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Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.
Aims:
We investigated whether the processes outlined in Clark’s (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.
Method:
We recruited three groups of adolescents (12–17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD (‘clinical control’), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms (‘community control’). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.
Results:
The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.
Conclusions:
We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark’s cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.
Drug use is common. It is estimated that one in ten people in the UK have tried an illegal psychoactive drug in the last year.
Young people use more drugs than any other age group, many by their mid-teens.
Cannabis is the most commonly used illegal psychoactive drug.
People use psychoactive drugs to change the way they feel.
Psychoactive drug use can result in new feelings that would otherwise be hard to experience, or take away unwanted feelings. To feel good, or stop feeling bad.
Sometimes psychoactive drugs are used for social gain, bringing a sense of belonging and identity.
As we will see in Chapter 11, some people experience mental health problems which increase their risk of using drugs
The UK has two drug laws, the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016. These laws place all psychoactive drugs under control and rank some drugs according to their potential to cause harm.
The UK drug laws make it an offence to produce, supply, import or export and, in some cases, possess a psychoactive drug.
Violence can happen everywhere in the lives of young people with cognitive disability. Young people with cognitive disability, family members, and workers talk about what needs to change. Services need to work together to help young people with cognitive disability. Others need to know about and respect the culture of young people with cognitive disability. Others need to respect young people’s choices on whom they want to love. Young people with cognitive disability can be helped to understand what is violence. Services can change what they do so that they can keep young people with cognitive disability safe. Young people with cognitive disability say that there should be ‘nothing about us unless it is led by us’.
This chapter explains what this book is about. Becoming an adult is different for everybody. Young people with cognitive disability can find it hard to get the right supports to become an adult. Many young people can experience violence and abuse. This book tells the stories of young people with cognitive disability from different backgrounds. Family members and practitioners also talk about stories of young people with cognitive disability.
This chapter looks at the Department of Child Safety and the criminal justice system. Child Safety often didn’t understand that a young person had a cognitive disability. Sometimes young people with cognitive disability were abused while they were in Child Safety. Young people with cognitive disability often did not get much help when they left Child Safety. Parents with cognitive disability often had their children removed from them by Child Safety. Some young people were abused by police. Young people with cognitive disability who went to prison didn’t get much help. They also found it hard when they left prison.
Young people with cognitive disability found school to be both good and bad. Things were good when young people had friends and when teachers listened and tried to help. Things were bad when the school wanted young people with cognitive disability to be like everyone else. Young people could be punished or neglected if they didn’t fit in with everyone else. Leaving school could be hard. Young people with cognitive disability often didn’t have a job or university to go to. The United Nations Convention on the Rights of Persons with Disabilities says that all people with disability have a right to a good education, and that people should be supported to get a job or to learn more after school.
This chapter explains how the researchers talked to young people with cognitive disability, their families, and practitioners. The researchers included people with disability on the research team. The researchers wanted to know what was happening for young people with cognitive disability. They wanted to know about the world in which young people with cognitive disability lived. There was much to be learnt about working well with people with disability in research. It’s important that people with cognitive disability have a voice in the research that is about them.
This chapter explores what we know about violence against young people with cognitive disability. It looks at what can make it more likely that young people with cognitive disability are abused. It’s hard to really know how many young people with cognitive disability have experienced violence. Young people with cognitive disability can be harmed by workers, family, or friends who are meant to help them. Abuse can happen in many places. Services and society need to learn how to keep young people with cognitive disability safe. We need to make sure young people can make decisions for themselves.
Young people with cognitive disability deserve to live in a home of their choice. They also deserve to get help when they feel mentally unwell. This chapter looks at where young people with cognitive people live. Many young people felt unsafe where they lived. Some young people needed mental health services. It could be hard to trust mental health staff. Mental health services were good when staff really wanted to help and listened to the young person. Young people with cognitive disability should be helped to make their own decisions.
Family, friends, partners, and pets can help young people with cognitive disability as they become adults. Some young people with cognitive disability had families who spoke up for them and helped them when times were hard. Some young people with cognitive disability had partners who helped them feel good about themselves. Friends could help young people with cognitive disability leave abusive situations. Professionals can do more to help young people with cognitive disability make friends and be part of their community.
Young people with cognitive disability, families, and practitioners reported many acts of violence against young people. The violence included physical abuse, sexual assault/abuse, neglect, exploitation, emotional and psychological abuse, and domestic and family violence. Young people were abused by other young people with disability, family members, partners, practitioners, and services. Young people in this book found the strength to speak up and tell their stories of violence.
This chapter tells Amethyst’s story. Amethyst is an Aboriginal and South Sea Islander young woman with cognitive disability. Amethyst is not her real name. Amethyst was abused many times as a child and a young adult. Her story can tell us a lot about what needs to change for young people with cognitive disability. We need to understand that abuse affects a person’s whole life, their family, and their world.
Becoming an adult involved lots of changes and challenges for young people with cognitive disability. Many services, and sometimes families, judged young people badly because they had a cognitive disability. Young people needed help to be independent, but this wasn’t always given to them. Some young people were lonely and found so-called friends who abused them. Aboriginal and/or Torres Strait Islander young people and young people from culturally and linguistically diverse backgrounds needed others to understand and respect their culture. LQBTIQA+ young people wanted love and acceptance as they became adults.
This chapter looks at services and focuses on the National Disability Insurance Scheme (NDIS). Services don’t always recognise what young people with cognitive disability can do. They can neglect young people with cognitive disability. This can lead to violence and abuse of the young person. This chapter looks at how young people with cognitive disability found support from NDIS agencies. Young people with cognitive disability had trouble getting onto the NDIS. Professionals, families, and young people needed to fight to make sure supports were helpful. The NDIS must get better for all people with disability.
Young people with childhood adversity (CA) were at increased risk to experience mental health problems during the COVID-19 pandemic. Pre-pandemic research identified high-quality friendship support as a protective factor that can buffer against the emergence of mental health problems in young people with CA. This longitudinal study investigated friendship buffering effects on mental health symptoms before and at three timepoints during the pandemic in 102 young people (aged 16–26) with low to moderate CA. Multilevel analyses revealed a continuous increase in depression symptoms following the outbreak. Friendship quality was perceived as elevated during lockdowns and returned to pre-pandemic baseline levels during reopening. A stress-sensitizing effect of CA on social functioning was evident, as social thinning occurred following the outbreak. Bivariate latent change score modeling revealed that before and during the pandemic, young people with greater friendship quality self-reported lower depression symptoms and vice versa. Furthermore, sequential mediation analysis showed that high-quality friendships before the pandemic buffered depression symptoms during the pandemic through reducing perceived stress. These findings highlight the importance of fostering stable and supportive friendships in young people with CA and suggest that through reducing stress perceptions high-quality friendships can mitigate mental health problems during times of multidimensional stress.
This book presents the lived experiences of young people with cognitive disability and their struggles as they transition to adulthood. Whether you are a young person yourself looking to transition to adulthood, a parent, or a professional supporting a young person, this book will help you understand the systemic failures which have caused abuse, exploitation, neglect and violence. But it will also outline the inner and outer resources which have enabled young people to maintain their self-belief and overcome adversity. Despite the fact society is failing these young people, the young people in this book speak of belief and have hope for the future. Drawing upon the United Nations human rights framework, this book provides a narrative for empowerment and reform. It involves the input of co-researchers with disability and includes Easy English summaries in each chapter to ensure its accessibility to young people with cognitive disability.
Studies show that mental health promotion is an effective strategy that can reduce the burden of mental health disorders and improve overall well-being in both children and adults. In addition to promoting high levels of mental well-being and preventing the onset of mental illness, these mental health promotion programmes, including mental illness prevention interventions, help increase levels of mental health literacy in community members. While there is evidence showing the effectiveness of mental health promotion, much of what is known about this field is informed by studies conducted in high-income countries. There is a need to gather evidence about the effectiveness of such interventions in low- and middle-income countries (LMICs) where mental health services are often inadequate. In this systematic review, we synthesised the available published primary evidence from sub-Saharan Africa (SSA) on the types and effectiveness of mental health promotion programmes for young people. We performed a search of selected global databases (PubMed, PsycINFO, ScienceDirect and Google Scholar) and regional databases (Sabinet African Journals). We included observational, mixed methods, trials, pilots and quantitative original papers published from 2013 to 2023. We used the Mixed Methods Appraisal Tool (MMAT) to evaluate the quality of methods in selected studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020) for reporting the evidence gathered. We identified 15 types of youth mental health promotion and illness prevention interventions. Among those identified, we found that school-based interventions enhanced mental health literacy, mental health-seeking behaviours and self-assurance and confidence among young people. Family-based interventions also showed a potential to improve relationships between young people and their caregivers. Future studies should explore how to further strengthen school- and family-based interventions that promote mental health among young people.
This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.
Methods
A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance.
Results
A total of 643 322 primary care patients in Wales UK, aged 6–17 years from 2010–2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5–3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0–23.8; 95% CI 2533) in 16–17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of ‘all’ antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both ‘all’ antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward.
Conclusions
Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.
Young people (YP) (between 10 and 24 years) are disproportionally vulnerable to developing and being affected by mental health conditions due to physical, social and emotional risk factors. YP in low-and middle-income countries (LMICs) have poorer access to, and quality of, mental health services compared to those in high-income countries. Digital mental health interventions (DMHIs) have been proposed as tools to address this burden of disease and reduce the global treatment gap in youth mental health outcomes. This study aimed to examine the evidence for DMHIs for treating mental disorders in YP based in LMICs. To do this, the author searched academic databases (MEDLINE, PsycINFO, Embase and Web of Science) for primary studies on DMHIs targeting YP in LMICs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed. The quality of the studies was assessed using the Critical Appraisal Skills Programme) framework. A narrative synthesis methodology was used to summarise and explain the findings. The authors identified 287 studies of which 7 were eligible in the final review. The authors found evidence of the effectiveness of multiple forms of DMHI (especially internet-based cognitive behavioural therapy) on anxiety and depression outcomes. Studies reported a lack of long-term benefits of treatment, high dropout rates, and did not include key geographical settings or data on cost-effectiveness. No studies were judged to be of high quality. This review highlights the available evidence showing that DMHIs can improve mental health outcomes for YP in LMICs, but due to the limited number of studies and lack of high-quality data, increased adoption and scaling up of digital interventions require more rigorous studies showing clinical effectiveness and ability to provide return on investment.
Identifying children and/or adolescents who are at highest risk for developing chronic depression is of utmost importance, so that we can develop more effective and targeted interventions to attenuate the risk trajectory of depression. To address this, the objective of this study was to identify young people with persistent depressive symptoms across adolescence and young adulthood and examine the prospective associations between factors and persistent depressive symptoms in young people.
Methods
We used data from 6711 participants in the Avon Longitudinal Study of Parents and Children. Depressive symptoms were assessed at 12.5, 13.5, 16, 17.5, 21 and 22 years with the Short Mood and Feelings Questionnaire, and we further examined the influence of multiple biological, psychological and social factors in explaining chronic depressive symptoms.
Results
Using latent class growth analysis, we identified four trajectories of depressive symptoms: persistent high, persistent low, persistent moderate and increasing high. After applying several logistic regression models, we found that loneliness and feeling less connected at school were the most relevant factors for chronic course of depressive symptoms.
Conclusions
Our findings contribute with the identification of those children who are at highest risk for developing chronic depressive symptoms.