A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study.

BACKGROUND: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. OBJECTIVE: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. METHODS: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. RESULTS: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. CONCLUSIONS: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028.

Sleep and childhood maltreatment: A matched-control study of sleep characteristics in Norwegian 16-19-year-olds.

Sleep problems are an important but understudied health problem in adolescents exposed to childhood maltreatment. The current study aimed to examine sleep characteristics and insomnia in a population with maltreatment history and compare them to a general population sample of adolescents. Data from a sample of Norwegian 16-19-year-old adolescents with childhood maltreatment experiences (n = 62) were linked to an age- and sex-matched general population sample (n = 238). Independent samples t tests were used to compare the two groups on several detailed sleep parameters, while general linear models were used to control for mental health problems, assessed by the Strengths and Difficulties Questionnaire. Mental health was examined as a potential mediator between childhood maltreatment and sleep characteristics. Adolescents exposed to childhood maltreatment had longer sleep onset latency (1:15 h vs. 47 min, p < 0.001), longer wake after sleep onset (34 min vs. 15 min, p < 0.003), lower sleep efficiency in weekdays (77.8%, vs. 85%, p < 0.007), and lower sleep efficiency in weekends (81.8% vs. 88.9%, p < 0.001) than the reference group. Mental health problems fully mediated the association between childhood maltreatment exposure and longer sleep onset latency and wake after sleep onset. The rate of insomnia did not significantly differ between the groups. This study suggests that older adolescents exposed to childhood maltreatment have more sleep problems than the general adolescent population, and that these problems may be explained by co-existing mental health problems. These findings highlight the potential utility of assessing and providing sleep-focused treatment to adolescents with a history of childhood maltreatment and mental health problems.

Childhood maltreatment and sleep in children and adolescents: A systematic review and meta-analysis.

Childhood maltreatment is a global problem with the risk of serious health consequences for children and adolescents, including sleep problems. Former systematic reviews have examined the association between childhood maltreatment and sleep problems in adults, but no systematic review has investigated the literature on childhood maltreatment and sleep problems in childhood and adolescence. We published a protocol (PROSPERO: CRD42021225741) and conducted a systematic literature search using nine electronic databases. Upon duplicate removal, 1530 records were screened against the inclusion criteria, and 26 studies were included in the review. The most studied sleep outcomes were symptoms of insomnia, sleep duration and nightmares. The results showed significant associations between exposure to childhood maltreatment and insomnia symptoms (OR 3.91, 95%CI: 2.64-5.79, p < .001), shorter sleep duration (-12.1 min, 95%CI: -19.4 to -4.7, p < .001) and nightmares (OR 3.15, 95%CI: 2.38-4.18, p < 001). There was a considerable heterogeneity in measures and instruments used to examine sleep and maltreatment. Our findings highlight the importance of screening and intervening for sleep problems in children and adolescents exposed to childhood maltreatment.

Pupils' Use of Social Media and Its Relation to Mental Health from a School Personnel Perspective: A Preliminary Qualitative Study.

The extent of mental health problems among adolescents seems to be on the rise, and this observed trend has often been linked to a coinciding increase in social media use. The goal of the current preliminary study was to investigate how senior high school personnel experience the role of social media in relation to the mental health of their pupils. Two focus group interviews (total n = 11) were completed and analyzed using reflexive thematic analysis, resulting in 4 themes and 11 subthemes. The results illustrate that school personnel experience social media as a tool for communication, but also as a potential cause of mental health issues and reduced academic performance among pupils. The participants called for schools to become better equipped to meet the opportunities and challenges of social media.

Study protocol: the Norwegian Triple-S Cohort Study - establishing a longitudinal health survey of children and adolescents with experiences of maltreatment.

BACKGROUND: Child maltreatment is prevalent and associated with both short- and long-term health problems. Previous studies have established child maltreatment as a risk factor for a wide range of problems over the life course such as mental- and somatic health problems, self-harm, alcohol- and drug abuse and decreased work-life participation. Still, there are few large and well-conducted longitudinal studies focusing on describing prevalence and identifying risk factors and long-term consequences of child maltreatment. The purpose of the current study is to recruit a large number of children and adolescents exposed to maltreatment and follow them long-term. METHODS/DESIGN: The current study is a longitudinal cohort study and will use a multi-informant design (child/adolescent, caregiver, and administrative data). Participants will be recruited from the Stine Sofie Centre (SSC), a learning and coping centre for children and adolescents (≤18 years) exposed to maltreatment, which includes physical and emotional abuse, neglect and/or sexual abuse. Questionnaire-based assessments from self-reports (as well as parent-reports) will be carried out at regular time intervals throughout their lives, on topics such as abuse, negative life events, mental and somatic health problems, resilience and coping, satisfaction with health services, social-, family-, and school function, as well as self-harm and substance abuse. Participants will be assessed upon entry to the centre and followed up annually until they reach 18 years and bi-annually after. Given written consent, participants' responses will be linked to relevant national registries in order to examine predictive factors and important outcomes in terms of subsequent health, education, criminal records and work affiliation. DISCUSSION: This study will examine short- and long-term consequences of child maltreatment across a range of health-related outcomes in a longitudinal perspective. Results from the current study might have implications for the development of preventive and intervention programs related to child maltreatment and the organization and follow-up of the services these children receive. The current study will hopefully contribute with knowledge of risk-factors, short- and long-term health-related and other issues that can contribute to practices aimed at improving the overall life-course for children and adolescents who have experienced childhood maltreatment.

Sexual harassment and assault predict sleep disturbances and is partly mediated by nightmares: Findings from a national survey of all university students in Norway.

Sexual harassment and assault is common in most domains of society, and has been linked to several adverse outcomes, including reduced sleep quality. However, less is known about the possible impact of sexual harassment and assault on various sleep problems among university students. In a sample of 49,051 students in Norway (69.2% women), we examined i) the associations of varying extents of sexual harassment (unwanted sexual comments, looks or gestures, photographs, indecent exposure, and physical harassment) and sexual assault (attempted or completed rape), with meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria of insomnia and with sleep duration, ii) the association of cumulative exposure to sexual harassment/assault with insomnia and sleep duration, and iii) to what extent nightmares could explain the association between sexual harassment and insomnia and sleep duration. For both genders, all forms of harassments with the exception of "indecent exposure" and "unwanted sexual photographs" for men were negatively associated with sleep duration, with the strongest associations being found for "rape" and "attempted rape". For both genders, the odds of insomnia increased as a function of cumulative harassment exposure. Similarly, a graded, negative association was found between cumulative harassment and sleep duration for both genders. Mediation analyses showed that 28% of the observed association between cumulative harassment and insomnia, and 15% of the association between cumulative harassment and sleep duration, was mediated by frequency of nightmares.

How do Norwegian adolescents experience the role of social media in relation to mental health and well-being: a qualitative study.

BACKGROUND: During the last decade, social media has permeated most parts of society. Adolescents are particularly active users of social media, and their use has been suggested as a contributing factor to mental health issues in this group. Quantitative studies have found associations between the frequency and/or duration of social media use and more mental health issues. However, most studies are cross-sectional and the identified associations are weak and of questionable practical significance. The aim of this study was to investigate adolescents' lived experiences of using social media, focusing on both negative and positive aspects, using a qualitative approach. Qualitative research enables in-depth explorations of the experiences of individuals, nuance quantitative findings, and offer the perspective of adolescents into policies regarding social media use. METHODS: Experiences and perspectives of 27 adolescents from two senior high schools in Norway were gathered using focus group interviews (mean age 16.8, range 15-18). The data were analysed using thematic analysis. RESULTS: According to the participants, social media use catalyse changes to how people communicate and relate to each other (theme 1). Some changes were positive, in terms of facilitating social connectedness, while others were negative, such as people behaving worse than in face-to-face interactions. Further, social media use affected the participants at the individual level (theme 2); positively in terms of a sense of belonging and social support, and negatively in terms of perceived stress, body pressure, and displacing other activities such as sleep and homework. The motivations for using, or not using, social media were multifaceted (theme 3), reflecting the positive and negative aspects of social media in terms of interpersonal and personal consequences. CONCLUSION: Social media was described as an important part of the participants' everyday life, with both a positive and negative impact on their mental health and well-being. Considering the compelling nature of social media and adolescents' relatively limited self-regulatory capacities, efforts to modify social media use should avoid relying on self-regulation, while also recognizing the importance of social media as an arena for peer interaction.

Social Media Use and Mental Health and Well-Being Among Adolescents - A Scoping Review.

Introduction: Social media has become an integrated part of daily life, with an estimated 3 billion social media users worldwide. Adolescents and young adults are the most active users of social media. Research on social media has grown rapidly, with the potential association of social media use and mental health and well-being becoming a polarized and much-studied subject. The current body of knowledge on this theme is complex and difficult-to-follow. The current paper presents a scoping review of the published literature in the research field of social media use and its association with mental health and well-being among adolescents. Methods and Analysis: First, relevant databases were searched for eligible studies with a vast range of relevant search terms for social media use and mental health and well-being over the past five years. Identified studies were screened thoroughly and included or excluded based on prior established criteria. Data from the included studies were extracted and summarized according to the previously published study protocol. Results: Among the 79 studies that met our inclusion criteria, the vast majority (94%) were quantitative, with a cross-sectional design (57%) being the most common study design. Several studies focused on different aspects of mental health, with depression (29%) being the most studied aspect. Almost half of the included studies focused on use of non-specified social network sites (43%). Of specified social media, Facebook (39%) was the most studied social network site. The most used approach to measuring social media use was frequency and duration (56%). Participants of both genders were included in most studies (92%) but seldom examined as an explanatory variable. 77% of the included studies had social media use as the independent variable. Conclusion: The findings from the current scoping review revealed that about 3/4 of the included studies focused on social media and some aspect of pathology. Focus on the potential association between social media use and positive outcomes seems to be rarer in the current literature. Amongst the included studies, few separated between different forms of (inter)actions on social media, which are likely to be differentially associated with mental health and well-being outcomes.

Lived experiences: a focus group pilot study within the MentALLY project of mental healthcare among European users.

BACKGROUND: Mental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems. METHOD: In total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N = 7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes. RESULTS: The theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential. CONCLUSION: Facilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.

A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed?

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.

Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries.

BACKGROUND: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. METHODS: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. RESULTS: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. CONCLUSIONS: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision.

Central themes, core concepts and knowledge gaps concerning social media use, and mental health and well-being among adolescents: a protocol of a scoping review of published literature.

INTRODUCTION: The use of social media has risen steadily since its introduction in the early 2000s, and today there are between 2 and 3 billion users worldwide. Research on the link between use of social media and mental health has resulted in a vast number of studies covering diverse aspects of the link between them. The existing body of knowledge on use of social media, and mental health and well-being among adolescents is complex and difficult to follow. In this paper, we present a protocol for a scoping review to systematically identify and summarise the central research foci and knowledge gaps in the research field of social media use, and mental health and well-being among adolescents. METHODS AND ANALYSIS: The current scoping review will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. The first step is to search relevant databases for eligible studies. Relevant databases are CINAHL, Ovid Medline, Embase, PsycINFO, Sociological Abstracts, Sociological Services Abstracts, ERIC, Cochrane Database of Systematic Reviews, CRD (Database of Abstracts of Reviews of Effects), NHS EED, HTA and Epistemonikos. Next, two reviewers from the research team will independently screen the identified studies for eligibility. Data extraction and data synthesis will be performed and result in summarised themes based on the findings. ETHICS AND DISSEMINATION: A scoping review can be described as a method of gaining an overview and understanding of a research area, with its strengths and weaknesses, and as it involves peer-reviewed and published articles, a scoping review does not require ethical approval. We expect that the results from the current scoping review will produce a consolidated overview of existing studies and research gaps, and gather this knowledge into a coherent review. The results will be disseminated through relevant journals and conferences.