Objective Children and young people (CYP) presenting in mental health crisis to acute paediatric settings represent a growing clinical and system-level challenge. These environments, primarily designed for physical healthcare, frequently lack tailored, evidence-based digital tools to support risk mitigation and clinical decision-making in safety-critical situations. In response, we co-developed a prototype digital risk mitigation pathway, designed as a clinical decision support system, to enhance safety and care quality for CYP in crisis. This study examined the feasibility of implementing this pathway across diverse general hospital contexts. Methods We conducted a multi-site, exploratory mixed-methods study using a multiple case study design across three acute paediatric hospitals in England. Data were collected between October 2022 and March 2023 through organisational surveys, documentary analysis, semi-structured interviews and focus groups. Qualitative data were analysed inductively, with within-case analysis followed by cross-case synthesis to identify patterns of barriers and enablers influencing implementation feasibility. Results Three organisational surveys were completed, 13 organisational documents analysed, and 30 healthcare professionals participated in interviews and focus groups. Five overarching themes were identified as key determinants of implementation: digital infrastructure; information and communications technology training and support; communication; information governance; and healthcare professional attributes. Marked variation in digital maturity was observed across sites. Feasibility was strongly shaped by the alignment of digital readiness with clinical safety requirements, device availability, workflow integration, governance processes and workforce support in time-pressured crisis care. Conclusion This study provides novel, contextually grounded insights into the organisational and workforce determinants shaping the feasibility of implementing digital decision support in acute paediatric care. Our findings highlight the central importance of aligning digital readiness with clinical safety priorities and addressing multi-level implementation challenges. These insights offer actionable evidence to inform the design, deployment and scaling of contextually responsive digital health interventions for CYP admitted in mental health crisis.

OBJECTIVE:This study aimed to identify and prioritise practical risk mitigation strategies that can be implemented by paediatric teams to improve the safety of children and young people (CYP) in mental health crises admitted to acute paediatric care. DESIGN:A sequential two-stage mixed-methods exploratory study. SETTING:UK acute paediatric hospitals/wards. PARTICIPANTS:16 Healthcare Professionals/CYP experts through experience. INTERVENTIONS:None. MAIN OUTCOME MEASURES:In stage 1, risk mitigation strategies were identified through a systematic review and qualitative interviews followed by thematic analysis. In stage 2, strategies were prioritised using a hybrid Nominal Group Technique and modified Delphi process and stratified according to clinical risk level (low, medium, high, very high) using a validated paediatric mental health risk assessment framework. RESULTS:26 risk mitigation strategies were identified, of which 16 achieved expert consensus (≥70%) for clinical usefulness. Clinically actionable strategies included: structured safety checks on admission and daily thereafter; proactive environmental modification to reduce triggers (noise, crowding, ligature risks); active 1:1 observation focused on therapeutic engagement rather than surveillance; prioritisation of timely assessment and escalation to specialist mental health services and routine use of multidisciplinary safety huddles. Strategies were mapped to risk level, enabling paediatric teams to tailor interventions proportionately to assessed risk. CONCLUSIONS:This study provides an evidence-informed, consensus-based set of risk mitigation strategies that can be implemented immediately within acute paediatric care. By embedding structured safety checks, therapeutic engagement and risk-informed environmental controls into routine practice, non-mental health clinicians can enhance safety and consistency of care for CYP admitted in mental health crisis.

BACKGROUND:Mental Health First Aid (MHFA) is used in workplaces to improve mental health literacy, reduce stigma, and promote help-seeking. This paper explores how employees perceive and engage with MHFA in work settings. METHODS:This qualitative study was embedded within the EMPOWER cluster randomised controlled trial (Atanda et al., 2020). Twenty-four participants, including Mental Health First Aiders, recipients of MHFA support, employees, and senior managers, took part in semi-structured interviews. Guided by a relativist epistemological position, data were analysed using reflexive thematic analysis.(Atanda et al., 2020). FINDINGS:Three themes were identified: (1) ambiguity surrounding the purpose of MHFA; (2) uncertainty and scepticism regarding the role and effectiveness of MHFA (subthemes: Anticipated Stigma, MHFA not addressing core concerns affecting staff well-being); and (3) risks to personal relationships following disclosure. Participants questioned the purpose, boundaries, and organisational value of MHFA, contributing to reluctance to engage. Disclosure decisions were shaped by concerns about stigma, confidentiality, and potential impacts on workplace relationships and career progression. DISCUSSION:The findings suggest MHFA is most effective when part of a broader organisational commitment to employee wellbeing. Clarifying MHFA's purpose, addressing workplace stigma, and tackling organisational sources of distress may improve engagement and strengthen mental health initiatives. CLINICAL TRIAL REGISTRATION:Clinicaltrials.gov NCT04311203. Registered on 17 March 2020, protocol published in 2020.

Seasonal affective disorder (SAD) is a seasonal pattern modifier to recurrent major depressive disorder. Despite cognitive behavioural therapy (CBT) having a strong evidence base of efficacy for depression, little research exists assessing CBT for SAD, especially in the acute phase of depression during winter months. The aim of this study was to determine the efficacy of CBT for acute SAD in adults. Eligible randomised controlled trials (RCTs) testing the efficacy of CBT on depression symptoms in adults with SAD were included. Depression outcomes were assessed using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. A meta-analysis using a fixed effects model was conducted to assess the effects of CBT on depression symptoms compared with light therapy (LT) at post-intervention and 1–2 years follow-up. Narrative synthesis was used for recurrence and remission rates. Three RCTs and two follow-up papers met the inclusion criteria. All RCTs measured efficacy of group-CBT for acute SAD and compared to LT. There was substantial variation in risk of bias for all outcomes across the trials. Three RCTs (n=220 participants) were included in the meta-analysis that found CBT was effective in reducing depressive symptoms compared with LT at 1–2-year follow-up post-intervention [MD=–4.5, 95% confidence interval (CI) (–6.88, –2.12), p<0.05]. There was no difference between CBT and LT at immediate post-intervention. Group-CBT appears equivalent to LT in treating acute SAD in adults at post-intervention, but appears more effective at long-term follow-up. The findings should be taken with caution due to few included studies and variation in risk of bias across studies. (1) Previous research into CBT and seasonal affective disorder has focused primarily on delivery of CBT during the non-acute phase of SAD, typically in non-winter months. (2) There are limited high quality randomised controlled trials testing the efficacy of CBT for seasonal affective disorder in the acute phase during winter months. (3) It appears that group-CBT for SAD is superior to LT at 1–2 years follow-up.

Poor mental wellbeing is a common challenge for healthcare workers. Mobile application-based interventions have shown growing attention to improve mental wellbeing due to their accessibility, cost efficiency, and ease of use. This study aims to assess the feasibility of a self-monitoring based mobile app to promote mental wellbeing of healthcare workers/trainees in the UK. Two-arm feasibility randomised controlled trial (RCT) will be conducted. While the control group will be informed about mental wellbeing improvement steps on a NHS website, the intervention group will use the mobile application (MYARKEO) for 6 weeks. Pre and post data will be collected through the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression Anxiety and Stress Scale (DASS-21), and the mHealth App Usability Questionnaire (MAUQ). Semi-structured interviews will be conducted with the intervention group. Primary outcomes will include (1) recruitment rate, (2) adherence to the intervention and control groups, (3) data collection procedures, (4) attrition rates and underlying reasons, and (5) the usability of the mobile app. The interviews will provide better understanding of user interactions with the mobile app.

Mental health (MH) problems in children and young people (CYP) are on the rise, negatively affecting their quality of life. General Practitioners (GPs) are the first port of call for any health-related issue; however, it has not been fully explored what kind of training, tools or management strategies they use for CYP’s MH. The study’s aim was to explore and report experiences, challenges and strategies that GPs in the UK have to address the MH needs of CYP. Ten semi-structured interviews were conducted with GPs. Qualitative content analysis was used resulting in two themes and five subthemes. Most GPs reported receiving experiential training to address MH issues on CYP and explained some of the most common presentations and whether these are primary or secondary causes for consultation. In the second theme ‘Management Approaches’, GPs draw on different barriers to communicating with CYP and their families or other relevant parties (school for instance), but they also discuss treatment approaches including pharmaceutical. Participants shared myriad tools, resources and strategies they have used to address CYP’s MH. Although GPs provided valuable insights on this topic, the study shows an urgent need for providing systematic training and management strategies to respond to MH problems appropriately.

Gender-affirming support from one's family is psychologically protective for trans and gender diverse (TGD) youth. However, the psychological processes through which family-based support is associated with mental health and well-being within this population are not yet understood. The Social Identity Approach to Health (SIAH), which highlights the important role of social group membership for people's health and well-being, was used to address this gap within a sequential explanatory mixed-methods design. Study 1 utilized an online survey (N = 140) to demonstrate that family identification is associated with reduced symptoms of anxiety and depression and increased well-being, which was mediated by increased social support and reduced loneliness. Using semistructured interviews (N = 27), Study 2 built on the findings from Study 1 by understanding the nature of young TGD people's experiences of their family groups, family support, loneliness, and mental health. Four main themes were found: (a) I can't be me when I am around you; (b) The psychological costs of authenticity; (c) Increasing the likelihood of receiving familial support; (d) The missing part of the jigsaw. Together, these studies provide a theoretical framework to understand why family support (from both bio-legal and nonbio-legal families) can be protective and/or harmful for young TGD people's mental health and well-being.

BACKGROUND:Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. AIM:To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. METHOD:Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. RESULTS:Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CONCLUSION:CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

In the United Kingdom, the prevalence of children and young people (CYP) accessing acute paediatric inpatient care with mental health problems is increasing, with self-harm and eating disorders particularly prevalent. This study evaluated CYP experiences of being in receipt of acute paediatric inpatient care following either self-harm or crisis stemming from an eating disorder to inform domains for a person-centred outcome measure (PCOM). A series of stakeholder engagement events were conducted between April and July 2015 where creative approaches were used to explore stakeholder experiences of care and to identify outcome domains that were subsequently prioritised using a Nominal Group Technique. Data were analysed using inductive thematic approach, with significance scores calculated for domain statements. Ninety-six stakeholders (15 CYP, eight parents and carers, and 73 professionals) participated. Findings showed five priority PCOM domains: privacy and surveillance; holistic care; making choices, appropriate communication; working together to achieve care goals; and respect and empowerment. This single centre evaluation highlights the need for a PCOM to be developed for this patient group that comprehensively reflects stakeholders' expectations in order to inform improvements to quality of acute paediatric care.

ENGAGING WITH STAKEHOLDERS TO EXPLORE PROOF-OF-CONCEPT FOR A MOBILE APPLICATION AIMED AT IMPROVING MENTAL WELLBEING IN NURSES: A TRAINER-LED EDUCATION AND QUALITATIVE INTERVIEW STUDY

Background The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant women (aged 16–24 years) in a future study. Methods This project was formed of three main phases conducted from March to August 2022: (1) mapping nature activities available across the East Midlands region and two focus groups with providers of nature activities ( n = 6); (2) public participation and involvement work to inform future research. This included four focus groups with young women ( n = 11), leading to the formation of a new young women’s panel (Research Influencers Group). Networking and stakeholder engagement to support future research. Results The mapping survey identified 68 nature-based organisations/projects operating in the region, many of whom expressed interest in being involved in future research. The young women’s focus groups confirmed the importance of the topic and generated a wealth of information to support the intervention design. A Research Influencer Group of five young women was established from the focus group participants. The Research Influencer Group chose the nature-based intervention and had input into all aspects of the study design. This group will continue into future projects. Focus groups with providers of nature activities have further advanced the study design. The project team have developed relationships with relevant stakeholders and networks that will inform the future trial. Conclusion This preparatory co-design work suggested that a nature-based intervention may be acceptable to young women, and providers of such interventions felt it was feasible to offer these activities to young pregnant women. This preparatory work has led to an outline research plan which has been co-produced with public contributors and stakeholders throughout. Limitations This preparatory work is limited by small focus group samples, and the possibility that not all providers were reached through the snowballing approach to the mapping survey. Future work Future research is needed to test the nature-based intervention; this would be in the form of a feasibility randomised controlled trial of nature-based interventions to promote the mental health and well-being of young pregnant women. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135167.

Objectives Acne is the most common skin disorder of adolescence. Adolescents and young adults with acne have an increased risk of depression and self-harm. Oral isotretinoin is an effective therapy for severe acne however its use is limited by safety concerns regarding the risk of depression, self-harm and suicide.1 Assessment and monitoring for adverse mental health events is established as an important outcome for clinical trials of acne therapies.2 We aim to identify validated and freely available PROMs for use with AYA aged between 12–25 years that measure one or more of the following constructs: depression, self-harm, suicidality for use in clinical trials of acne therapies. Methods We undertook a scoping review of contemporary literature adhering to a published framework3,4 to identify validated and freely available PROMs for young people aged between 12–25 years that measure one or more of: depression, self-harm, suicidality. We included PROMS that had a parent report component. We excluded PROMS that are designed for use in a population outside the age of interest or for use with a specific health population. We also excluded PROMS that had more than 35 items or did not primarily measure one of the key constructs Results The scoping review identified 97 PROMS meeting the inclusion criteria n=58 for depression, n=18 for self-harm and n=22 for suicidality. On application of the exclusion criteria this was filtered to a total of 33 PROMS measuring depression n=30 (table 1) and suicidality n=3 (table 2). The PROMS were categorised by their utility at with different ages (tables 1 & 2) as not all PROMS were validated for use in all adolescents and young adults. A parent report component was present for 5 of the depression PROMS (table 1). No suitable PROMS for self-harm were identified. Conclusion This scoping review identified a wide range of validated and freely available PROMS for depression in AYA including several that have a parent report component. Only a limited number of suicidality PROMS that would be suitable for clinical trials of acne therapy were identified and no suitable PROMS for self-harm were found. The next steps will be work with AYA, parents/carers and expert clinicians and researchers to determine the acceptability, feasibility and utility of the identified PROMS before we can recommend which are most appropriate for use in clinical trials of acne therapies. References Paljarvi T, McPherson T, Luciano S, Herttua K, Fazel S. Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data. Br J Dermatol 2022;187:64–72. https://doi.org/10.1111/bjd.21049 Layton AM, Eady EA, Thiboutot DM, Tan J; Acne Core Outcomes Research Network (ACORN) Outcomes Identification Group. Identifying What to Measure in Acne Clinical Trials: First Steps towards Development of a Core Outcome Set. J Invest Dermatol. 2017 Aug;137(8):1784–1786. doi: 10.1016/j.jid.2017.04.017. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005;8(1):19–32. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Sci 5, 69 (2010). https://doi.org/10.1186/1748-5908-5-69

Background Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention. Aims To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK. Method In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression. Results This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health. Conclusion The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.

Background/Aims Media coverage has highlighted the difficulties encountered by young people in the UK in accessing appropriate mental health care after turning 18 years old. Little appears to be known about the experiences of 18–25-year-olds and their carers of receiving adult mental health services. This systematic review aimed to synthesise the qualitative evidence on the experiences, views and beliefs of emerging adults and their carers of using mental health services in the UK, using meta-ethnographic methods to identify the current research, any gaps in research and directions of future research. Methods A systematic review and meta-ethnographic synthesis of nine qualitative studies was conducted. Three overarching themes were found: locus of control, embarking into adulthood, and accessibility and engagement. Results Emerging adults view embarking into adulthood as an essential part of their recovery. A reappraisal of the balance between confidentiality and collaboration with family, for this age group, is suggested. Emerging adults perceive stigma from service providers, which creates a barrier to accessibility and engagement with services. A coaching approach to care could support social inclusion, facilitate choice and promote self-determination for this cohort Conclusions Addressing embarking needs, the locus of control and the accessibility of services may improve emerging adults’ experience of using mental health services. There is an impetus for mental health nurses to consider a coaching approach to care planning.

Background Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches.

Anxiety disorders are the most prevalent mental health issues worldwide and can have significant detrimental effects on people's quality of life and daily functioning. Nurses in a range of healthcare settings are likely to encounter people with various anxiety disorders, so it is essential that they have adequate knowledge and understanding of these conditions. This article explores the development of anxiety, before outlining the aetiologies and symptoms of common anxiety disorders. The author also provides an overview of some of the treatments available for anxiety disorders and explains the nurse's role in supporting those affected by these conditions.

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups (n = 6) were conducted with nature activity providers and young mothers (n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women's engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.

BACKGROUND:Using technology to deliver psychosocial interventions such as reminiscence therapy (RT) to people with dementia may improve their mental health. Yet, establishing the feasibility of digital interventions in low- to middle-income countries is still in the early stages. This study aimed to: (i) determine the feasibility of using digital touch screen technology to deliver RT among people with dementia living in Jordanian care homes; and (ii) compare study outcomes pre- and post-reminiscence sessions to investigate whether specific outcomes are sensitive to change and explore the acceptability and experiences of the intervention.METHODS:A pragmatic mixed-method study design was implemented. Sixty residents with dementia were recruited from two Jordanian care homes (Site 1: n = 35; Site 2: n = 10). A process evaluation was conducted alongside a single-group pre-post-intervention study. The intervention involved 10 supported RT sessions of up to 1 h each, delivered over 5 weeks. Feasibility was determined by assessing the rate of recruitment, adherence, retention, data completion, implementation fidelity, and adverse events. Qualitative semi-structured interview questions were used to explore experience and acceptability, and data were thematically analysed.RESULTS:Response rate was 100%; loss to follow up at post-intervention was 25%. Median session attendance for those who received the intervention was 80%. No serious adverse events were reported. A positive, statistically significant and clinically relevant difference was found in all outcome measures before and after reminiscence sessions. Qualitative findings suggest that digital RT intervention is generally well accepted by people with dementia who reported positive changes, including enhanced communication and cognitive abilities.CONCLUSION:Using digital touch screen technology to deliver RT is feasible and acceptable among people with dementia in Jordanian care homes. Digital RT intervention is a promising approach to improving mental health and communication for people living with dementia.