarettes, chewing tobacco, cigars, etc) in the past 3 months in young people at their first presentation to primary mental health services as a function of age. Cross-sectional self-report measures were collected using a tablet device from young people presenting to one of five Australian primary mental health (headspace) services. Logistic regression assessed correlates of past 3-month tobacco use in adolescents (12-17 years) and young adults (18-25 years). RESULTS: Regular (at least monthly) tobacco use in the past 3 months was found in 23.4% (n = 247, N = 1055) of the sample. Increasing age (odds ratio [OR] =1.47 per year; 95% confidence interval [CI]: 1.15 to 1.89), male sex (OR = 1.98; 95% CI: 1.02 to 3.83), being in a relationship (OR = 1.96; 95% CI: 1.01 to 3.82), and poorer functioning (OR = 0.95 per unit Social and Occupational Functioning Assessment Scale increase; 95% CI: 0.91 to 0.99) predicted regular tobacco use in adolescents, but not in young adults. Living in a regional location (OR = 2.10; 95% CI: 1.40 to 3.13) and not studying (OR = 0.47; 95% CI: 0.31 to 0.73) predicted tobacco use in young adults. Having a diagnosed mental illness other than depression and/or anxiety predicted tobacco use in both groups (adolescents OR = 2.49; 95% CI: 1.26 to 4.94; young adults OR = 1.80; 95% CI: 1.13 to 2.89). CONCLUSIONS: Nearly a quarter of young people with mental illness are using tobacco, supporting the need for early intervention approaches. Adapting treatment targets by age could improve the impact of interventions in adolescents versus young adults. Poor functioning and lack of engagement in education were associated with tobacco use in both age groups, respectively; however, more research is needed to determine the direction of these relationships. IMPLICATIONS: Young people with mental illness have a high prevalence of recent tobacco use and this is evident when they first present to youth primary mental health services. Youth-oriented mental health settings may provide a unique window for tobacco use prevention and early intervention to reduce smoking in people with mental illness, a priority population. Age-specific targeted approaches might be needed in adolescents and young adults.

Psychological, Physical, and Sexual Violence Against Children in Australian Community Sport: Frequency, Perpetrator, and Victim Characteristics.

Childhood sport participation is associated with physical, social, and mental health benefits, which are more likely to be realized if the sport environment is safe. However, our understanding of children's experience of psychological, physical, and sexual violence in community sport in Australia is limited. The aims of this study were to provide preliminary evidence on the extent of experiences of violence during childhood participation in Australian community sport and to identify common perpetrators of and risk factors for violence. The Violence Towards Athletes Questionnaire (VTAQ) was administered online to a convenience sample of Australian adults (>18 years), retrospectively reporting experiences of violence during childhood community sport. Frequencies of experience of violence were calculated and Chi-square tests were conducted to determine differences between genders. In total, there were 886 respondents included in the analysis. Most survey respondents were women (63%) and about a third were men (35%). About 82% of respondents experienced violence in sport as a child. Psychological violence was most prevalent (76%), followed by physical (66%) and sexual (38%) violence. Peers perpetrated the highest rates of psychological violence (69%), and the rates of physical and psychological violence by coaches (both >50%) were also high. Age, sexual orientation, disability, and hours of weekly sport participation as a child were all associated with childhood experience of violence in sport. The rates of interpersonal violence against children in sport were high. This novel data on perpetrators of the violence and the risk factors for experiencing violence provides further context to inform safeguarding strategies in sport. A national prevalence study is recommended to advance our understanding of the childhood experiences of violence in Australian sport.

Gender-specific psychosocial stressors influencing mental health among women elite and semielite athletes: a narrative review.

Elite and semielite athletes commonly experience mental health concerns and disorders. Compared with men athletes, women athletes are at greater risk of a range of psychological stressors that contribute to health concerns and mental health disorders, which can impact their career satisfaction and longevity. In order to address and improve the mental health of women athletes, it is necessary to simultaneously tackle the gender specific psychosocial stressors that contribute to mental health outcomes. This narrative review examines the gender-specific stressors that affect mental health and well-being in women athletes, some of which are modifiable. Psychosocial stressors identified include exposure to violence, be it psychological, physical or sexual in nature, which can result in a myriad of acute and long-lasting symptoms; and inequities as reflected in pay disparities, under-representation in the media, fewer opportunities in leadership positions and implications associated with family planning and motherhood. Strategies to promote mental health in women athletes should be considered, and where possible, should proactively address gender-specific stressors likely to influence mental health in order to maximise positive outcomes in women athletes.

The engagement of tertiary students with an online mental health intervention during the coronavirus disease 2019 pandemic: A feasibility study.

Background: We discuss the feasibility of a brief, online mental health promotion programme for tertiary students and establish recommendations for future programmes. Methods: The programme 'Student Elevenses' was delivered at a tertiary education institution. 'Student Elevenses' aimed to promote student wellbeing during the coronavirus disease 2019 crisis, comprised of 10-15-min daily online micro-interventions targeting six lifestyle areas for wellbeing, and was delivered via video conference. Upon programme completion, all students were invited to complete barriers to engagement survey, irrespective of whether they had attended or heard of the programme. Descriptive statistics were calculated for demographics, as well as feasibility and acceptability outcomes including recruitment rates, attendance rates and reported barriers to attendance. Open-ended questions were coded for themes. Results: Less than 1% of those who consented to participate actually attended the programme, with attendance ranging from 2 to 17 participants. Participants were predominantly female (68%), domestic students (81%) and had a mean age of 29.5 years. The barriers students reported included fixed time, online format, a belief programme would not be helpful, preference for existing supports and perceived impacts of coronavirus disease 2019. Students recommended embedding support within policies/teaching, offering a range of supports and involving students in design. Conclusion: Barriers to mental health promotion via telehealth should be considered to promote accessibility and acceptability for tertiary students. Future programmes should consider reaching students through mandatory activities (e.g. lectures, tutorials) and should include student consultation and co-design to support the development of programmes that meet student needs and preferences.

Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial.

Background: Treatment resistance is a significant problem among young people experiencing moderate-to-severe anxiety, affecting nearly half of all patients. This study investigated the safety and efficacy of cannabidiol (CBD), a non-intoxicating component of Cannabis sativa, for anxiety disorders in young people who previously failed to respond to standard treatment.Methods: In this open-label trial, 31 young people aged 12-25 years with a DSM-5 anxiety disorder and no clinical improvement despite treatment with cognitive-behavioral therapy and/or antidepressant medication were enrolled between May 16, 2018, and June 28, 2019. All participants received add-on CBD for 12 weeks on a fixed-flexible schedule titrated up to 800 mg/d. The primary outcome was improvement in anxiety severity, measured with the Overall Anxiety Severity and Impairment Scale (OASIS), at week 12. Secondary outcomes included comorbid depressive symptoms, Clinical Global Impressions scale (CGI) score, and social and occupational functioning.Results: Mean (SD) OASIS scores decreased from 10.8 (3.8) at baseline to 6.3 (4.5) at week 12, corresponding to a -42.6% reduction (P < .0001). Depressive symptoms (P < .0001), CGI-Severity scale scores (P = .0008), and functioning (P = .04) improved significantly. Adverse events were reported in 25 (80.6%) of 31 participants and included fatigue, low mood, and hot flushes or cold chills. There were no serious and/or unexpected adverse events.Conclusions: These findings suggest that CBD can reduce anxiety severity and has an adequate safety profile in young people with treatment-resistant anxiety disorders. Randomized controlled trials are needed to confirm the efficacy and longer-term safety of this compound.Trial Registration: New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12617000825358.

Heterogeneity of quality of life in young people attending primary mental health services.

AIMS: The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. METHODS: Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life-6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. RESULTS: 1107 young people (12-25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. CONCLUSIONS: Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.

Lifestyle behaviours and mental health and wellbeing of tertiary students during COVID-19 lockdown in Australia: A cross-sectional study.

BACKGROUND: Australia experienced significant COVID-19 lockdown restrictions throughout 2020 that had an impact on mental health and disrupted health-promoting lifestyle behaviours. Lockdowns may have exacerbated existing mental health concerns among tertiary students, who experience higher levels of mental health concerns compared to the wider community. This study aimed to investigate the association between modifiable lifestyle factors and wellbeing of students at a Melbourne-based tertiary education institution during COVID-19 lockdown. METHODS: This quantitative, cross-sectional study was conducted across campuses in Melbourne and Sydney. Data was collected via online questionnaire during the 7th week of a second-wave lockdown. Descriptive statistics were calculated for demographic variables (n = 239). Linear regression models were estimated to determine multivariate associations between lifestyle variables and psychological distress. RESULTS: Participants were on average 30.98 years old (SD = 9.78), predominantly female, domestic students, undergraduate, not the first member of their family to attend university and living out of family home. Mindfulness, diet quality, sleep quality and moderate-vigorous physical activity (MVPA) were all inversely correlated with psychological distress. Unadjusted and adjusted models show that mindfulness, sleep quality, and MVPA were all independently inversely related to psychological distress. Greater mindfulness, sleep quality and engagement in MVPA were associated with lower psychological distress during COVID-19 lockdowns. LIMITATIONS: As this study is cross-sectional and we cannot rule out reverse causality. CONCLUSION: This study highlights the potential for lifestyle focused mental-health promotion delivered through tertiary education institutions to support students in times of crisis as well as more generally.