ObjectivesThe war in Ukraine has had an impact on the population’s mental health. Displacement, economic instability, loss of loved ones, and shortages of basic resources have contributed to distress, including anxiety, depression, and post-traumatic stress disorder (PTSD).MethodsThis study examined mental health symptoms and coping strategies in a sample of 100 Ukrainian adults (mean age = 35.5 ± 12.5; 73% female). Participants completed self-report questionnaires assessing symptoms of depression, anxiety, and PTSD, along with stressors, coping, and help-seeking behaviour. Logistic regression was used to identify predictors of mental health outcomes and service use.ResultsSymptoms of depression were reported by 70% of participants, anxiety by 80%, and 31% met criteria for probable PTSD. Despite this, only 15% sought psychological help. Women were more likely than men to report anxiety and PTSD. Perceived stress significantly predicted mental health outcomes and was associated with a greater likelihood of help-seeking.ConclusionThese findings highlight the urgent need to improve access to psychological and psychiatric care in Ukraine.

ABSTRACT This study adopts a multi‐informant (students and teachers) approach to explore the prospective associations of the teacher–student relationship and students' school bonding with students' academic achievement in primary school. The analytical sample consisted of 1349 Swiss children (Grade 1: 48.8% female; M age = 7.45, SD = 0.38, range 6.06–8.93) and 250 teachers. 976 children were followed up 5 years later (Grade 6; M age = 12.63, SD = 0.37, range 11.31–14.01). Sex, parental migration background, parental formal education level and the baseline of academic achievement at age 7 were control variables. Positive teacher–student relationship predicted mathematics achievement later. Positive teacher–student relationship and school bonding predicted language achievement later but not consistently. The quality of primary education teacher–student relationship seems to play a crucial role in students' academic achievement. Educational and political implications are discussed.

There has been considerable recent debate surrounding the effects of social media use and adolescents' mental health. A key source of controversy is whether observed associations might be confounded by 'third variables' (which influence both social media use and mental health). To address this, we used counterfactual analysis to account for measured confounding. This approach provides estimates of causal effects by comparing observed outcomes with those that would be expected under an alternative exposure condition. We employed it to evaluate the link between social media use (including messaging and visiting social networking websites) at ages 11 and 14 and later mental health issues (including emotional symptoms, self-harm, and/or suicide attempts) at ages 14 and 17. Data was from the UK Millennium Cohort Study (MCS), a nationally representative sample. The study was conducted with the input of a young persons' advisory group, who informed our prioritization of the study research question, helped interpret findings, and identify study limitations. Inverse probability of treatment weighting (IPTW) analyses indicated no significant effects of social media use frequency at age 11 (defined as use on most days) or time spent at age 14 (>= 2 h per weekday) on emotional problems or self-harm at age 14 or 17, respectively (analytic n = 3036-4419). The only exception was significant association between higher time spent on social media at age 14 and lifetime suicide attempts at age 17. These findings highlight the importance of considering potential confounders when examining social media use effects. Given that frequency and timebased measures are unlikely to capture the complexity of this association, we recommend future research also apply similar approaches utilizing more nuanced measures.

Introduction Emotion dysregulation (ED) is a commonly associated feature of attention deficit hyperactivity disorder (ADHD) in adolescence, yet there is a lack of scalable interventions tailored for those with ADHD symptoms. The present article outlines the protocol for a mixed-methods single-arm small-scale efficacy trial study evaluating a novel digital health intervention (DHI) in the form of a smartphone app designed to address this gap. The intervention was co-designed with adolescents with ADHD and draws on therapeutic approaches such as psychoeducation, dialectical behaviour therapy and emotion-focused variants of cognitive behavioural therapy. Methods and analysis The study will use a mixed-methods pre–post design involving up to 100 participants, comprising 50 adolescents aged 11–15 years who have an ADHD diagnosis or are on a waitlist for assessment and moderate-to-severe ED, and up to 50 parents/caregivers participating as optional informants. Young people will use the intervention over a four-week period. Quantitative outcomes, including ED, adaptive ER strategy use, anxiety, and depression, will be assessed at baseline and follow-up using self-report and optional parent-report measures. Quantitative engagement data will additionally be passively collected through the DHI software. Qualitative interviews will be conducted to obtain complementary, in-depth data on user experience, perceived engagement, and the feasibility of the DHI use. Quantitative data will be analysed using linear mixed-effects regression models, and qualitative data will be analysed using thematic analysis. Ethics and dissemination The study received multi-tiered ethical approval by the College of Arts, Humanities and Social Sciences, as well as the School of Philosophy, Psychology and Language Science at the University of Edinburgh. Additionally, the study obtained favourable ethical opinion by the National Health Service (NHS) research ethics committee. Findings will be disseminated through peer-reviewed publications, conference presentations, and accessible co-produced summaries shared with relevant stakeholder groups, including young people, families, clinicians, and ADHD charities.

Background:Future time perspective dimensions have been linked to various mental illnesses. Given the tendency for mental illnesses to co-occur, it is necessary to disentangle associations between future-oriented constructs and shared versus symptom-domain-specific psychopathology. Methods:After conducting a factor analysis to establish an optimal factor structure of the psychopathology data from Wave 8 of the Zurich Project on Social Development from Childhood to Adulthood study (N = 1180; M age ≈ 20), this study examined the associations between mental illness dimensions and two future time perspective components: future self-connectedness and future self-valence. Results:An S-1 bifactor specification was selected for primary interpretation. Both future time perspective components were negatively associated with internalising, attention deficit hyperactivity disorder, psychosis-like dimensions, and substance use, alongside a S-1 aggression factor. Conclusion:These findings suggest transdiagnostic relevance of self-connectedness and future self-valence but should be considered preliminary given single-item measurement and limited construct coverage. Replication with more comprehensive measures is warranted.

BACKGROUND:Juvenile delinquency remains a major concern. While adversity is linked to delinquency, less is known about how different operationalizations of adversity compare in predicting delinquency. Many studies overlook key features including type, co-occurrence, timing, and chronicity. OBJECTIVE:This study compared three approaches to operationalizing adversity across two developmental periods-childhood and adolescence-by examining individual adversities, cumulative adversity scores, and latent class analysis (LCA), and examining their associations with delinquency. PARTICIPANTS AND SETTING:Data were drawn from the Millennium Cohort Study, a nationally representative UK longitudinal sample (N = 9980). METHODS:Linear regression analyses assessed associations for individual adversities measured separately in childhood and adolescence, cumulative adversity scores calculated for each period, and LCA-derived adversity patterns spanning both periods. RESULTS:Several childhood adversities (parental divorce/separation, maternal alcohol and drug use) and several adolescent adversities (maternal drug use, accidents or injuries, conventional criminal victimization, sexual victimization, and electronic victimization) predicted higher delinquency. LCA identified four groups: low adversity with moderate childhood physical threat, high deprivation with childhood threat, maternal substance use with adolescent threat, and high general adversity. Individuals in the low-adversity class reported less delinquency than average, whereas those in the high-adversity class reported more. Cumulative scores were also positively associated with delinquency, with adolescent cumulative adversity showing the stronger effects. CONCLUSIONS:Deprivation-related adversities in childhood and threat-related adversities in adolescence were particularly influential. Individuals exposed to high cumulative adolescent adversity or chronic multi-domain adversities were most vulnerable. Each operationalization provided distinct insights, underscoring the importance of how adversity is conceptualized.

Cyberbullying victimization (CV) is a significant stressor linked to youth mental health outcomes, including both emotional and conduct problems. While previous studies have identified various mediators including affective, cognitive, and social domains, few studies have simultaneously examined them within an integrated model in a longitudinal design. This study investigates whether loneliness, emotion dysregulation, and self-esteem mediate the association between CV and later emotional and conduct problems. A total of 501 Chinese adolescents aged between 15 and 18 years old (53.3% female; M age = 16.33, SD = 0.47) participated in a two-wave longitudinal study with a 6-month interval. Structural equation modeling was used to test mediation effects, controlling for gender and age. Results revealed that CV at Time 1 (T1) was prospectively associated with higher emotional and conduct problems at Time 2 (T2). Loneliness and emotion dysregulation at T2 were significant mediators of CV and both emotional and conduct problems, whereas self-esteem at T2 was not a significant mediator for both outcomes. Subscale analyses of emotion dysregulation revealed distinct emotion-cognitive patterns across outcomes. Limited access to effective emotion-regulation strategies primarily explained the association between CV and emotional problems, whereas impulse-control difficulties most strongly accounted for the link between CV and conduct problems. Interventions should be multi-component, targeting these shared and distinct psychological factors through strategies addressing social isolation and emotion regulation skills while also incorporating outcome-specific approaches for comprehensive prevention and treatment.

The quality of relationships between staff and children in residential childcare is crucial for fostering healthy psychological and emotional development in vulnerable populations. This study explores the links between staff burnout, emotional intelligence (EI) and the quality of interactions in childcare facilities providing residential care and full-time education in the UK. More specifically, the aim of the study was to assess the role of EI in mitigating burnout's adverse effects on staff-child relationships. Using cross-sectional survey data from 78 participants (70.5% residential childcare workers; 29.5% residential teachers), the results indicated a significant negative association between burnout and relationship quality, with EI showing a positive correlation with better relationship outcomes. However, contrary to expectations, EI did not moderate the link between burnout and relationship quality, suggesting that even individuals with high EI are not fully protected from the impacts of burnout. Further analysis revealed that client-related burnout had a particularly detrimental effect on staff-child relationships, highlighting the need for targeted interventions.

Objective To investigate suicidal ideation among adolescents with learning disabilities and examine whether learning disabilities and a range of risk and protective factors assessed at age 13 are associated with suicidal ideation at age 15. Methods Longitudinal data were drawn from a youth population-based cohort (Zurich Project on the Social Development from Childhood to Adulthood [z-proso]; N = 1675). Modified Poisson regression was used to estimate the relative risk of suicidal ideation at age 15, with learning disabilities along with the other variables as predictors. An additional model included an interaction term between learning disabilities and anxiety/depression symptoms to test whether the association between anxiety/depression and suicidal ideation varied by learning disability status. Average marginal effects were used to estimate absolute differences in predicted probabilities between groups. Results Adolescents with learning disabilities reported significantly higher rates of suicidal ideation (32.5 %) and self-injury (18.4 %) compared to peers without learning disabilities. They showed elevated levels of most risk factors and lower levels of protective factors. Significant predictors of increased relative risk of suicidal ideation included female sex, anxiety/depression symptoms, bullying experiences, and learning disabilities, the latter associated with a 40.2 % higher risk (RR = 1.402, 95 % CI = [1.070, 1.387]). Average marginal effects indicated that anxiety/depression significantly increased suicidal ideation risk among adolescents without learning disabilities but not among those with learning disabilities. Conclusions Findings suggest that learning disabilities are a significant risk factor for adolescent suicidal ideation, highlighting the need for early identification, tailored assessment, and targeted prevention strategies.

There is a growing body of evidence indicating that cyberbullying victimisation (CV) among youth is associated with internalising problems, such as depression, anxiety, non-suicidal self-injury (NSSI) and suicidality. Despite numerous individual studies examining the mechanisms linking CV to internalising problems, no meta-analyses have systematically synthesised the evidence on mediating pathways, leaving a critical gap in understanding how CV is linked to these internalising problems. This systematic review and meta-analysis addressed this gap by identifying and synthesising key factors that influence the link between CV and internalising problems. We searched multiple databases, identifying 125 quantitative studies in English or Chinese that met our inclusion criteria. Our review categorised the mediators into emotional dysregulation, social support, cognitive processes, internalising problems, externalising problems and life stressors across cross-sectional and longitudinal studies with 260,608 participants from 33 countries. Separate meta-analytic structural equation modelling (MASEM) analyses revealed that emotional dysregulation, internalising problems, life stressors and social support partially mediated the impact of CV on depression/anxiety, and internalising problems partially mediated the association between CV and NSSI/suicidality. These findings highlight the need for prevention and intervention strategies focused on these mechanisms to improve youth mental well-being.

BackgroundLived experience (LE) expertise is increasingly recognised as a vital component in mental health research. In our project to develop a digital tool for counterfactual analysis (DigiCAT), with an emphasis on researching active ingredients for adolescent mental health, we incorporated LE expertise across the lifecycle of tool development and dissemination.MethodsWe consulted young person advisory groups (YPAGs; aged 11-18 years old) across three project phases-Discovery, Prototyping, and Dissemination-using structured discussions, ranking exercises, and iterative feedback loops to shape research priorities, tool design and user tutorials, and dissemination strategies of the tool.ResultsThe YPAGs advised on active ingredients and features of such ingredients that existing research has not taken into account. Examples include young person advisory group (YPAG) suggestions to prioritise research in social media, peer relationships, and teacher-student relationships. We incorporated these suggestions as illustrative examples in our tutorial paper introducing DigiCAT to our target audience, to demonstrate how insights from YPAGs can inform the use of the tool in research, by guiding areas of study. These areas were also prioritised in our own empirical analyses using the tool. Additionally, the YPAG contributed practical guidance on how to effectively involve youth LE experts in both research and digital tool development processes.ConclusionsThe integration of LE expertise fundamentally shaped the development of our tutorial paper, influencing both its instructional components and its broader discussion of applications in mental health research. This project highlights the value of embedding LE perspectives into research guidance for software use, offering a model for future mental health and digital innovation initiatives.

Emotion regulation difficulties affect many adolescents with attention-deficit/hyperactivity disorder (ADHD), and previous research has highlighted a need for accessible interventions to support them in this domain, especially in real-life contexts. Digital health interventions (DHIs) can be embedded in adolescents’ daily lives and thus offer considerable promise for meeting this need. However, there is a lack of information to guide the development of suitable emotion regulation DHIs for this population. The goal of this study is, therefore, to identify recommendations to guide the development of emotion regulation DHIs for adolescents with ADHD. This narrative review synthesizes diverse relevant evidence to inform their development, including promising therapeutic approaches and components and relevant design and development considerations. We find that there is very little direct evidence of “what works” for emotion regulation DHIs and emotion regulation interventions more generally for adolescents with ADHD; however, we identify promising therapeutic approaches for new DHIs. We also recommend following a co-design or coproduction approach with adolescents with ADHD, including exploring elements designed to motivate and engage young people to support sustained adherence. We conclude that DHIs are a promising approach for emotion regulation interventions for adolescents with ADHD, could draw on a range of existing therapeutic approaches, and should be co-designed with users themselves.

Background Reading has been proposed as a protective factor in mental health; however, evaluating this is challenging due to a lack of trials and the possibility of confounding in observational studies.Methods We used the complementary approaches of covariate balancing propensity score weighting and random intercepts cross-lagged panel models in the large longitudinal Zurich Project on Social Development from Childhood to Adulthood study. Outcomes were measured from age 13 to 20 for anxiety and depression and at age 20 for psychosis-like symptoms.Results After accounting for potential confounding there were no significant effects of reading frequency on adolescent mental health across either approach.Conclusion Increasing reading frequency without considering motivation, content and style of reading engagement is not a promising protective factor in adolescent mental health.

Care-experienced mothers represent a vulnerable population at the intersection of complex childhood adversity and the challenges of parenthood, making them a crucial focus for research on mental health. The current study aimed to explore how care-experienced women perceive and manage the impact of motherhood on their mental health. Using interpretative phenomenological analysis, we examined how care-experienced mothers interpret and make sense of motherhood and mental health in their specific contexts. Through the analysis of five mothers' interviews, four superordinate themes were identified: (1) The value and fragile benefits of motherhood; (2) When the past and present collide; (3) The value and power of identities; and (4) Engagement with services: the push and pull. The findings suggest that care-experienced mothers are more vulnerable to distress when their identities are solely tied to motherhood and when they experience power imbalance in support services. This highlights the importance of fostering self-worth beyond the maternal role and the need to provide accessible non-stigmatizing services. It is therefore important for policymakers and health professionals to work in collaboration with care-experienced mothers to establish compassionate, tailored, and ongoing support beyond statutory care. This support will be crucial in helping mothers with care histories maintain better mental health and consequently equip them to develop healthier relationships with their children and themselves.

Previous evidence has suggested a strong association between school exclusion and mental health. However, as mental health risks are themselves related to the risk of experiencing a school exclusion, it has been challenging to determine the extent to which school exclusion impacts later mental health, as opposed to reflecting a marker for pre-existing risks. In this study we therefore used an inverse propensity weighting approach in the Next Steps dataset (N=6,534, from wave 1, 2014, to wave 8, 2015). We found that after weighting for propensity of treatment scores estimated based on a wide range of factors, there was a significant effect of school exclusion on a wide range of mental health and wellbeing outcomes. These results provide some of the most robust evidence to date that school exclusion harms long-term mental health. They imply that policies should aim to reduce exclusion and ensure access to preventative mental health support for those who experience a school exclusion.

Future time perspective (FTP) is a general mental capacity to anticipate future, which activates self-regulation (e.g., goal-seeking behaviours). It has been shown negatively associated with various psychological problems cross-sectionally. However, this association requires corroboration from longitudinal within-person analyses, and in domain-specific FTP. Random intercept cross-lagged panel models (RI-CLPMs) with several adjustments and sensitivity analyses were fitted to the z-proso longitudinal data to analyse how occupational FTP and psychological/neurodevelopmental outcomes (ADHD/externalising/internalising problems) covaried across ages 13, 15, and 17 (controlling for sex, SES, school type). A small effect was found (FTP at age 15 predicting externalising problems at age 17, β= .146, p= .05) in a RI-CLPM, and in a (contemporaneous) reciprocal panel model specification ADHD at age 17 predicted FTP at age 17 (β= -.310, p= .024). However, no cross-lagged effects were found to be robustly supported across different model specifications/adjustments.

Background: Given the challenges and resources involved in mental health intervention development and evaluation, it is valuable to obtain early evidence on which intervention targets represent the most promising investments. Observational datasets provide a rich resource for exploring these types of questions; however, the lack of randomisation to treatments in these data means they are vulnerable to confounding issues. Counterfactual analysis refers to a family of techniques within the potential outcomes framework that can help address confounding. In doing so, they can help differentiate potential intervention targets that may reflect genuine active ingredients in mental health from those that are only associated with mental health outcomes due to their common dependence on ‘third variables’. However, counterfactual analysis is rarely used for this purpose and where it is used in health research it is often implemented in a suboptimal fashion. One key reason may be a lack of accessible tutorials and software that embeds best practices. Method: To help promote the principled use of counterfactual analysis we developed DigiCAT. DigiCAT is an open digital tool built in R and Shiny that implements a range of counterfactual analysis methods. It is accompanied by accessible tutorials. The tool has been designed to handle real data, with capabilities for missing data, non-binary treatment effects, and complex survey designs. Results: The current article describes the development of DigiCAT, drawing on user and lived experience expert input and provides an overview of its features and examples of its uses. Conclusions: Counterfactual analysis could help prioritise intervention targets by establishing which ones remain associated with mental health outcomes after accounting for potential confounding. Accessible digital tools supported by clear guidance may help promote the uptake and principled use of these techniques.

Many autistic adolescents and young adults present with aggressive behaviours, which can be challenging for caregivers. The present study aimed to explore the underlying mechanisms between social communication understanding and aggressive behaviours in autistic and non-autistic adolescents, specifically the role of emotional dysregulation and its impact on avoidance with caregivers. Caregivers of autistic (n = 275) and non-autistic adolescents (n = 123) completed standardised caregiver-report questionnaires measuring social communication understanding, emotional dysregulation, avoidance between the adolescent and caregiver and aggressive behaviours. A serial mediation analysis indicated that levels of social communication understanding were indirectly associated with aggressive behaviours. This occurred through increased emotional dysregulation, which may have led to increased avoidance between the autistic and non-autistic adolescents and their caregivers. These findings support a sequential process by which adolescents with low social communication understanding are more likely to behave aggressively through being emotionally dysregulated and the impact of this on the increased avoidance within the caregiver–adolescent dyad. This process was found within autistic and non-autistic adolescents, suggesting a mechanism across individuals with aggression. These findings indicate that interventions based on improving emotion regulation ability and responses between adolescents and their caregivers may aid in reducing aggressive behaviours in adolescents and young adults with lower social communication understanding.

Experiences of childhood psychological maltreatment have been found to be associated with various mental health outcomes, and this association persists into adulthood. This study investigated whether some types of psychological maltreatment are more harmful than others; whether the harms associated with different types of psychological maltreatment are generalized or specific to particular domains of psychopathology; and whether the associations vary by gender. Participants (N = 544, 63.9% mother as primary caregiver) were Chinese adults from various regions in China. Participants completed measures of childhood psychological maltreatment experiences perpetrated by their primary caregiver and the mental health outcomes of depression, anxiety, anger, physical aggression, and hostility. The data were analyzed in a hierarchical model in which depression and anxiety were defined as indicators of an internalizing factor, while anger, physical aggression, and hostility were defined as indicators of an externalizing factor. Internalizing and externalizing then defined a higher-order general psychopathology factor. The results suggested equivalent harms of psychological abuse and psychological neglect. Further, the associations between psychological maltreatment and mental health were not unique to specific symptoms domains but showed broadband associations with general psychopathology. These findings suggest that trans-diagnostic interventions may be the most effective approach for addressing the mental health impacts of psychological maltreatment.