An examination of sociodemographic and clinical factors influencing help-seeking attitudes and behaviors among adolescents with mental health problems.

This study investigated sociodemographic and clinical factors influencing help-seeking attitudes and behavior among adolescents with mental health problems. As part of the ProHEAD ("Promoting Help-seeking using E-technology for ADolescents") consortium a school-based, online assessment of sociodemographic information, psychopathology, risk-taking and self-harming behavior, help-seeking attitudes and behavior, and barriers to help-seeking was conducted in adolescents aged ≥ 12 years recruited from randomly selected schools in five regions of Germany. Linear regression analyses with the LMG formula were performed to explore predictors of help-seeking attitudes and behavior and assess their relative importance. Nine thousand five hundred and nine participants (95.5%) completed the online assessment (mean age: 15.1 years, 58.6% female). In total, 1606 participants (16.9%) showed relevant mental health problems (e.g., depressive and eating disorder symptoms, alcohol problems, and thoughts of self-harming behavior). Among them, 895 (55.7%) reported having sought help (lifetime), with higher rates for informal (n = 842, 52.4%) compared to professional (n = 380, 23.7%) sources. High help-seeking propensity emerged as the most important factor contributing to professional help-seeking, followed by elevated levels of psychopathology and perceived barriers, with sociodemographic factors being less impactful. Psychopathological severity also outweighed sociodemographic factors in predicting negative help-seeking attitudes. These findings indicate that attitudes towards seeking professional help, perceived barriers, and psychopathology severity critically influence limited adolescent help-seeking behavior. This emphasizes the need for initiatives that promote help-seeking, reduce negative attitudes, and address structural barriers in adolescent mental health care.

Managing the COVID-19 pandemic in people with mental disorders: An exploratory telephone interview study in a psychiatric outpatient department.

BACKGROUND: The COVID-19 pandemic and associated lockdown measures reduced well-being in the general population significantly and led to an increase in anxiety and depression symptoms, however, results on the impact on people with mental disorders are heterogeneous to date. The aim of this study was to investigate the mental health status, social support, perceived stress, and the medical care provision of people with mental disorders during the time period immediately after the first COVID-19 lockdown in spring 2020 in Germany. METHODS: Participants were people with mental disorders currently receiving treatment in the psychiatric outpatient department of the University Hospital Leipzig, Germany. Structured telephone interviews were administered to assess depressive symptoms, self-rated medical care provision, attitudes and social and emotional aspects of the pandemic (social support, perceived stress, loneliness, resilience, and agreeableness). RESULTS: A total of N = 106 people completed the telephone interview. The most frequent clinician-rated diagnoses were attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD; n = 29, 27.4%) and obsessive-compulsive disorder (OCD; n = 24, 22.6%). The mean Patient Health Questionnaire-9 sum score was 10.91 (SD = 5.71) and the majority of participants (n = 56, 52.8%) reported clinically relevant depressive symptoms. A low self-rated medical care provision was significantly associated with higher depressive symptom load. In a regression analysis, higher perceived stress levels and low medical care provision significantly predicted depressive symptoms. Furthermore, 38.1% (n = 40) reported to feel relieved as a result of the restrictions and, due to previous experience in dealing with crisis, half of the participants (n = 53, 50.5%) stated they were better able to deal with the current situation than the general population. CONCLUSIONS: This study emphasizes the importance of maintenance of medical care provision for people with mental disorders, as cancelled or postponed treatment appointments and perceived stress were associated with higher depressive symptoms. Regular treatment services showed to have a protective effect. In addition, a majority of people with mental disorders felt prepared for managing the COVID pandemic due to existing crisis management abilities. These resources should also be taken into account for further future treatment considerations. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00022071).

Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients.

OBJECTIVE: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. METHOD: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. RESULTS: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. DISCUSSION: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

Weight-related teasing and non-normative eating behaviors as predictors of weight loss maintenance. A longitudinal mediation analysis.

Weight loss maintenance is essential for the reduction of obesity-related health impairments. However, only a minority of individuals successfully maintain reduced weight in the long term. Research has provided initial evidence for associations between weight-related teasing (WRT) and greater non-normative eating behaviors. Further, first evidence was found for associations between non-normative eating behaviors and weight loss maintenance. Hence, the present study aimed to examine the predictive value of WRT for weight loss maintenance and the role of non-normative eating behaviors as possible mediators of this relationship. The study was part of the German Weight Control Registry that prospectively followed individuals who had intentionally lost at least 10% of their maximum weight and had maintained this reduced weight for at least one year. In N = 381 participants, retrospective WRT during childhood and adolescence, current non-normative eating behaviors (i.e., restrained, external, emotional eating), and change in body mass index (BMI, kg/m(2)) over two years were examined using self-report assessments. Structural equation modeling was used to analyze the assumed mediational relationship. As a result, a greater effect of retrospective WRT during childhood and adolescence predicted less successful adult weight loss maintenance over two years. Current emotional eating fully mediated this relationship while current restrained and external eating yielded no mediational effects. Hence, a greater effect of WRT predicted greater current emotional eating, which in turn predicted a smaller decrease or a greater increase in BMI. Our findings suggest that suffering from WRT during childhood and adolescence might lead to emotional eating which in turn impairs long-term weight loss maintenance. Thus, our results highlight the need for interventions aiming at reducing weight stigmatization and targeting emotional eating for successful long-term weight loss maintenance.

[Evaluation of the One-Year Multimodal Weight Loss Program DOC WEIGHT® 1.0 for Obesity Class II and III]. / Evaluation des einjährigen multimodalen Therapieprogramms DOC WEIGHT® 1.0 zur Gewichtsreduktion bei Patienten mit Adipositas Grad II und III.

According to treatment guidelines, treatment for obesity (body mass index [BMI]≥30.0 kg/m(2)) comprises nutritional, physical, and behavioral interventions. However, evidence-based programs for the treatment of severe obesity are rare. In an uncontrolled study, a total of 190 participants (BMI≥35.0 kg/m(2)) of the one-year multimodal treatment program DOC WEIGHT(®) 1.0 were assessed at pre- (t0) and post-intervention (t1) as well as at 1-year follow-up (t2). Results revealed significant improvements from t0 to t1 in body weight, waist circumference, eating disorder psychopathology, and quality of life that persisted to t2. Long-term multimodal outpatient treatment for severe obesity focusing on behavior modification is promising, however, high rates of loss to follow-up limit explanatory power. To improve evidence, consecutive evaluation is intended.

International and domestic university students' mental health over the course of the COVID-19 pandemic in Germany: Comparison between 2020, 2021, and 2022.

BACKGROUND: The COVID-19 pandemic affected university students' mental health worldwide. International students were presenting high levels of stress, anxiety, and depressive symptoms before the pandemic. This study aimed to investigate (i) differences between various timepoints of the COVID-19 pandemic (2020, 2021, and 2022) in mental health outcomes and social and emotional aspects in domestic and international students, separately, (ii) differences between international and domestic students between the three timepoints on mental health outcomes and social and emotional aspects, and (iii) possible moderation effects of timepoints on mental health outcomes and social and emotional aspects of domestic and international students. MATERIAL AND METHODS: Data from three cross-sectional anonymous online surveys conducted in German universities were analyzed and compared. Data were collected in 2020, 2021, and 2022, respectively, with a total N = 14,498. Depressive symptoms, hazardous alcohol use, social support, self-efficacy, resilience, perceived stress, and loneliness were assessed through standardized self-report instruments. Differences between domestic and international students in mental health outcomes, and social and emotional aspects across three timepoints were assessed with one-way and two-way ANCOVAs. RESULTS: Regardless of the timepoint, international students presented more depressive symptoms and perceived stress, lower perceived social support and resilience, but higher levels of self-efficacy and less alcohol consumption compared to domestic students. A significant interaction effect between timepoint and student status emerged only for loneliness. CONCLUSIONS: International students generally presented poorer mental health outcomes than domestic students. Mental health care and prevention such as low-threshold, online counseling should address university students, especially international students.

Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study.

BACKGROUND: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person's mental health state and is known to be a marker for psychopathology. OBJECTIVE: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. METHODS: For this study, the anonymized chat content of a German messenger-based psychosocial chat counseling service for children and adolescents ("krisenchat") between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. RESULTS: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. CONCLUSIONS: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users' psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services.

Intentions and barriers to help-seeking in adolescents and young adults differing in depression severity: cross-sectional results from a school-based mental health project.

BACKGROUND: Mental health problems, such as depression, have a high prevalence in young people. However, the majority of youths suffering from depression do not seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between youthswith different levels of depressive symptoms. METHODS: This cross-sectional study is part of a large-scale, multi-center project. Participants were n = 9509 youths who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, youths were allocated to the following three subgroups: (a) without depressive symptoms, (b) with subclinical symptoms, (c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior, help-seeking intentions and perceived barriers (Barriers questionnaire) between these subgroups. An additional exploratory qualitative content analysis examined text answers on other perceived barriers to help-seeking. RESULTS: Participants were mostly female (n = 5575, 58.6%) and 12 to 24 years old (M = 15.09, SD 2.37). Participants with different levels of depressive symptoms differed significantly in help-seeking behavior, intentions and perceived barriers. Specifically, participants with clinical depressive symptoms reported more previous help-seeking, but lower intentions to seek help compared to participants without symptoms (all p < 0.05). Participants with subclinical depressive symptoms reported a similar frequency of previous help-seeking, but higher intentions to seek help compared to participants without symptoms (all p < 0.05). Perception of barriers was different across subgroups: participants with clinical and subclinical depressive symptoms perceived the majority of barriers such as stigma, difficulties in accessibility, and family-related barriers as more relevant than participants without depressive symptoms. Across all subgroups, participants frequently mentioned intrapersonal reasons, a high need for autonomy, and a lack of mental health literacy as barriers to help-seeking. CONCLUSIONS: Youths with higher levels of depressive symptoms are more reluctant to seek professional help and perceive higher barriers. This underlines the need for effective and low-threshold interventions to tackle barriers, increase help-seeking, and lower depressive symptoms in adolescents and young adults differing in depression severity. TRIAL REGISTRATION: DRKS00014685.

Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic.

Background: The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. Objective: The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. Methods: The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. Results: In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). Conclusion: A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. Clinical trial registration: https://clinicaltrials.gov/, DRKS00027911.

Corrigendum: Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic.

[This corrects the article DOI: 10.3389/fpsyt.2023.1271702.].

Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study.

BACKGROUND: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. OBJECTIVE: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). METHODS: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and participants' quality of life (abbreviated World Health Organization Quality of Life assessment). A 9-answer option questionnaire and open-ended questions also assessed the group's perceived positive and negative outcomes. RESULTS: The total sample comprised 32 participants. Most (23/32, 72%) were doctoral students. Credibility and expectancy scores were high. Participants' satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants' experiences (T2: 29/32, 91%; T3: 27/32, 84%) and felt encouraged to take better care of themselves (T2: 22/32, 69%; T3: 24/32, 75%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). CONCLUSIONS: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants' quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances.

Differences in Help-Seeking Behavior among University Students during the COVID-19 Pandemic Depending on Mental Health Status: Results from a Cross-Sectional Survey.

BACKGROUND: Current evidence suggests that a significant proportion of university students are affected by mental disorders and suicidal ideation. Despite this, a treatment gap exists. Therefore, the present study assessed students' knowledge and past use of on- and off-campus mental health services and help-seeking intentions. Furthermore, resilience was investigated as a potential barrier to help-seeking behavior. METHODS: Data were collected between April and May 2022 from N = 5510 students from Saxony, Germany. To compare dependent variables, subgroups were computed according to students' mental health status. Variables were assessed using standardized questionnaires. Chi-square tests were used for comparisons between groups. Multiple regression models were used to investigate the influence of resilience on help-seeking behavior. RESULTS: Between 34 and 38% (depending on the subgroup) of participants indicated that they were not aware of their universities' psychosocial counseling services. Furthermore, between 17 and 19% of participants indicated that they were not willing to seek help from professional mental health services. Finally, the previously found negative effect of resilience on help-seeking behavior was confirmed. CONCLUSION: The results showed a lack of awareness regarding universities' mental health services and a treatment gap among university students. Universities and healthcare providers need to educate students about mental health services and how to access them. Further research is needed to elucidate the differential impact of resilience on mental health and help-seeking.

Two years COVID-19 pandemic: Development of university students' mental health 2020-2022.

Background: The literature indicates a negative impact on the mental health of university students during the COVID-19 pandemic. It remains unclear if this negative impact persists even after lockdown measures are lifted. The current study therefore investigates the mental health status of students by drawing on two previous studies the present study seeks to investigate differences in the mental health status across three time points. Methods: A cross-sectional, anonymous online survey among students of six universities was conducted between April and May 2022 (N = 5,510). Symptoms of depression, anxiety, hazardous alcohol use and eating disorders as well as social and emotional variables were assessed utilizing standardized instruments. Risk- and protective factors for severity of depressive and anxiety symptoms were investigated using multiple regression models. Differences in e.g., symptoms of depression across three time points were assessed with one-way analysis of variance. Results: More than one third of students exhibited clinically relevant symptoms of depression (35.5%), hazardous alcohol use (33.0-35.5% depending on gender) or anxiety disorder (31.1%). Taken together, almost two out of three (61.4%) students reported clinically relevant symptoms in at least one of the aforementioned symptom patterns, while almost one fifth of students reported suicidal ideation or thoughts of self-harm (19.6%). Higher perceived stress and loneliness significantly predicted higher levels of depressive symptoms, while resilience and social support were identified as protective factors. Compared to 2020 and 2021, levels of depressive symptoms were significantly reduced in 2022, levels of hazardous alcohol consumption showed a small but significant increase from 2021 to 2022. Worryingly, prevalence of suicidal ideation was the highest yet, being significantly higher than in 2020 (14.5%) and 2021 (16.5%). Conclusion: These results confirm previous results that the pandemic had and still has a negative impact on the mental health of university students. The present study broadens this view by the fact that some areas seem to recover quicker, while others seem to increase worryingly. Especially the persistent rise in suicidal ideation from 2020 to 2021 and to 2022, a constant reduction in reported social support and associated perceived loneliness is concerning. The claim for low-threshold and accessible mental health support for university students remains the same as in the beginning of the pandemic.

Who are frequent chatters? Characterization of frequent users in a 24/7 messenger-based psychological chat counseling service for children and adolescents.

Background: Online helplines have shown a high acceptance, feasibility, and usability, especially with young people. Helplines usually aim to provide one-time crisis intervention; however, there are users who frequently use such services, tying a disproportionately large proportion of service capacities. To date, there is no research on the characterization of frequent users of online helplines. Therefore, the aim of the present study is to characterize frequent chatters in a chat-based counseling context. Methods: This cross-sectional study retrospectively analyzed anonymous data of users who approached the German messenger-based psychological chat counseling service krisenchat between May 2020 and July 2021 (N = 6657), with a focus on frequent users - the "frequent chatters". Frequent chatters were defined as those who received an above average (M + 2 ∗ SD) amount of messages from counselors over a period of one week and had at least 7 days of contact with the service over the entire data collection period. Chi-square-tests and Mann-Whitney-U tests were conducted to identify differences between frequent users and the population of all users. Results: In total, n = 99 (1.5 %) users met the definition for frequent chatters and accounted for roughly a tenth (9.85 %) of all chats of the service. The mean frequent chatter was 17 years old (M = 17.29, SD = 3.56), female (n = 78, 82.1 %), and approached the service in the late afternoon (M = 5:00 pm, SD = 5:25 h). Compared to the general user population, frequent chatters reported significantly more severe concerns to counselors, of which 81.8 % included psychiatric symptoms, such as suicidality (43.4 %) and non-suicidal self-injury (41.4 %). In addition, frequent chatters were significantly more likely to contact krisenchat alongside the use of other professional help services. Further, frequent chatters wrote significantly longer and more messages during the counseling process and within a session than the general user population of krisenchat. Compared to the general user population, frequent chatters did not differ in their satisfaction with the service. Conclusion: Frequent users are known from telephone helplines and are also represented in a chat-based context. Compared to the general user population, they are more likely to report serious mental health conditions and half of them currently receive professional help, suggesting a high need for social support. In light of the increasing development of chat-based helplines, there is a need for further research on frequent chatters to develop tailored counseling strategies for their needs and to analyze options for an optimized service provision. Study registration: DRKS00026671.

How are Brazilian university students coping with the COVID-19 pandemic? Results of an online survey on psychosocial well-being, perceived burdens, and attitudes toward social distancing and vaccination.

BACKGROUND: The COVID-19 pandemic caused significant disruption to education systems worldwide, increasing pre-existing concerns regarding university students' mental health. Brazil was among the countries most affected by COVID-19 cases and deaths and was considered a pandemic epicenter. This study aimed to investigate Brazilian university students' mental health status and perceived burdens during the COVID-19 pandemic. MATERIAL AND METHODS: From November 2021 to March 2022, a cross-sectional and anonymous online survey was conducted among students of a Brazilian federal university. Mental health status (depressive symptoms, alcohol and drug consumption) and social and emotional aspects in the pandemic context (social support, perceived stress, loneliness, resilience, and self-efficacy) were assessed with standardized measures. Students' attitudes toward the COVID-19 pandemic and vaccination and perceived burdens of the pandemic were also investigated. RESULTS: A total of N = 2,437 students completed the online survey. The PHQ-9 mean sum score was 12.85 (SD = 7.40), while n = 1,488 (61.10%) participants reported a sum score of 10 or more, indicating clinically relevant depressive symptoms. Further, n = 808 (33.1%) of the total sample reported suicidal thoughts. Levels of depressive symptoms, perceived stress, and loneliness were higher among undergraduate/bachelor students than doctoral students. Almost all participants (97.3%) reported being fully vaccinated against COVID-19. Multiple regression analyses showed that being single, having an income decreased during the pandemic, having a previous mental illness, having a chronic somatic condition, not finding positive aspects in the pandemic, lower self-efficacy, lower social support, lower resilience, and higher experienced loneliness were significantly associated with higher levels of depression. CONCLUSIONS: The study showed high levels of depressive symptoms and suicidal ideation among Federal University of Parana students. Therefore, health care providers and universities need to recognize and address mental health issues; psychosocial policies must be enhanced to mitigate the impact of the pandemic on students' mental health and wellbeing.

The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study.

BACKGROUND: Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person. OBJECTIVE: This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking. METHODS: This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey. RESULTS: The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user's parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being. CONCLUSIONS: The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project.

Background: Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project. Methods: Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis. Results: Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%). Conclusion: The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

Stable through the COVID-19 pandemic: Results from a longitudinal telephone interview study in psychiatric outpatients.

BACKGROUND: The COVID-19 pandemic was associated with far-reaching changes all over the world. Health care systems were and are also affected. Little is known about the impact of these changes and the duration of the pandemic on people with mental disorders. The aim of this longitudinal follow-up study was to investigate the mental health status, medical care provision, and attitudes towards the pandemic of these people at the end of the second pandemic lockdown in Germany in 2021, and to compare these findings with the results of 2020. METHODS: People with mental disorders currently receiving treatment in the psychiatric outpatient department of the University Hospital Leipzig, Germany, were asked about depressive symptoms (PHQ-9), self-reported medical care provision, attitudes and social and emotional aspects of the pandemic (social support [ESSI], perceived stress [PSS-4], loneliness [UCLA-3-LS], and resilience [BRS]) using structured telephone interviews. RESULTS: In total, N = 75 participants who had already participated in the first survey in 2020 took part in the follow-up telephone interviews. The most frequent clinician-rated diagnoses were attention deficit disorder/attention deficit hyperactivity disorder (n = 21; 28.0%) and obsessive-compulsive disorder (n = 16; 21.3%). In comparison to 2020, a significantly higher proportion of participants reported no problems in receiving medical care provision. Compared to the previous year, the resilience of the participants had significantly decreased. Depressive symptoms, social support, perceived stress, and loneliness remained stable. Significantly more participants felt restricted by the pandemic-related government measures in 2021 than in 2020. CONCLUSIONS: This study highlights the importance for continued efforts to maintain stable medical care provision for people with mental disorders during the COVID-19 pandemic, as except for a decrease in resilience, mental health status remained stable. Nonetheless there is still a need for continued treatment to stabilise and improve this status.

Suicidal Ideation Among Children and Young Adults in a 24/7 Messenger-Based Psychological Chat Counseling Service.

Background: Suicidality in children and young adults is a pervasive problem: approximately 40% of respondents in epidemiological surveys in German schools reported suicidal ideation, while up to 9% reported a suicide attempt in the past. While there is compelling evidence for the effectiveness of telephone-based hotline services, an increasing preference of adolescents for messenger-based counseling services can be observed. Therefore, the present study aims to investigate the utilization behavior and user satisfaction of users contacting a German messenger-based chat counseling service ("krisenchat") regarding suicidal ideation. Methods: The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of krisenchat users who used the service between May 2020 and July 2021. Chi-square-tests were used to identify associations of sociodemographic characteristics and utilization behavior with suicidal ideation. Mann-Whitney-U-tests were used to compare the user satisfaction and the recommendation-to-others-rate between suicidal and non-suicidal krisenchat-users. Results: In total, chat data of N = 11,031 users were collected. Of the n = 6,962 users included in the final analysis, n = 1,444 (20.7%) contacted krisenchat because of suicidal ideation. The average user experiencing suicidal ideation was 17 years old, female and currently not receiving other treatment. Further, suicidal ideation was significantly and positively associated with age and non-suicidal self-injury. Regarding utilization patterns, there were significant positive associations between suicidal ideation and counseling session count, mean amount of messages sent, and mean amount of words used per message by the user. User satisfaction was high, with 64.7% (n = 413) of users that answered the feedback survey and experiencing suicidal ideation rating the help they received as at least "good" and a recommendation rate of 89.6% (n = 571). Most importantly, no differences were found between users reporting suicidal ideation and those that do not regarding satisfaction and the probability of recommending the service. Conclusion: Results imply satisfaction with the counseling service among users with suicidal ideation. Nevertheless, there is a need for further research into messenger-based counseling services regarding the prevention of suicidal behavior in children, youths, and young adults. Longitudinal studies are especially needed to assess the effectiveness of messenger-based interventions. Study Registration: DRKS00026671.

Acceptability and feasibility of a messenger-based psychological chat counselling service for children and young adults ("krisenchat"): A cross-sectional study.

BACKGROUND: Adolescence represents a vulnerable period to experience personal crises or mental health problems. However, many concerns stay unnoticed due to the hesitance of young people to seek help and the unavailability and inaccessibility of appropriate help services. Contemporary interventions have been developed incorporating with target group specific needs and preferred modes of communication. krisenchat (German for "crisis chat") is a German low-threshold chat-based psychosocial crisis counselling service that is available around-the-clock. Despite the growing number of online support services, there is a dearth of research regarding the acceptability, usability, and feasibility. METHODS: The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of all krisenchat users between May 2020 and July 2021. Predictors of user satisfaction were identified using exploratory multiple regression analysis. Subgroup analyses were conducted using chi-square-tests to identify differences in user satisfaction. RESULTS: Data of N = 6962 users was included in the analysis. More than 50% of those reported not having contacted the professional health care system before. The mean user of krisenchat was 17 years old (M = 16.6, SD = 3.5), female (female: 83.4%, male: 14.7%, diverse: 1.8%), and first approached the service at 4 PM (M = 4:03 PM, SD = 5:44 h). More than 60% of the users contacted the service between 4 PM and 12 AM, 10% even between 12 AM and 8 AM. The most frequent chat topics were concerns regarding psychiatric symptoms (60.1%), psychosocial (34.0%) or emotional distress (30.2%). The majority of the users (64.7%) reported high levels of satisfaction and 88.3% a high likelihood (60% or more) of recommending krisenchat to others. Also, the results indicate that the number of messages and their respective length differed between users and counsellors, with users writing several, but shorter messages and counsellors replying with fewer, but longer messages. CONCLUSION: The results of the present study imply a high acceptability and feasibility of krisenchat. Overall, there is a high need for a 24/7 messenger-based chat counselling service in crises for children and young adults. Currently, there is no other online service for youth that is available after 7 PM or at weekends, which indicates the great importance of krisenchat and its function to bridge a current gap in the mental health care system. A need for further research emerges e.g., for subgroup differences regarding utilization patterns and also for further insights regarding help-seeking behavior via social media in youth. STUDY REGISTRATION: DRKS00026671.