A third of adolescents aged 11 to 19 years report depression symptoms, yet many go undiagnosed or do not receive timely treatment. Those who do seek support often face barriers including stigma and long waiting times, resulting in a significant needs-access gap for adolescents looking to access treatment for depression. Parents play a central role in recognizing adolescents’ symptoms and seeking treatment for them. To deepen the understanding on how to better support parents to support their adolescent child, this meta-synthesis aimed to systematically review qualitative studies on parents’ lived experiences of having an adolescent with depression. A pre-planned systematic search using five databases identified 25 papers meeting full inclusion criteria. Data were extracted and a thematic synthesis was conducted using NVivo, with reporting following PRISMA guidelines. Six themes were generated: (1) How do you know when your adolescent has depression?; (2) Understanding the causes of adolescent depression; (3) Emotional turbulence in parents; (4) Effects on the whole family; (5) Experiences with help-seeking; and (6) Stigma and judgment from others. The findings collectively highlight the need for increased parental involvement in professional treatment provision for adolescent depression, alongside better support for parents’ own wellbeing, and improved access to psychoeducation and parent-directed interventions for adolescents with depression. PROSPERO registration ID CRD42024527144. This systematic review synthesizes evidence on the lived experience of parents of adolescents with depression. 25 papers published between 2004 and 2025 were included in the meta-synthesis. Parents struggle to recognize depression symptoms in adolescents and report self-blame, helplessness and distress. Parents are motivated to initiate the help-seeking process, but their experiences with professional support vary. There is a need for parent-directed support and increased parental involvement in adolescent depression treatment.

Abstract Introduction Poor sleep has been linked to a range of negative physical and mental health outcomes in young people. Although effective treatments exist, issues with accessibility and engagement remain. Project Sleep is a Single Session Intervention (SSI) developed based on behavioral principles of evidence-based treatments and structured according to SSI principles. Developed with young people in the US and UK, participants receive sleep psychoeducation, engage in a personalized activity focused on behavioral principles for their sleep problem (e.g., insomnia, sleep irregularity), and develop an action plan. The current study is an international collaboration of a pre-post programme evaluation to test the preliminary effectiveness of Project Sleep for motivation to improve sleep. Methods A total of 1,027 young people (ages 13-25 years) who self-identify as having sleep problems participated in Project Sleep. Participants were recruited from the community in the US and UK and through participant registry pools at the universities. The mean age was 18.79 years, 79% identified as girls, and 46% had minoritized racial/ethnic identities. Participants completed a program feedback scale (1-5), as well as their motivation, control, and readiness to improve sleep rated pre-post SSI (on 0-10 scale; 10 = most). Results Most participants reported 6.79 hours of sleep per night (SD=1.48) and most (80%) reported clinical insomnia symptoms (ISI=11.73; 8-23). Participants reported their biggest sleep challenge as “difficulty falling or staying asleep” (41%), “trouble keeping a regular sleep schedule” (40%), or “Not feeling ready for sleep at bedtime” (19%). On average, Project Sleep took 18.19 minutes (SD=11.89). Participants agreed the program was easy (M=4.69), helpful (M=4.39), and would recommend it to a friend (M = 4.30). Participants’ ratings increased pre-to-post SSI across all domains, with most notable gains for perceived importance of improving sleep (pre=7.48; post=8.73) and control over improving sleep (pre=4.97; post=6.88). Conclusion Project Sleep demonstrated initial acceptability and effectiveness for enhancing knowledge about and motivation to improve sleep. Project Sleep has the potential to improve scalability of access to effective, evidence-based strategies to improve sleep and health among young people. Support (if any)

Sleep problems rise in prevalence during adolescence and young adulthood and pose risk for a myriad of negative mental and physical health outcomes. Existing behavioral sleep interventions assumes existing moderate to severe sleep problems and that these problems are caused by behavioral habits, not structural/environmental factors. This study tested the proximal impacts of Project Sleep, a digital single-session intervention (SSI) for young people with mild sleep problems OR an interest in learning about sleep habits, with the aim of reducing and preventing sleep problems. This study specifically investigates whether there are differential effects of the intervention for those with structural sleep barriers, to lay the groundwork for future randomized controlled trial and long-term follow up studies assessing the effects of this intervention for this group. Participants were aged 13-25 with self-reported sleep problems (N=759, Mage=18.7; 48% white, 81% girls, 38% LGBTQ+). Structural sleep barriers were reported by 45%: uncomfortable temperature (20%), exceess noise (17%), shared rooms (13%), excess light (10%), nighttime workers in the home (7%), unstable living conditions (2%). Participants rated perceived importance of sleep and making a change to sleep, readiness for change, and perceived control over sleep pre- and post-SSI. Moderation models assessed whether structural factors influenced outcomes. T-tests and correlations tested whether participants’ feedback differed by structural barriers. After adjusting for multiple comparisons, those experiencing structural barriers improved similarly to peers on all pre/post-SSI change metrics (corrected ps > .05). There were also no differences in participants’ feedback about their experience of the SSI by structural barrier (ps > .05). This study thus provides preliminary evidence that Project Sleep may be an effective sleep health promotion tool among young people, including those with structural sleep barriers. However, given this study measured only proximal impacts, future research should continue to test these questions using a randomized controlled trial and long-term follow-up design.

Background:Single-session interventions (SSIs) are emerging as one promising way to support one's mental health. Growth mindset refers to the beliefs about the malleability of traits and attributes. Building upon a feasibility study of a growth mindset single session intervention, this randomised controlled trial aimed to evaluate its efficacy when delivered online to young people. Methods:We recruited participants aged 14-18-year-olds via social media, schools, and charities in the UK. They were randomised to receive either an online video-based intervention or were placed on a waitlist control. They reported anxiety and depression symptoms, as well as personality mindset and psychological flexibility at baseline and at 1-month follow up. An intention-to-treat (ITT) analysis and a case completer analysis were conducted. Results:In a sample of 104 participants (mean age = 16.3), an ITT analysis yielded negligible effects on anxiety and depression symptoms (d = 0.07, 95% CI: [-0.32, 0.47]) and psychological flexibility (d = -0.12, 95% CI: [-0.50, 0.25]) at 4-week follow-up. The personality mindset measure yielded a significant large effect relative to waitlist (d = -0.96, 95% CI: [-1.87, -0.04], p = 0.02), however it was statistically non-significant with Bonferroni correction. Case completer analysis resulted in similar observations. Conclusion:The intervention impacted personality mindset but had limited effect on anxiety and depression. Large sample sizes, improve retention rate, and a longer follow-up period are needed in future studies.

Objectives: Sleep problems are linked to negative mental health outcomes, both of which rise in prevalence during adolescence and young adulthood. Existing evidence-based sleep treatments are effective but remain largely inaccessible for this age group. Young people also have lower agency over structural barriers affecting sleep (e.g., home environment, school start times). Methods: Project Sleep is a digital single-session intervention (SSI) designed with feedback from young people. Participants were aged 13-25 with self-reported sleep problems (N=759, Mage=18.7; 48% white, 81% girls, 38% LGBTQ+). Structural sleep barriers were reported by 45%: uncomfortable temperature (20%), exceess noise (17%), shared rooms (13%), excess light (10%), nighttime workers in the home (7%), unstable living conditions (2%). Participants rated perceived importance of sleep and making a change to sleep, readiness for change, and perceived control over sleep pre- and post-SSI. Moderation models assessed whether structural factors influenced outcomes. T-tests and correlations tested whether participants’ feedback differed by structural barriers. Benjamini-Hochberg correction was used to adjust for multiple comparisons. Results: After adjusting for multiple comparisons, those experiencing structural barriers improved similarly to peers on all pre/post-SSI change metrics (corrected ps > .05). There were also no differences in participants’ feedback about their experience of the SSI by structural barrier (ps > .05). Conclusions: This brief, accessible SSI provides proximal support for youth with structural sleep barriers. However, areas that could benefit from continued adaption are discussed. Future research will work with young people experiencing structural sleep barriers to best address their needs.

This project investigates initial feasibilty, acceptability, and proximal outcomes for Project Sleep, a single-session intervention designed to mitigate sleep problems among young people.

BackgroundMental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. ObjectiveCOMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. MethodsWe conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. ResultsOf the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD –1.31, 95% CI –2.51 to –0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD –1.33, 95% CI –2.10 to –0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants’ favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects. ConclusionsThis study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement. Trial RegistrationClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141

BACKGROUND:Providing digital mental health interventions online could expand access to help for young people, but requiring parental consent may be a barrier to participation. We therefore need a method that enables young people <16 years old (ie, presumed competent in the UK) to demonstrate Gillick Competence (understanding of purpose, process, potential benefits and potential harms) to self-consent to online, anonymous, low-risk studies. AIM:To explore whether a new method for assessing Gillick Competence to participate in low-risk, anonymous online studies is acceptable to both young people and parents. METHODS:We interviewed 15 young people aged 13-5 years and 12 parents of this age group in the UK. Using a qualitative approach, we explored the acceptability of a series of multiple-choice questions (MCQs) designed to assess understanding of a specific online self-help research study testing a self-kindness intervention. RESULTS:The MCQ answers that participants gave mostly corresponded with their narrative explanations of their understanding during interviews. Young people and parents thought that the process was empowering and could increase access to research while also promoting independence. However, they emphasised the importance of individual differences and different research contexts and highlighted the need for safeguards to be in place. CONCLUSIONS:The MCQs were acceptable to both young people and parents, providing preliminary evidence for the potential of this process for allowing <16s to self-consent to online, anonymous, low-risk mental health research. Further research is needed to validate the effectiveness of this process among a diverse range of populations and research contexts.

Augmented Depression Therapy (ADepT) is an individual psychotherapy for depression, which has been shown to be effective in the general adult population. A randomised multiple baseline case series evaluated the feasibility, acceptability, and effectiveness of ADepT in young adults (aged 20-24). Eleven depressed young adults were recruited from a UK university wellbeing service to receive ADepT during the COVID-19 pandemic, with outcomes evaluated relative to pre-specified continuation targets. All participants received a minimum adequate treatment dose (>60% target); 89% judged ADepT as acceptable and satisfactory and would recommend it to others (>60% target); only 9% showed reliable deterioration for depression or wellbeing (meeting <30% target); and there were no trial- or treatment-related serious adverse events. Qualitative interviews revealed most participants were satisfied with and experienced benefits from ADepT. At post-treatment, reliable improvement was shown by 33% of participants for depression and 67% of participants for wellbeing (not meeting target of both >60%), with medium effect size improvements for depression (g = 0.78) and large effect size improvement for wellbeing (g = 0.93; not meeting target of both >0.80). ADepT is feasible, acceptable, and safe in young adults but may require modification to maximise effectiveness. Further research outside of the COVID-19 pandemic is warranted.

Objective Young people in low- and middle-income countries (LMICs), including South Africa, are disproportionately affected by multiple risk factors for developing mental health problems and there are numerous barriers to accessing mental health care. In such contexts non-governmental organisations (NGOs) play a key role in providing support. We report on the mental health care services provided by NGO Community Keepers in South Africa. Method Community Keepers (CK) offers psychosocial support to young people, parents, and teachers, during regular school hours, and free of charge. At the end of 2019, CK was based at 23 schools in 12 areas in the Western Cape Province, South Africa. In this paper we describe the model of service provision and present descriptive statistics from retrospective observational service data using routinely collected quantitative data from 2019, including details about referrals received, referral sources and reasons, and feedback received from children, parents, and teachers on the psychosocial support CK delivered. Results During 2019, 34 676 individuals accessed 18169 psychosocial support sessions rendered by CK. The most common referral source of learners to CK was self-referrals (40.6%), and the main referral reasons were emotional (psychological) problems, behaviour problems, or family (community) problems. At termination of therapy 320 (79.2%) learners said they strongly agreed that they would recommend CK to someone at their school. At termination of therapy with learners, 95 (39.3%) teachers rated CK’s services as excellent, 139 (57.4%) teachers gave a rating of good, and 204 (79.7%) parents reported an improvement in their relationship with their children. Conclusions CK is an example of how psychosocial support can be embedded in schools in a LMIC. CK’s multifaceted model of service delivery could be used by other school-based mental health care service providers in other LMICs to inform and/or refine the services that they wish to offer.

Most of the world's population of young people live in lower-and middle-income countries (LMICs; (Weine, Horvath Marques, Singh, & Pringle, 2020)), and these young people experience heightened rates of known risk factors for developing mental disorders such as poverty and exposure to trauma (Atwoli, Stein, Koenen, & McLaughlin, 2015). Access to professional psychological treatments is limited in LMICs due to structural barriers (e.g., a dearth of trained professionals) and cultural factors like stigma and beliefs about mental health and illness. Therefore, schools, which are widely attended, may be a good location for providing mental health interventions, and it is important that we develop and evaluate feasible, acceptable, effective, and scalable interventions for use in this context. Yet under 10% of clinical trials of psychotherapies (Venturo-Conerly, Eisenman, Wasil, Singla, & Weisz, 2022) have been conducted in LMICs. And there are particular challenges to conducting research in schools, as has been highlighted in the UK context by Moore et al. (2022). Building on that commentary, our aim herein is to share our learnings from conducting psychotherapy research in schools in Kenya and South Africa.

INTRODUCTION:In low- and middle-income countries (LMICs), including South Africa, there is a paucity of psychosocial support services. Therefore, services are often provided in schools by non-government organisations like Community Keepers (CK). The COVID-19 pandemic and resultant restrictions meant that children and young people's (CYP) lives changed, negatively affecting their mental health. Further, organisations like CK had to change their working processes. METHOD:This project compared routinely collected data from CK from 2019 (pre-pandemic) to 2020 (pandemic) to describe the changes that occurred in referral patterns to, and service provision by, CK. RESULTS:Both pre-pandemic and during the pandemic, most referrals of CYP were for emotional/psychological support and behavioural difficulties. In 2020, referrals for general guidance increased, whilst referrals for peer group issues and sexuality decreased. Further, CK completed more brief check-ins, provided wellbeing workshops to increased numbers of teachers, parents and CYP, and had more consultation sessions with other service providers during the pandemic. DISCUSSION:Routinely collected data from this community-based service in a LMIC context shows differences in the way that support was provided, and to whom, during the COVID-19 pandemic. Clinical implications, including the importance of increasing access to psychosocial support via technology, are included.

Chronic fatigue is a distressing symptom for endometriosis patients but is not widely investigated in the literature. Our aim was to explore patients’ lived experiences of chronic fatigue and how they make meaning of it. We analysed a subset of data from seven severely fatigued endometriosis patients, drawn from a broader qualitative study in South Africa, using an interpretive phenomenological analysis. Three superordinate themes and eight subordinate themes were developed. The three superordinate themes were powerlessness, which was a core aspect of the chronic fatigue experience among participants; struggle and anguish, as their lives had become a daily struggle resulting in feelings of despair and anger; and otherness, as they felt different from their peers due to the fatigue. The findings demonstrate the far-reaching effects that chronic fatigue has in the lives of endometriosis patients, including on their self-perception, and highlights the critical need for fatigue management strategies within treatment protocols.

Background Sleep problems are common in adolescents and have detrimental impacts on physical and mental health and daily functioning. Evidence-based treatment like cognitive behaviour therapy for insomnia (CBT-I) is often hard to access, and adolescents may not engage in and adhere to longer, clinician-delivered interventions. Brief, self-guided, and accessible sleep interventions are needed. Objective To explore the user experience of a prototype online self-help single session sleep intervention developed for adolescents. Methods Eleven participants aged 17–19 years (8 females, 3 males) took part in online retrospective think-aloud interviews. Participants first completed the prototype intervention independently and were then shown the intervention page by page and asked to verbalise their thoughts and experiences. Transcripts were analyzed thematically. Results Participants found the intervention helpful. Four themes were generated - ‘Educative: Learning, but more fun’, ‘Effortless: Quicker and Easier’, ‘Personalization: Power of Choice’, and ‘Positivity: Just Good Vibes’. The theme ‘Educative: Learning, but more fun’ encompassed two sub-themes ‘Opportunity to Learn’ and ‘Aesthetics and Learning’. These themes reflected participants’ views that the intervention was educative, personalised, solution-oriented and easy to use, but could incorporate more graphics and visuals to aid in learning and could be made more effortless and positive through modifications to its design. Conclusions Findings convey the importance of ensuring educative well-designed content, personalization, a positive tone, and ease of use while designing interventions targeting adolescents’s sleep and mental health. They also indicate areas for further developing the intervention.

Objective Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom‐based programme for the promotion of mental health in young adolescents. Method We pilot tested an 8 session, cognitive‐behavioural therapy‐based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners ( n = 222; Mean age = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt‐out, child assent, assessment completion at baseline and follow‐up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one‐month follow‐up. Results Most eligible learners at both schools agreed to participate (85% – school 1; 91% – school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre–post differences on self‐esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow‐up. Conclusions This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school‐based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self‐esteem and emotion regulation and was liked by the learners.

BACKGROUND:Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find. METHOD:We recruited 24 YP (aged 13-18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis. RESULTS:Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking. CONCLUSION:Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.

Emerging evidence indicates that perceptions of self-harm behaviours and self-harm scars may thwart recovery from depression, yet limited research has explored adolescent accounts of their self-harm and scars during therapy. This study sought to explore how adolescents describe their self-harm behaviours and scars during Cognitive Behavioural Therapy (CBT) and explore the sociocultural discourses that may influence these descriptions. The participants were six female adolescents (aged 14-17 years old) with clinical depression, who were engaging in self-harm. All participants accessed CBT as part of clinical trial evaluating three psychological treatments for major depressive disorder in Child and Adolescent Mental Health Services. Audio-taped CBT sessions were analyzed using discourse analysis. Within CBT sessions, adolescents drew upon stigma discourses in talking about their self-harm. Adolescent also described their self-harm scars as shameful and stigmatizing, and as "proof" of the legitimacy of their depression. It is important for CBT practitioners to understand the context of sociocultural discourses around self-harm behaviours and self-harm scars, which are reflected in how adolescents with depression describe these within therapy and may serve to maintain distress. The study indicates that awareness of use of language and intersecting sociocultural discourses can inform CBT practice.

Depression is common in adolescence, and subthreshold symptoms even more so. Untreated, it is disabling. Yet, upscaling traditional clinic-based provision would be prohibitively expensive. We aimed to investigate frontline, non-specialist professionals' use of and attitudes towards technology to increase the availability of early help.Method: Cross-sectional survey of a convenience sample of professionals in the UK (N = 115, including low intensity practitioners, GPs, education staff, school nurses). The survey included rating scales and free text boxes. Quantitative data were analysed descriptively, and we used reflexive thematic analysis for the qualitative data.Results: Frontline professionals rate their technological competence as good and have favourable attitudes towards using technology to support adolescents with depression symptoms. They rated online resources as most useful with mild-moderate symptoms, compared to severe symptoms (t(110) = 14.54, p < .001, Cohen's d = 1.49). Technology was viewed as important to bridge the needs-access gap and professionals were interested in learning about online SSIs due to usefulness (r = .32, p < .001).Conclusion: Technology, such as SSIs, are of interest to mental health professionals and may be useful for supporting adolescents with depression. Future research should explore the use of SSIs for treating adolescent depression.