A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India.

Introduction: In low- and middle-income countries (LMICs), the gap between need for mental health (MH) treatment and access to services is stark, particularly among children and adolescents. In service of addressing this treatment gap, the current study provides an in-depth illustration of later-stage collaborative design of a school-based, transdiagnostic MH intervention in New Delhi and Goa, India, using a combination of contextual insights from local stakeholders and knowledge derived from the global evidence base. Methods: Using an inductive-deductive approach to qualitative thematic analysis, we examined coded data from qualitative sources related to experiences of developing and implementing an intervention prototype. These sources included notes from meetings attended by treatment development team members and providers, written feedback on protocol materials (e.g., provider manual, student handouts), field notes reflecting researcher observations, and minutes from weekly clinical supervision meetings. Results: Results revealed that codes involving cultural/contextual considerations, protocol material and content, and intervention complexity arose consistently throughout treatment development and across document types, illustrating their central role in finalizing protocol design. Discussion: These findings have implications for the future of mental health treatment development and implementation globally.

Resilience Resources Scale: A brief resilience measure validated with undergraduate students.

Objective: This paper presents a theory-based brief resilience scale, the Resilience Resources Scale (RRS), and evidence for its factor structure, reliability, and validity in two studies of undergraduate students. Participants: Study 1 sampled 295 students and Study 2 sampled 244 students. Methods: Study 1 participants completed the RRS and other measures online at one of two time points eight weeks apart (n = 193), or at both time points (n = 102). Study 2 participants completed the RRS and other measures online on a single occasion. Results: Factor analyses provided evidence for a one-factor model. Results indicated high internal consistency and strong test-retest reliability. Evidence of concurrent and predictive validity is presented. Conclusions: The RRS measures resilience resources known to be protective of physical and mental health. This brief scale has sound psychometric properties in these initial studies of undergraduate students. We offer possible directions for use of the RRS in this and other populations.

A pilot study to evaluate feasibility and acceptability of training mental health workers in India to select case-specific intervention procedures within a dynamic modular treatment designed for a low-resource setting.

RATIONALE, AIMS AND OBJECTIVES: A key consideration in designing scalable solutions for improving global mental health involves balancing the need for interventions to be uncomplicated for mental health workers (MHWs) and the need for the intervention to be widely applicable to many clients. Often these needs are in competition, since interventions are routinely simplified by removing procedures or reducing their dynamic responsivity, which in turn lowers their overall utility in serving large, clinically diverse populations. The principal aim of this pilot study involved evaluating the feasibility and acceptability of a brief strategy designed to delegate problem classification and practice selection to MHWs operating within a flexible, modular, cognitive behavioural protocol. A secondary aim involved gathering data on which to base a hypothesis regarding the potential effectiveness of this strategy. METHOD: Within an open trial, an educationally diverse sample of local MHWs in India (N = 18) reviewed fictional case vignettes, classified mental health problems, and then selected practices before and after a two-hour training that included a one-page decision-making resource. Feasibility was measured by assessing the integrity of the study protocol and training, the measurement and administration of questionnaires as well as study recruitment and completion. Acceptability of the intervention was measured by MHW-perceived performance, ease of use, value, importance, and intention for continued use. Decision-making accuracy was assessed by comparing MHWs' clinical decisions with criteria established through consensus among psychologists with expertise in modular protocols. RESULTS: Results suggested high feasibility and acceptability on all metrics. Secondary analysis revealed that MHW's decision-making accuracy and confidence also significantly improved, providing a basis for the hypothesis that this brief approach is useful for building MHW capacity in low-resource settings. CONCLUSION: Overall these findings provide initial support for these methods and potential training outcomes to test within a larger, randomized controlled trial.

Neuroanatomical differences in the memory systems of intellectual giftedness and typical development.

INTRODUCTION: Studying neuro-structural markers of intellectual giftedness (IG) will inform scientific understanding of the processes helping children excel academically. METHODS: Structural and diffusion-weighted MRI was used to compare regional brain shape and connectivity of 12 children with average to high average IQ and 18 IG children, defined as having IQ greater than 145. RESULTS: IG had larger subcortical structures and more robust white matter microstructural organization between those structures in regions associated with explicit memory. TD had more connected, larger subcortical structures in regions associated with implicit memory. CONCLUSIONS: It was found that the memory systems within brains of children with exceptional intellectual abilities are differently sized and connected compared to the brains of typically developing children. These different neurodevelopmental trajectories suggest different learning strategies. A spectrum of intelligence types is envisioned, facilitated by different ratios of implicit and explicit system, which was validated using a large external dataset.

Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India.

This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.

Is psychopathology elevated in Big-C visual artists and scientists?

The idea that psychopathology is associated with exceptional creativity has persisted despite a paucity of corroborating or disconfirming evidence. The authors measured psychopathology, including schizotypal personality traits, social responsiveness/autism spectrum traits, and lifetime incidence of mental disorders, along with lab-based tests of creativity in a unique sample of Big-C (exceptionally creative) individuals. The authors examined Big-C visual artists (VIS; n = 35), Big-C scientists (SCI; n = 41), and a smart comparison group (SCG; n = 31) matched on age, sex, race/ethnicity, parental education, and estimated IQ. Neither lifetime nor current prevalence of mental disorders was higher in Big-C groups relative to either the SCG or epidemiologic estimates, but individuals without a lifetime history of psychiatric disorder scored higher on a test of creative cognition relative to those who had at least one lifetime diagnosis. The groups differed in self-reported symptoms: VIS reported more schizotypal features than both SCI and SCG, and higher levels of socially divergent traits than SCI. Self-reported symptoms were below diagnostic thresholds in all 3 groups. The findings indicate that neither exceptional creativity nor performance on tests that putatively assess creativity are associated with mental illness but suggest that certain schizotypal features and socially divergent traits-at subclinical levels-are associated with Big-C achievement, at least in visual artists. The findings further raise questions about the sensitivity of laboratory tests for Big-C cognition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Functional magnetic resonance imaging of divergent and convergent thinking in Big-C creativity.

The cognitive and physiological processes underlying creativity remain unclear, and very few studies to date have attempted to identify the behavioral and brain characteristics that distinguish exceptional ("Big-C") from everyday ("little-c") creativity. The Big-C Project examined functional brain responses during tasks demanding divergent and convergent thinking in 35 Big-C Visual Artists (VIS), 41 Big-C Scientists (SCI), and 31 individuals in a "smart comparison group" (SCG) matched to the Big-C groups on parental educational attainment and estimated IQ. Functional MRI (fMRI) scans included two activation paradigms widely used in prior creativity research, the Alternate Uses Task (AUT) and Remote Associates Task (RAT), to assess brain function during divergent and convergent thinking, respectively. Task performance did not differ between groups. Functional MRI activation in Big-C and SCG groups differed during the divergent thinking task. No differences in activation were seen during the convergent thinking task. Big-C groups had less activation than SCG in frontal pole, right frontal operculum, left middle frontal gyrus, and bilaterally in occipital cortex. SCI displayed lower frontal and parietal activation relative to the SCG when generating alternate uses in the AUT, while VIS displayed lower frontal activation than SCI and SCG when generating typical qualities (the control condition in the AUT). VIS showed more activation in right inferior frontal gyrus and left supramarginal gyrus relative to SCI. All groups displayed considerable overlapping activation during the RAT. The results confirm substantial overlap in functional activation across groups, but suggest that exceptionally creative individuals may depend less on task-positive networks during tasks that demand divergent thinking.