Effects of the incredible years parenting program on children's interpersonal conflict: An integrative data analysis.

Behavioral parenting programs, such as Incredible Years (IY), reduce conduct problems in children. However, conduct problems encompass many different behaviors, and little is known about the effects of parenting programs on specific aspects of children's conduct problems, such as children's relationships with others. The aim of this study was to examine, for the first time, the effects of the IY parenting program on children's levels of conflict with their parents, siblings, and peers. We used individual participant-level data pooled across 12 randomized trials in Europe, comprising a total of 1,409 families: child aged 1-11 years (M = 5.53 years, SD = 1.56) and 61% male, 60% low-income families, and 30% from an ethnic minority. Multilevel models were used to explore the effects of IY on children's conflict with parents, siblings, and peers. The IY program reduced children's conflict with their parents (ß = -.21), but there were no main effects of the program on conflict with siblings or peers. Moderation analyses showed that IY reduced conflict in sibling relationships for the 22% of families with the most severe sibling conflict at baseline. This suggests that high-quality behavioral parenting programs, such as IY, can effectively reduce children's conflict within the home (i.e., with parents and siblings), especially when initial levels of sibling conflict are high, but do not have broader benefits on children's interpersonal conflict outside of the home (i.e., with peers). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Concurrent and longitudinal associations of developmental language disorder with peer victimization in adolescence: evidence from a co-twin study.

BACKGROUND: Children with developmental language disorder (DLD) experience higher levels of peer victimization than their peers. However, it is not known if such associations reflect genetic and environmental confounding. We used a co-twin control design to investigate the association of language difficulties (DLD and separately poor pragmatic language) with peer victimization and compare the developmental trajectories of peer victimization across adolescence for those with and without language difficulties. METHODS: Participants were 3,400 pairs of twins in the Twins Early Development Study (TEDS), a UK-based population birth cohort. Language abilities were assessed via online tests at age 11 and peer victimization was self-reported at ages 11, 14 and 16. Language difficulties were defined as language abilities at least -1.25 SD below the mean of the TEDS sample. We performed linear regressions and latent growth curve modeling at a population level and within monozygotic and same-sex dizygotic twin pairs. RESULTS: At population level, youth with DLD experienced higher levels of peer victimization at ages 11 (ß = 0.27, 95% Confidence Interval (CI) 0.20-0.35), 14 (ß = 0.15, 95% CI 0.03-0.27) and 16 (ß = 0.17, 95% CI 0.03-0.32) and a sharper decline in peer victimization between ages 11 and 16 compared to their peers without DLD. The associations between DLD and peer victimization were reduced in strength and not statistically significant in within-twin models. Moreover, there was no difference in the rate of change in peer victimization between twin pairs discordant for DLD. Results were similar for the association of poor pragmatic language with peer victimization. CONCLUSIONS: Associations between language difficulties (DLD and separately, poor pragmatic language) and peer victimization were confounded by genetic and shared environmental factors. Identifying specific factors underlying these associations is important for guiding future work to reduce peer victimization among adolescents with language difficulties.

Maternal experienced bereavement and offspring mental health in early adulthood: the role of modifiable parental factors.

BACKGROUND: It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. METHODS: We analysed data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety-related disorders were self-reported at 18 years old using the Clinical Interview Schedule-Revised (CIS-R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. RESULTS: Maternal experienced bereavement was not associated with depression or anxiety-related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. CONCLUSIONS: Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed.

Same sex-attraction as a predictor of suicide and self-harm behaviours: The role of bullying and social support.

Sexual minority youth are at higher risk of self-harming than heterosexual adolescents. Understanding why sexual minority youth are more vulnerable to poor mental health and identifying factors that might buffer against this risk is important for developing targeted interventions. We used the Millennium Cohort Study to investigate whether same-sex attraction at age 14 is associated with suicide attempts and self-harm at age 17. Additionally, we tested whether bullying victimisation might mediate any observed associations, and whether social support might protect against any increased risk. Sexual minority youth were 2.44 times more likely to attempt suicide and 2.59 times more likely to self-harm aged 17. There was no evidence for an association between greater social support and lower levels of self-harm. However, greater social support in sexual minority youth is associated with reduced risk for suicide attempt. Bullying partially mediated the relationship between same-sex attraction and mental health. Greater levels in bullying in sexual minority youth were associated with 1.32 times higher risk for suicide and 1.30 times higher risk for self-harm. Social support was not associated with reduced risk of suicide attempt or self-harm among bullied sexual minority youth. Sexual minority youth in the UK are at higher risk for suicide attempt and self-harm. To address this disparity, health and educational practitioners should understand this heightened risk for poor mental health, and address bullying as one risk factor. Further interventions are needed to assist sexual minority youth beyond social support provision through friends and family.

Heterogeneity in children's reading comprehension difficulties: A latent class approach.

Background: Poor comprehenders are traditionally identified as having below-average reading comprehension, average-range word reading, and a discrepancy between the two. While oral language tends to be low in poor comprehenders, reading is a complex trait and heterogeneity may go undetected by group-level comparisons. Methods: We took a preregistered data-driven approach to identify poor comprehenders and examine whether multiple distinct cognitive profiles underlie their difficulties. Latent mixture modelling identified reading profiles in 6846 children from the Avon Longitudinal Study of Parents and Children, based on reading and listening comprehension assessments at 8-9 years. A second mixture model examined variation in the cognitive profiles of weak comprehenders, using measures of reading, language, working memory, nonverbal ability, and inattention. Results: A poor comprehender profile was not identified by the preregistered model. However, by additionally controlling for overall ability, a 6-class model emerged that incorporated a profile with relatively weak comprehension (N = 947, 13.83%). Most of these children had weak reading comprehension in the context of good passage reading, accompanied by weaknesses in vocabulary and nonverbal ability. A small subgroup showed more severe comprehension difficulties in the context of additional cognitive impairments. Conclusions: Isolated impairments in specific components of reading are rare, yet a data-driven approach can be used to identify children with relatively weak comprehension. Vocabulary and nonverbal ability were most consistently weak within this group, with broader cognitive difficulties also apparent for a subset of children. These findings suggest that poor comprehension is best characterised along a continuum, and considered in light of multiple risks that influence severity.

Associations between School-Level Disadvantage, Bullying Involvement and Children's Mental Health.

Bullying is a modifiable risk factor for poor mental health across childhood and adolescence. It is also socially patterned, with increased prevalence rates in more disadvantaged settings. The current study aimed to better understand whether school-level disadvantage is associated with different types of bullying roles, and whether it is a moderator in the association between bullying and children's mental health. Cross-sectional data were used from 4727 children aged 6-11 years, from 57 primary schools across England and Wales. The child data included previous bullying involvement and bullying role characteristics (bully, victim, bully-victim, reinforcer, defender, outsider), and the teacher-reported data included each child's mental health (emotional symptoms and externalizing) problems. School-level disadvantage was calculated from the proportion of children in the school eligible to receive free school meals (an indicator of disadvantage). Children in more disadvantaged schools were more likely to report being bully perpetrators, bully-victims, and engage less in defending behaviors during a bullying incident. Children from more disadvantaged schools who reported bullying others showed fewer emotional symptoms than those from less disadvantaged schools. There was no other evidence of moderation by school-level disadvantage between bullying roles and emotional and externalizing problems. The findings highlight the potential for school-based interventions targeting children's emotional and social development, targeting bullying, and promoting defending behaviors, particularly in more disadvantaged settings.

Children's resilience to sibling victimization: The role of family, peer, school, and neighborhood factors.

Although common, little is known about the potential impacts of sibling victimization, and how best to ameliorate these. We explored longitudinal associations between sibling victimization and mental health and wellbeing outcomes, and promotive and risk factors that predicted better or worse outcomes following victimization. Data were from >12,000 participants in the Millennium Cohort Study, a longitudinal UK birth cohort, who reported on sibling victimization at age 11 and/or 14 years. We identified potential risk and promotive factors at family, peer, school, and neighborhood levels from age 14 data. Mental health and wellbeing outcomes (internalizing and externalizing problems, mental wellbeing, self-harm) were collected at age 17. Results suggested that over and above pre-existing individual and family level vulnerabilities, experiencing sibling victimization was associated with significantly worse mental health and wellbeing. Having no close friends was a risk factor for worse-than-expected outcomes following victimization. Higher levels of school motivation and engagement was a promotive factor for better-than-expected outcomes. This indicates that aspects of the school environment may offer both risk and promotive factors for children experiencing sibling victimization at home. We argue that effective sibling victimization interventions should be extended to include a focus on factors at the school level.

Examining Children and adolescent mental health trajectories during the COVID-19 pandemic: Findings from a year of the Co-SPACE study.

Background: A major concern throughout the COVID-19 pandemic has been on young people's experiences with mental health. In this study we mapped children and adolescents' mental health trajectories over 13 months of the pandemic and examine whether family, peer, and individual-level factors were associated with trajectory membership. Methods: This study focuses on a sub-sample from the Co-SPACE study of 3322 children and adolescents (aged 4-16 years) for whom parents completed a survey at Time 0 and at least one follow-up survey between March 2020 and May 2021. We used growth mixture models to examine trajectories in emotional, conduct, and hyperactivity/inattention difficulties using the Strengths and Difficulties Questionnaire and multinomial logistic regression models to estimate factors associated with individual trajectory membership. Results: The average trend in young people's mental health appeared to follow changes in national guidelines regarding the pandemic. Distinct trends in GMM models highlighting individual differences showed that a 5-trajectory model best explained the changes in emotional problems whilst 4-trajectory models best explained variation in hyperactivity/inattention and conduct problems. While most young people followed low stable (62%-85%) or moderate stable (28%) symptom trajectories, 14%-31% experienced very high, high stable or increasing mental health difficulties. Young people following high stable trajectories were more likely to have special educational needs and/or neurodevelopmental disorders, parents reporting higher levels of distress and parent-child conflict, and were less likely to have at least one close friend. Conclusions: Most young people adapted well and experienced low stable symptoms, but nearly one third experienced high stable or increasing mental health difficulties. Young people with complex needs and parents with higher psychological distress were particularly vulnerable to high stable problems while those with positive peer relationships were less vulnerable. This study offers insight into potential factors that can be addressed using targeted interventions to improve the wellbeing of parents and young people in the event of future lockdowns and school closures.

Improving the Way that We Conceptualise Adverse Childhood Experiences - A Commentary on Sisitsky et al. (2023).

Research on adverse childhood experiences (ACEs) has traditionally relied on cumulative ACE scores, which prevents understanding about the effects of distinct adversities and their mechanistic pathways. Dimensional and person-centred approaches have been proposed as alternative methods to conceptualise ACEs, which address limitations of the cumulative ACE score. In this issue, Sisitsky et al. (Research on Child and Adolescent Psychopathology, 2023) apply these approaches to identify dimensions of ACEs and profiles of children with distinct patterns of early exposure, in a large, racially diverse cohort from the US. The authors also examine the longitudinal associations between profiles of early adversity in early childhood with later mental health and telomere length. In this commentary, we discuss key findings from the study and recommend future avenues for improving the conceptualisation of ACEs.

Developing a virtual reality environment for educational and therapeutic application to investigate psychological reactivity to bullying.

Understanding how bullying victimisation influences cognitive and emotional processes may help to direct early intervention to prevent the development of psychopathology. In a convenience sample of 67 female adolescents, we assessed the potential of a newly developed classroom-set bullying experience in virtual reality (VR) to evoke psychological reactions. Two VR experiences were co-developed with young people, one neutral and one hostile (bullying). Participants were matched and assigned to a condition based on measures of anxiety, depression, paranoia, and previous bullying, before experiencing either the neutral or hostile scenario. Before and after the VR session, participants completed measures of negative affect and levels of distress. All participants remained immersed for the whole duration, which supports the acceptability of using these VR experiences with more vulnerable participants. Those experiencing the hostile version reported greater negative affect post-immersion compared to those experiencing the neutral version (p = .018; d = 0.61). Although non-significant, a similar outcome was found regarding distress (p = .071; d = 0.37). Whilst we did not find a significant relationship between pre-existing internalisation on negative affect and distress, our sample was limited by containing adolescents with relatively low levels of previous bullying experience. Yet we still found evidence that the VR scenario evoked bullying-related psychological reactions. Further testing with a more representative groups of adolescents, especially those with more experience of bullying, would be advised. The VR scenario could potentially be used in educational and therapeutic settings to enhance empathy towards victimised children or enhance resilience following victimisation.

External Locus of Control but not Self-Esteem Predicts Increasing Social Anxiety Among Bullied Children.

Background: Elevated social anxiety is more likely among bullied children than those who have not been bullied but it is not inevitable and may be influenced by cognitive factors. Lower self-esteem and more external locus of control are associated with bullying and social anxiety but the impact of these factors over time among bullied children is less clear. Method: Children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) reported bullying experiences at age 8 (n = 6,704) and were categorized according to level of bullying exposure. The impact of self-esteem and locus of control on social anxiety was assessed up to age 13 across the bullying exposure groups using multi-group latent growth curve analysis. Complete data was available for 3,333 participants. Results: More external locus of control was associated with a steeper increase in social anxiety among severely bullied children [B = .249, p = .025]. Although self-esteem at age 8 was associated with existing social anxiety it did not predict later increases in social anxiety. Conclusion: These results indicate that beliefs about lack of personal control among severely bullied children may contribute to increasing social anxiety over time. Exploring related cognitions may be helpful in this potentially vulnerable group.

Why do ambulance employees (not) seek organisational help for mental health support? A mixed-methods systematic review protocol of organisational support available and barriers/facilitators to uptake.

INTRODUCTION: The COVID-19 pandemic is exacerbating a wide range of symptoms of poor mental health among emergency medical service (EMS) ambulance populations. Evidence suggests that using organisational support can improve employee outcomes and in turn, patient outcomes. Understanding why EMS staff do and do not use support services is therefore critical to improving uptake, ensuring equitable access, and potentially influencing workforce well-being, organisational sustainability and patient care delivery. This systematic review aims to identify what support is available and any perceived barriers and facilitators to accessing and utilising organisational support. METHODS AND ANALYSIS: Searches performed between 18 February 2022 and 23 February 2022 will be used to identify studies that report barriers and facilitators to EMS employee support among all government/state commissioned EMS ambulance systems. Electronic databases, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, EMCARE, HMIC, Medline and PsycINFO will be searched. All relevant English-language studies of adult employees of government/state commissioned EMS ambulance organisations published since December 2004 will be screened and relevant data extracted by two independent reviewers. A third reviewer will resolve any disagreements.The primary outcome is the identification of perceived barriers or facilitators to EMS staff using organisational support for mental health. The secondary outcome is the identification of supportive interventions offered through or by ambulance trusts. Study selection will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of included studies will be appraised by administering rating checklists. A narrative synthesis will be conducted to report qualitative and quantitative data and will include population characteristics, methodological approach and information about barriers and facilitators. ETHICS AND DISSEMINATION: Ethical approval is not required because only available published data will be analysed. Findings will be disseminated through peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42022299650.

Research Review: Do antibullying interventions reduce internalizing symptoms? A systematic review, meta-analysis, and meta-regression exploring intervention components, moderators, and mechanisms.

BACKGROUND: Effective antibullying interventions may reduce the impact of bullying on young people's mental health. Nevertheless, little is known about their effectiveness in reducing internalizing symptoms such as anxiety or depression, and what factors may influence intervention effects. The aim of this systematic review, meta-analysis, and metaregression is to assess the effects of school-based antibullying interventions on children's and adolescent's internalizing symptoms. The secondary aims are to explore potential moderators, intervention components, and reductions in bullying as mediators of intervention effects on internalizing symptoms. METHODS: We searched nine databases: PsycINFO, Web of Science, ERIC, SCOPUS, CINAHL, Medline, Embase, ProQuest, and Cochrane Library, and performed an author search of included studies in English from January 1983 to April 2021. We included studies that evaluated school-based antibullying interventions using controlled designs and reporting on both bullying and internalizing outcomes. Random-effects and metaregression models were used to derive Hedges g values with pooled 95% CIs as estimates of effect size and to test associations between moderator variables and effect size estimates. Path analysis was used to test potential mediation using effect size measures of victimization, perpetration, and internalizing outcomes. Quality and risk of bias were assessed using Cochrane collaboration tools. RESULTS: This review included 22 studies with 58,091 participants in the meta-analysis. Antibullying interventions had a very small effect in reducing overall internalizing symptoms (ES, 0.06; 95% CI, 0.0284 to 0.1005), anxiety (ES, 0.08; 95% CI, 0.011 to 0.158), and depression (ES, 0.06; 95% CI, 0.014 to 0.107) at postintervention. The reduction in internalizing symptoms did not vary significantly across geographic location, grade level, program duration, and intensity. The intervention component 'working with peers' was associated with a significant reduction, and 'using CBT techniques' was associated with a significant increase in internalizing outcomes. Bullying victimization and perpetration did not mediate the relationship between intervention condition and internalizing outcomes. CONCLUSIONS: Antibullying interventions have a small impact on reducing internalizing symptoms. Ongoing development of antibullying interventions should address how best to maximize their impact on internalizing symptoms to safeguard young people from the damaging mental health outcomes of bullying.

The Impact of Monetary Poverty Alleviation Programs on Children's and Adolescents' Mental Health: A Systematic Review and Meta-Analysis Across Low-, Middle-, and High-Income Countries.

Poverty alleviation programs, such as cash transfers and monetary grants, may not only lift people out of poverty but, some argue, may improve mental health as well. However, to date, the impact of such programs on children and adolescents' mental health is unclear. We carried out a systematic review and meta-analysis of poverty alleviation interventions providing monetary support and reporting mental health outcomes in 0-19 year olds in low-, middle-, and high-income countries. We searched 11 databases for research published between January 1, 1990 and June 1, 2020 and included interventions offering unconditional and/or conditional monetary support and reporting mental health outcomes. After screening 7,733 unique articles, we included 14 papers (16,750 children and adolescents at follow-up) in our narrative summary. We meta-analyzed data on internalizing symptoms from 8 papers (13,538 children and adolescents analyzed). This indicated a small but significant reduction in adolescents' internalizing problems postintervention compared to control (odds ratio 0.72, 95% confidence interval 0.59-0.88, p < .01; I2 = 67%, τ2 = 0.05, p < .01). Our narrative synthesis provides further support for the overall effectiveness of cash programs but also notes that monetary support alone may not be sufficient in extreme risk settings and that imposing conditions may be actively harmful for the mental health of adolescent girls. We provide causal evidence that monetary interventions reduce internalizing symptoms of adolescents experiencing poverty. We recommend that future programming thoughtfully considers whether to apply conditions as part of their interventions and highlight the importance of providing additional comprehensive support for children and adolescents living in extreme risk settings.

Prospective associations between internalising symptoms and educational achievement in youth: A monozygotic twin differences study.

BACKGROUND: Educational achievement is an independent predictor of many life outcomes and so it is important to understand its causes and correlates. Internalising symptoms, encompassing anxiety and depression symptoms, are one candidate influence. METHODS: Using a prospective and genetically-informative design, the present study investigated the associations between internalising symptoms and educational achievement, controlling for IQ at age 7 years and socioeconomic status, among participants of the Twin and Early Development Study (up to N = 10,791). Internalising symptoms were measured by the parent-rated Anxiety Related Behaviours Questionnaire (ages 7, 9, 16 years), and educational attainment were indexed by UK-wide standardized examination results at ages 16 and 18 years, and self-reported transition to university education. RESULTS: Negative affect was the only internalising symptom subtype that was uniquely associated with academic underachievement at all timepoints, from mid-adolescence to early adulthood. The association between negative affect and achievement became non-significant when using MZ twin difference scores, suggesting that the majority of the relationship is accounted for by genetic and shared environmental effects. LIMITATIONS: Limitations include the reliance on parent-reported internalising symptoms. CONCLUSIONS: Negative affect in youth may be an important marker of later academic underachievement. Findings suggest that academic underachievement is not simply a consequence of the disruption caused by negative affect symptoms and therefore educational interventions may be required to optimise outcomes.

The UK stand together trial: protocol for a multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of KiVa to reduce bullying in primary schools.

BACKGROUND: Reducing bullying is a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in Finland and requires rigorous testing in other countries, including the UK. This trial aims to test the effectiveness and cost-effectiveness of KiVa in reducing child reported bullying in UK schools compared to usual practice. The trial is currently on-going. Recruitment commenced in October 2019, however due to COVID-19 pandemic and resulting school closures was re-started in October 2020. METHODS: Design: Two-arm pragmatic multicentre cluster randomised controlled trial with an embedded process and cost-effectiveness evaluation. PARTICIPANTS: 116 primary schools from four areas; North Wales, West Midlands, South East and South West England. Outcomes will be assessed at student level (ages 7-11 years; n = approximately 13,000 students). INTERVENTION: KiVa is a whole school programme with universal actions that places a strong emphasis on changing bystander behaviour alongside indicated actions that provide consistent strategies for dealing with incidents of bullying. KiVa will be implemented over one academic year. COMPARATOR: Usual practice. PRIMARY OUTCOME: Student-level bullying-victimisation assessed through self-report using the extensively used and validated Olweus Bully/Victim questionnaire at baseline and 12-month follow-up. SECONDARY OUTCOMES: student-level bullying-perpetration; student mental health and emotional well-being; student level of, and roles in, bullying; school related well-being; school attendance and academic attainment; and teachers' self-efficacy in dealing with bullying, mental well-being, and burnout. SAMPLE SIZE: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 90% power to identify a relative reduction of 22% with a 5% significance level. RANDOMISATION: recruited schools will be randomised on 1:1 basis stratified by Key-Stage 2 size and free school meal status. Process evaluation: assess implementation fidelity, identify influences on KiVa implementation, and examine intervention mechanisms. Economic evaluation: Self-reported victimisation, Child Health Utility 9D, Client Service Receipt Inventory, frequency of services used, and intervention costs. The health economic analysis will be conducted from a schools and societal perspective. DISCUSSION: This two-arm pragmatic multicentre cluster randomised controlled trial will evaluate the KiVa anti-bullying intervention to generate evidence of the effectiveness, cost-effectiveness and scalability of the programme in the UK. Our integrated process evaluation will assess implementation fidelity, identify influences on KiVa implementation across England and Wales and examine intervention mechanisms. The integrated health economic analysis will be conducted from a schools and societal perspective. Our trial will also provide evidence regarding the programme impact on inequalities by testing whether KiVa is effective across the socio-economic gradient. TRIAL REGISTRATION: Trials ISRCTN 12300853 Date assigned 11/02/2020.

Trends in inpatient care for psychiatric disorders in NHS hospitals across England, 1998/99-2019/20: an observational time series analysis.

PURPOSE: It is unclear how hospitals are responding to the mental health needs of the population in England, against a backdrop of diminishing resources. We aimed to document patterns in hospital activity by psychiatric disorder and how these have changed over the last 22 years. METHODS: In this observational time series analysis, we used routinely collected data on all NHS hospitals in England from 1998/99 to 2019/20. Trends in hospital admissions and bed days for psychiatric disorders were smoothed using negative binomial regression models with year as the exposure and rates (per 1000 person-years) as the outcome. When linear trends were not appropriate, we fitted segmented negative binomial regression models with one change-point. We stratified by gender and age group [children (0-14 years); adults (15 years +)]. RESULTS: Hospital admission rates and bed days for all psychiatric disorders decreased by 28.4 and 38.3%, respectively. Trends were not uniform across psychiatric disorders or age groups. Admission rates mainly decreased over time, except for anxiety and eating disorders which doubled over the 22-year period, significantly increasing by 2.9% (AAPC = 2.88; 95% CI: 2.61-3.16; p < 0.001) and 3.4% (AAPC = 3.44; 95% CI: 3.04-3.85; p < 0.001) each year. Inpatient hospital activity among children showed more increasing and pronounced trends than adults, including an increase of 212.9% for depression, despite a 63.8% reduction for adults with depression during the same period. CONCLUSION: In the last 22 years, there have been overall reductions in hospital activity for psychiatric disorders. However, some disorders showed pronounced increases, pointing to areas of growing need for inpatient psychiatric care, especially among children.

Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes.

PURPOSE: Bullying behaviours and other conduct problems often co-occur. However, we do not yet know whether bullying behaviours are associated with early factors and later poor outcomes independently of conduct problems. While there are differing, specific interventions for bullying behaviours and for conduct problems, it is unclear if such specificity is justified given parallels between both behaviours. METHODS: We used prospective data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2232 children. Mothers and teachers reported on children's bullying behaviours and conduct problems at ages 7 and 10. We collected measures of risk factors, including temperament and family factors, when children were age 5. We assessed behavioural, emotional, educational and social problems when participants reached the ages of 12 and 18. RESULTS: Bullying behaviours and conduct problems co-occurred in childhood. Our findings indicated that bullying behaviours and other conduct problems were independently associated with the same risk factors. Furthermore, they were associated with the same poor outcomes at both ages 12 and 18. Despite this, bullying behaviours were uniquely associated with behavioural, emotional, educational and social problems at age 18. CONCLUSIONS: Our findings suggest that anti-bullying programmes and interventions aimed at reducing conduct problems could benefit from greater integration. Furthermore, our study highlights the mental health problems children who bully may face in later years and the need to consider those in intervention plans.

The Role of Schools in Early Adolescents' Mental Health: Findings From the MYRIAD Study.

OBJECTIVE: Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom. METHOD: Baseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health. RESULTS: The study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p < .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p < .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p < .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health. CONCLUSION: School-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people. CLINICAL TRIAL REGISTRATION INFORMATION: MYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.

Peer victimisation during adolescence and its impact on wellbeing in adulthood: a prospective cohort study.

BACKGROUND: Peer victimisation is a common occurrence and has well-established links with a range of psychiatric problems in adulthood. Significantly less is known however, about how victimisation influences positive aspects of mental health such as wellbeing. The purpose of this study was therefore to assess for the first time, whether peer victimisation in adolescence is associated with adult wellbeing. We aimed to understand whether individuals who avoid a diagnosis of depression after victimisation, maintain good wellbeing in later life, and therefore display resilience. METHODS: Longitudinal data was taken from the Avon Longitudinal Study of Parents and Children, a prospective cohort study based in the UK. Peer victimisation was assessed at 13 years using a modified version of the bullying and friendship interview schedule, and wellbeing at age 23 using the Warwick-Edinburgh Mental Well-Being Scale. The presence or absence of depression was diagnosed using the Clinical Interview Schedule-Revised at 18 years. A series of logistic and linear regression analyses were used to explore relationships between peer victimisation, depression, and wellbeing, adjusting for potentially confounding individual and family factors. RESULTS: Just over 15% of victims of frequent bullying had a diagnosis of depression at age 18. Victimisation also had a significant impact on wellbeing, with a one-point increase in frequent victimisation associated with a 2.71-point (SE = 0.46, p < 0.001) decrease in wellbeing scores aged 23. This finding remained after adjustment for the mediating and moderating effects of depression, suggesting that the burden of victimisation extends beyond depression to impact wellbeing. Results therefore show that individuals who remain partially resilient by avoiding a diagnosis of depression after victimisation have significantly poorer wellbeing than their non-victimised counterparts. CONCLUSION: Overall, our study demonstrates for the first time that victimisation during adolescence is a significant risk factor for not only the onset of depression, but also poor wellbeing in adulthood. Such findings highlight the importance of investigating both dimensions of mental health to understand the true burden of victimisation and subsequent resilience. In addition to the need for interventions that reduce the likelihood of depression following adolescent victimisation, efforts should also be made to promote good wellbeing.