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Many young people with mental disorders are not identified until some years after the first onset of symptoms and then frequently do not receive professional intervention. One promising strategy to better identify these young people is mental health screening in schools. Despite a growing literature on the benefits of school-based screening, it remains a relatively uncommon practice and little is known about the practices of those schools that do screen. Moreover, the barriers that prevent schools from screening are not well understood. This study reports on the perceptions of school psychologists about universal mental health screening in schools regarding the prevalence of screening; the practices within schools that do screen; and the perceived barriers to implementing screening. Results indicated that screening remains uncommon, with only 14.8% of school psychologists working in schools that screened in the previous 12 months. The most significant barriers to screening related to being adequately resourced to implement programs, and particularly concerns about how to follow-up students identified as being at-risk. Despite this, school psychologists endorse the potential benefit of screening and report being likely to run screening programs if perceived barriers could be reduced.

In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.

Bullying is a pervasive and debilitating issue for youth that can lead to substance abuse, worse outcomes at school, mental and physical health problems, and in some instances serious acts of school violence. There are three criteria that must be present in order to be classified as bullying: Repetition, intentionality, and imbalance of power. Most efforts in this area have focused on reducing bullying behavior, with both whole of school and targeted approaches showing some success. However, a meta-analytic review of bullying interventions revealed that on average, school-based interventions led to only a small decrease in bullying (20-23%) and an even smaller decrease in victimization (17-20%) while programs that worked with peers actually led to an increase in victimization. One therapeutic technique that may help to reduce negative emotional outcomes for victims is encouraging forgiveness. The aim of this study was to determine the effects of imagery re-scripting terminating in images of either forgiveness or revenge of a bullying victimization scenario on affect and evaluative responses to the bullying.

The purpose of this paper is to determine how youth with anxiety recruited for a school-based randomized controlled trial (RCT) compare demographically and clinically to clinically referred youth with anxiety who participated in an RCT conducted in community mental health clinics. Youth ("N" = 99) with anxiety aged 12-15 years were: (a) 37 youth ("M" age = 13.70, SD = 0.89; 97.3% Norwegian; 19.0% male) from a school-based RCT and (b) 62 youth ("M" age = 13.8, SD = 1.0; 88.7% Caucasian; 29.5% male) from an RCT conducted in community mental health clinics. The youth were assessed for anxiety diagnoses, functional impairment, internalizing symptoms, and externalizing symptoms. Compared to the clinically referred youth who received care in community mental health clinics, the youth in the school sample met criteria for fewer anxiety diagnoses, lower severity of diagnoses, and less functional impairment caused by mental health problems. However, the school sample had significantly higher levels of youth-rated anxiety symptoms, "t"(95) = -2.33, "p" = 0.02, parent-rated depression, "t"(94) = 4.45, "p" < 0.001, and externalizing symptoms, "t"(96) = 2.86, "p" = 0.005. Finally, only 12.1% of the youth who met diagnostic criteria reported receiving services at a community mental health clinic in the last year. Although many of the youth in the school sample met diagnostic criteria for one or more anxiety disorders, few had received services in community mental health clinics. This suggests that recruiting in schools may help identify youth with anxiety that may not otherwise seek mental health services.

This study examined the mental health literacy of a group of adolescents, with particular reference to their ability to recognize symptoms of depression in their peers. Respondents were 202 Australian adolescents (122 males, 80 females) aged 15-17 years. Their mental health literacy was examined through a questionnaire that presented them with five scenarios of young people. Respondents showed a mixed ability to correctly recognize and label depression, although they were able to differentiate depressed and non-depressed scenarios in terms of severity and expected recovery time. Results are discussed in light of findings from adult mental health literacy and clinical implications.

This paper describes the development and psychometric evaluation of a brief self‐report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4–11) as well as depression and eating difficulties (grades 6–11), with optional items for suicidality and self‐harm (grades 7–11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4–5 and 31 items for grades 6–11 that fulfilled pre‐set criteria. Study 2 extended testing with 10,479 students in grades 4–11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6–11) creating a total of 35 items for grades 6–11. All items, for both grade‐level versions, met the pre‐set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas.87 to.95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help‐seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school‐based screening for mental health problems. [ABSTRACT FROM AUTHOR]

This study examined the impact of COVID-19 lockdowns and physical distancing requirements on engagement with and sense of connectedness to social activities among older adults. Community-dwelling cognitively healthy older adults (N = 126) completed self-report questionnaires post-lock down (November 2020 to February 2021) assessing participation format (face-to-face with restrictions, online), frequency of attendance, and connectedness with a range of existing social groups. Thirty-two percent of participants stopped and had not re-engaged with social activities post lockdown. These participants reported the lowest connectedness ratings and quality of life related to psychological health than compared to those who continued to engage with social groups, albeit in a controlled format. Adapted face-to-face formats were associated with significantly greater connectedness than engagement via online methods for hobbies, cultural activities, meal entertainment, and other social activities, but not for sporting, community, religious, or volunteering activities. Qualitative data suggested online social participation was not as enjoyable as adapted face-to-face formats. For older adults who attended social activities via online formats, sense of connectedness was reduced for some activities. Given the importance of social connectedness for well-being in late life, interventions may be needed to help older adults re-engage in face-to-face formats without restrictions. What is already known about this topic: Poor social connection is associated with reduced mental well-being and physical health in older adults. Local lockdown orders in response to the 2020 wave of the COVID-19 pandemic led to temporary closure of community activities groups, suspension of religious, sporting, and social activities. and restrictions on face-to-face contact with family. Many community organisations, social groups, and families adapted activities to online formats. What this topic adds: Older adult who stopped attending and did not re-engage in social groups had the lowest connectedness ratings and quality of life related to psychological health, compared to those who continued to engage with social groups in some format. Face-to-face engagement, even with restrictions, was associated with significantly greater connectedness in older adults than engagement online for hobby, cultural activities, meal entertainment and other social activities besides sporting, community, religious, or volunteering activities. Qualitative data suggested that online social participation was not as enjoyable as adapted face-to-face formats. [ABSTRACT FROM AUTHOR]

Research has consistently shown that more physically attractive individuals are perceived by others to be happier and better psychologically adjusted than those perceived as less attractive. However, due to the lack of longitudinal research in adolescents, it is still unclear whether poor mental health predicts or is predicted by either objective or subjective attractiveness during this critical developmental period. The purpose of the current study was to examine prospective bidirectional associations between both subjective and objective ratings of attractiveness, life satisfaction and symptoms of social anxiety, depression and eating disorders (i.e., internalizing symptoms) from early to mid-adolescence. Participants (T1: N = 528, 49.9% girls; Mage = 11.19; SD = 0.55) were followed annually over four time points. The cross-lagged panel model results revealed evidence of prospective associations between both forms of attractiveness and life satisfaction and internalizing symptoms, which were driven more by changes in the mental health outcomes than by changes in the subjective and objective attractiveness ratings. The results also indicated that the pattern, strength, and direction of the associations tested were robust across boys and girls, and white and non-white ethnic groups. Overall, the findings suggest that it is important to find effective ways of educating adolescents who are unhappy with their appearance that making changes to improve their mental health, rather than focusing on their physical appearance, will have benefits not only for how they perceive themselves but also for how they are perceived by others. [ABSTRACT FROM AUTHOR]

Many young people with mental disorders are not identified until some years after the first onset of symptoms and then frequently do not receive professional intervention. One promising strategy to better identify these young people is mental health screening in schools. Despite a growing literature on the benefits of school-based screening, it remains a relatively uncommon practice and little is known about the practices of those schools that do screen. Moreover, the barriers that prevent schools from screening are not well understood. This study reports on the perceptions of school psychologists about universal mental health screening in schools regarding the prevalence of screening; the practices within schools that do screen; and the perceived barriers to implementing screening. Results indicated that screening remains uncommon, with only 14.8% of school psychologists working in schools that screened in the previous 12 months. The most significant barriers to screening related to being adequately resourced to implement programs, and particularly concerns about how to follow-up students identified as being at-risk. Despite this, school psychologists endorse the potential benefit of screening and report being likely to run screening programs if perceived barriers could be reduced. Impact and Implications statement Universal mental health screening in schools remains uncommon. The main perceived barriers relate to adequate resources – partly in terms of available time - and to management of at-risk students. Despite these barriers, school psychologists see school-based screening as useful for student wellbeing. [ABSTRACT FROM AUTHOR]

Background: Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods: A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion: Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Trial registration: Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10th July 2019). [ABSTRACT FROM AUTHOR]

The restrictions put in place to contain the COVID-19 virus have led to widespread social isolation, impacting mental health worldwide. These restrictions may be particularly difficult for adolescents, who rely heavily on their peer connections for emotional support. However, there has been no longitudinal research examining the psychological impact of the COVID-19 pandemic among adolescents. This study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents' mental health, and moderators of change, as well as assessing the factors perceived as causing the most distress. Two hundred and forty eight adolescents (Mage = 14.4; 51% girls; 81.8% Caucasian) were surveyed over two time points; in the 12 months leading up to the COVID-19 outbreak (T1), and again two months following the implementation of government restrictions and online learning (T2). Online surveys assessed depressive symptoms, anxiety, and life satisfaction at T1 and T2, and participants' schooling, peer and family relationships, social connection, media exposure, COVID-19 related stress, and adherence to government stay-at-home directives at T2 only. In line with predictions, adolescents experienced significant increases in depressive symptoms and anxiety, and a significant decrease in life satisfaction from T1 to T2, which was particularly pronounced among girls. Moderation analyses revealed that COVID-19 related worries, online learning difficulties, and increased conflict with parents predicted increases in mental health problems from T1 to T2, whereas adherence to stay-at-home orders and feeling socially connected during the COVID-19 lockdown protected against poor mental health. This study provides initial longitudinal evidence for the decline of adolescent's mental health during the COVID-19 pandemic. The results suggest that adolescents are more concerned about the government restrictions designed to contain the spread of the virus, than the virus itself, and that those concerns are associated with increased anxiety and depressive symptoms, and decreased life satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: Preadolescent social media use is normative and could influence mental health. This study investigated: (a) Differences between preadolescent users and non‐users of various social media platforms on mental health, (b) unique links between time spent on those platforms, appearance‐based activities on social media, and mental health, and (c) the moderating role of biological sex on those relationships. Method: Preadolescent youth (N = 528; 50.9% male) completed online surveys. Results: Users of YouTube, Instagram, and Snapchat reported more body image concerns and eating pathology than non‐users, but did not differ on depressive symptoms or social anxiety. Appearance investment uniquely predicted depressive symptoms. Appearance comparisons uniquely predicted all aspects of mental health, with some associations stronger for females than males. Conclusions: Preadolescents could be encouraged to reduce their opportunities to make appearance comparisons and to invest less in their appearance on social media. Preadolescents may benefit from social media intervention programs. [ABSTRACT FROM AUTHOR]

This research investigated associations between socially prescribed and self-orientated perfectionism, and the social functioning of 510 preteens (Mage = 11.2). The study focused on predictions from the Perfectionism Social Disconnection Model (PSDM) by determining whether rejection sensitivity and social isolation, in that sequence, mediated the associations between both perfectionism types and mental health outcomes. Employing both survey and experimental methods, findings indicated that both types of perfectionism in preadolescence were associated with increased interpersonal difficulty, rejection sensitivity and feelings of social isolation, as well as higher levels of eating disorder symptoms, depression, and anxiety. Results from serial mediation analyses found general support for the theoretical predictions of the PSDM for socially prescribed perfectionism, and extending upon previous research, for self-orientated perfectionism. The age of the sample suggests that both forms of perfectionism may be important targets in programs to prevent the development of mental health problems. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a key risk and maintenance factor for many psychological disorders and is considered a transdiagnostic process. However, there are few disorder-neutral measures that assess RNT in adults, only 1 of moderate length considered suitable for children, and none that are validated for both children and adults. This study aimed to address this gap by developing a brief measure of RNT that can be used with both children and adults and can be quickly administered in research and clinical contexts. In Study 1, we administered the new 5-item Persistent and Intrusive Negative Thoughts Scale (PINTS) to 527 children (50.3% boys; Mage = 11.2). A 1-factor model fit well and was invariant for boys and girls. The scale showed high internal consistency and good stability across a 2-week interval. The PINTS was significantly associated with measures of depression, anxiety, and disordered eating and was weakly associated with adaptive forms of coping, demonstrating good divergent validity. In Study 2, there were 419 adults (38.9% men; Mage = 31.7) who completed the PINTS. The results replicated and extended the results of Study 1 by demonstrating that the PINTS had good construct, convergent, and criterion validity as well as good internal consistency and stability over time and was invariant across gender and age. It was concluded that the PINTS is a brief, valid, and useful tool for investigating RNT as a transdiagnostic process in the etiology and maintenance of psychological disorders in both children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Time spent on social media and making online comparisons with others may influence users’ mental health. This study examined links between parental control over the time their child spends on social media, preadolescents’ time spent browsing social media, preadolescents’ appearance comparisons on social media, and preadolescents’ appearance satisfaction, depressive symptoms, and life satisfaction. Preadolescent social media users (N = 284, 49.1% female; aged 10-12) and one of their parents completed online surveys. Preadolescents, whose parents reported greater control over their child’s time on social media, reported better mental health. This relationship was mediated by preadolescents spending less time browsing and making fewer appearance comparisons on social media. Parental control over time spent on social media may be associated with benefits for mental health among preadolescents. [ABSTRACT FROM AUTHOR]

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3-6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. Methods: Design: a randomised controlled trial was used. Setting: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. Secondary outcomes: the secondary outcomes were parenting practices and parent mental health. Results: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal - 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms - mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = -0.47, 95% confidence interval = [-0.81, -0.13], p = 0.006). Parents' participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. Conclusion: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood. [ABSTRACT FROM AUTHOR]

Background: The differential susceptibly hypothesis suggests that certain genetic variants moderate the effects of both negative and positive environments on mental health and may therefore be important predictors of response to psychological treatments. Nevertheless, the identification of such variants has so far been limited to preselected candidate genes. In this study we extended the differential susceptibility hypothesis from a candidate gene to a genome-wide approach to test whether a polygenic score of environmental sensitivity predicted response to cognitive behavioural therapy (CBT) in children with anxiety disorders.Methods: We identified variants associated with environmental sensitivity using a novel method in which within-pair variability in emotional problems in 1,026 monozygotic twin pairs was examined as a function of the pairs' genotype. We created a polygenic score of environmental sensitivity based on the whole-genome findings and tested the score as a moderator of parenting on emotional problems in 1,406 children and response to individual, group and brief parent-led CBT in 973 children with anxiety disorders.Results: The polygenic score significantly moderated the effects of parenting on emotional problems and the effects of treatment. Individuals with a high score responded significantly better to individual CBT than group CBT or brief parent-led CBT (remission rates: 70.9, 55.5 and 41.6%, respectively).Conclusions: Pending successful replication, our results should be considered exploratory. Nevertheless, if replicated, they suggest that individuals with the greatest environmental sensitivity may be more likely to develop emotional problems in adverse environments but also benefit more from the most intensive types of treatment. [ABSTRACT FROM AUTHOR]

Objectives In order to assist mental health services in developing countries, a key issue is the availability of psychometrically sound, brief, and cost-effective measures that have been tested within the relevant context. The present study was designed to evaluate within a young Bangladeshi population, the psychometric properties of two widely used Western measures of internalizing distress in young people: the short form of the Spence Children's Anxiety Scale and the Short Moods and Feelings Questionnaire. Method The sample included 1,360 children and adolescents aged 9-17 years ( M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh, including both community and emotionally at-risk participants. A total of 179 children were re-tested on the measures within 3-4 weeks. Results Confirmatory factor analyses showed single-factor structures for both scales in the total sample and in both community and at-risk participants separately. Multiple group analyses across gender and age-group within the at-risk and community samples showed that the single-factor structure was suitable regardless of subgroup. Analyses also indicated acceptable internal consistency, test-retest reliability and construct validity for both scales. Conclusion The two measures show promise as brief, reliable, and valid instruments for the assessment of internalizing distress among young people from Bangla-speaking communities. Practitioner points Positive clinical implications These two measures of internalizing distress in young people showed solid psychometric properties within samples collected from various parts of Bangladesh. The measures can therefore be used to assess anxiety and depression in Bangla-speaking youth., These measures should be of value in both clinical settings and at a community level to assess the need for services., Cautions and limitations Resource limitations did not allow comparison against diagnostic criteria and therefore cut-off scores to indicate clinical status among Bangladeshi youth will require further research. [ABSTRACT FROM AUTHOR]

Background: Fear of negative evaluation (FNE) defines social anxiety yet the process of inferring social evaluation, and its potential role in maintaining social anxiety, is poorly understood. We developed an instrumental learning task to model social evaluation learning, predicting that FNE would specifically bias learning about the self but not others. Methods: During six test blocks (3 self-referential, 3 other-referential), participants (n = 100) met six personas and selected a word from a positive/negative pair to finish their social evaluation sentences “I think [you are / George is]…”. Feedback contingencies corresponded to 3 rules, liked, neutral and disliked, with P[positive word correct] = 0.8, 0.5 and 0.2, respectively. Results: As FNE increased participants selected fewer positive words (β = −0.4, 95% CI −0.7, −0.2, p = 0.001), which was strongest in the self-referential condition (FNE × condition 0.28, 95% CI 0.01, 0.54, p = 0.04), and the neutral and dislike rules (FNE × condition × rule, p = 0.07). At low FNE the proportion of positive words selected for self-neutral and self-disliked greatly exceeded the feedback contingency, indicating poor learning, which improved as FNE increased. Conclusions: FNE is associated with differences in processing social-evaluative information specifically about the self. At low FNE this manifests as insensitivity to learning negative self-referential evaluation. High FNE individuals are equally sensitive to learning positive or negative evaluation, which although objectively more accurate, may have detrimental effects on mental health. [ABSTRACT FROM AUTHOR]

Background: A recent paper reported the outcomes of a study examining a new self-guided internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety or depression. This study found the intervention resulted in significant symptom reductions. It also found that automated emails increased treatment completion and clinical improvements in a subsample with elevated anxiety and depression. Aims: To examine the clinical outcomes and the effect of automated emails at 12 months post-treatment. Method: Participants, who were randomly allocated to a Treatment Plus Automated Emails Group (TEG; n = 100), a standard Treatment Group (TG; n = 106) or delayed-treatment Waitlist Control Group (Control; n = 51), were followed up at 12 months post-treatment. Eighty-one percent, 78% and 87% of participants in the TEG, TG and treated Waitlist Control Group provided symptom data at 12-month follow-up, respectively. The primary outcome measures were the Patient Health Questionnaire-9 Item Scale (PHQ-9) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7). Results: Significant improvements in symptoms of anxiety and depression were observed over time in both the TEG and TG (Fs >69, ps <.001) these were sustained from post-treatment to 12-month follow-up (ps >.05), and were associated with large effect sizes. No statistically significant differences in symptoms were found between the TEG and TG at post-treatment, 3-month or 12-month follow-up. Previously reported symptom differences between TEG and TG participants with comorbid symptoms were no longer present at 12-month follow-up (ps >.70). Conclusions: The overall benefits of the Wellbeing Course were sustained at 12-month follow-up. Although automated emails facilitated Course completion and reductions in symptoms for participants with comorbid anxiety and depression from pre-post treatment, these differences were no longer observed at 12-month follow-up. The results indicate that automated emails promote more rapid treatment response for people with elevated and comorbid symptoms, but may not improve longer term outcomes. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12610001058066 [ABSTRACT FROM AUTHOR]

Abstract: Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months. [Copyright &y& Elsevier]

Background: Depression and anxiety are common, disabling and chronic. Self-guided internet-delivered treatments are popular, but few people complete them. New strategies are required to realise their potential. Aims: To evaluate the effect of automated emails on the effectiveness, safety, and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment, the Wellbeing Course, for people with depression and anxiety. Method: A randomised controlled trial was conducted through the website: www.ecentreclinic.org. Two hundred and fifty seven people with elevated symptoms were randomly allocated to the 8 week course either with or without automated emails, or to a waitlist control group. Primary outcome measures were the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7). Results: Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls. Automated emails increased rates of course completion (58% vs. 35%), and improved outcomes in a subsample with elevated symptoms. Conclusions: The new self-guided course was beneficial, and automated emails facilitated outcomes. Further attention to strategies that facilitate adherence, learning, and safety will help realise the potential of self-guided interventions. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12610001058066 [ABSTRACT FROM AUTHOR]

Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful 'efficacy' trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry. Methods/Design: This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≉16% (n≉500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child's bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (costconsequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms. Discussion: This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally. Trial Registration: ISRCTN30996662 RCH Human Research Ethics Approval: 30105A [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the time-course of attentional bias in socially phobic (SP) and non-phobic (NP) adults. Participants viewed angry and happy faces paired with neutral faces (i.e., face-face pairs) and angry, happy and neutral faces paired with household objects (i.e., face-object pairs) for 5000ms. Eye movement (EM) was measured throughout to assess biases in early and sustained attention. Attentional bias occurred only for face-face pairs. SP adults were vigilant for angry faces relative to neutral faces in the first 500ms of the 5000ms exposure, relative to NP adults. SP adults were also vigilant for happy faces over 500ms, although there were no group-based differences in attention to happy-neutral face pairs. There were no group differences in attention to faces throughout the remainder of the exposure. Results suggest that social phobia is characterised by early vigilance for social cues with no bias in subsequent processing. [Copyright &y& Elsevier]

The article focuses on a study which examines the efficacy of early parenting intervention for preschool-aged children with anxiety and behavioral inhibition disorders. The study demonstrates the high levels of inhibition of selected children of parents with a current anxiety disorder. Methods of the study include the controlled trials which examine the early intervention with strategies on graded exposure, contingency management, parent training, and parent anxiety management to help reduce the risk of anxiety in preschool-aged children. Results of the study emphasize that children with parent intervention show a significant reduction in the severity of anxiety disorders.

Abstract: In the past few years, the field of psychology has seen a dramatic increase in interest in the prevention of mental disorder and emotional difficulties. This special series provides some excellent examples of the promises held by a- variety of prevention programs. At the same time, the papers in this volume highlight several important issues to consider and barriers to the implementation of prevention programs. This discussion paper explores the themes and issues raised by these papers and considers some of the lessons to be extracted for research into and implementation of prevention programs across mental health. [Copyright &y& Elsevier]

Abstract: This study examined the mental health literacy of a group of adolescents, with particular reference to their ability to recognize symptoms of depression in their peers. Respondents were 202 Australian adolescents (122 males, 80 females) aged 15–17 years. Their mental health literacy was examined through a questionnaire that presented them with five scenarios of young people. Respondents showed a mixed ability to correctly recognize and label depression, although they were able to differentiate depressed and non-depressed scenarios in terms of severity and expected recovery time. Results are discussed in light of findings from adult mental health literacy and clinical implications. [Copyright &y& Elsevier]

Objective: To evaluate a school-based early intervention program for the reduction of anxious symptoms in at-risk children from low socioeconomic status neighborhoods. Method: A total of 425 children (8-11 years old) from nine schools in low socioeconomic status areas were screened to identify children with high-level anxious symptoms. Ninety-one children were selected, and schools were assigned to either an eight-session active intervention or a waitlist control. Active intervention was conducted in small groups during school time by both school and health personnel. Parents of children in active intervention were offered two information sessions. Results: Demographic data indicated a low socioeconomic status for the sample. Children assigned to active intervention demonstrated a significant reduction in symptoms of anxiety relative to children assigned to waitlist and differences were maintained 4 months after treatment according to both self-report (F287 = 6.73, p < 0.005, partial η² = 0.134) and teacher report (F2,87 = 7.99, p = .001, partial η² = 0.155). Parents did not return sufficient data for meaningful statistical analysis. Conclusions: School-based early intervention appears to offer an effective means of reducing anxious symptomatology in economically disadvantaged populations. The school environment offers promise as a means of extending the reach of efficacious interventions for mental health to underserviced populations. [ABSTRACT FROM AUTHOR]

Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance.Method: Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors.Results: Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy.Conclusions: The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care. [Copyright &y& Elsevier]

A questionnaire measure of major life events was given to 64 subjects with diagnoses of panic disorder with agoraphobia, 33 subjects with other anxiety disorders, and 34 nonanxious subjects. Anxious subjects indicated the life events that had occurred in the 6-month period immediately before their current disorder began and rated the impact of each event on a 7-point scale. Nonanxious subjects made the same ratings for a 6-month period 1 ½-2 years before the study. There was no significant difference between groups in the number of life events reported. However, anxious subjects rated these events as having a significantly greater negative impact than did nonanxious subjects. [ABSTRACT FROM AUTHOR]

Background: Prevention of depression and anxiety disorders early in life is a global health priority. Evidence on risk and protective factors for youth internalizing disorders indicates that the family represents a strategic setting to target preventive efforts. Despite this evidence base, there is a lack of accessible, cost-effective preventive programs for parents of adolescents. To address this gap, we recently developed the Partners in Parenting (PiP) program-an individually tailored Web-based parenting program targeting evidence-based parenting risk and protective factors for adolescent depression and anxiety disorders. We previously reported the postintervention outcomes of a single-blinded parallel-group superiority randomized controlled trial (RCT) in which PiP was found to significantly improve self-reported parenting compared with an active-control condition (educational factsheets).Objective: This study aimed to evaluate the effects of the PiP program on parenting risk and protective factors and symptoms of adolescent depression and anxiety using data from the final assessment time point (12-month follow-up) of this RCT.Methods: Parents (n=359) and adolescents (n=332) were recruited primarily from secondary schools and completed Web-based assessments of parenting and adolescent depression and anxiety symptoms at baseline, postintervention (3 months later), and 12-month follow-up (317 parents, 287 adolescents). Parents in the PiP intervention condition received personalized feedback about their parenting and were recommended a series of up to 9 interactive modules. Control group parents received access to 5 educational factsheets about adolescent development and mental health. Both groups received a weekly 5-min phone call to encourage progress through their program.Results: Intervention group parents completed an average of 73.7% of their intended program. For the primary outcome of parent-reported parenting, the intervention group showed significantly greater improvement from baseline to 12-month follow-up compared with controls, with a medium effect size (Cohen d=0.51; 95% CI 0.30 to 0.72). When transformed data were used, greater reduction in parent-reported adolescent depressive symptoms was observed in the intervention group (Cohen d=-0.21; 95% CI -0.42 to -0.01). Mediation analyses revealed that these effects were mediated by improvements in parenting (indirect effect b=-0.08; 95% CI -0.16 to -0.01). No other significant intervention effects were found for adolescent-reported parenting or adolescent depression or anxiety symptoms. Both groups showed significant reductions in anxiety (both reporters) and depressive (parent reported) symptoms.Conclusions: PiP improved self-reported parenting for up to 9 months postintervention, but its effects on adolescent symptoms were less conclusive, and parent-reported changes were not perceived by adolescents. Nonetheless, given its scalability, PiP may be a useful low-cost, sustainable program to empower parents of adolescents.Trial Registration: Australian Clinical Trials Registration Number (ACTRN): 12615000328572; http://www.anzctr.org.au/ACTRN12615000328572.aspx (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj). [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety disorders are significant contributors to burden of disease in young people, highlighting the need to focus preventive efforts early in life. Despite substantial evidence for the role of parents in the prevention of adolescent depression and anxiety disorders, there remains a need for translation of this evidence into preventive parenting interventions. To address this gap, we developed a single-session, Web-based, tailored psychoeducation intervention that aims to improve parenting practices known to influence the development of adolescent depression and anxiety disorders.Objective: The aim of this study was to evaluate the short-term effects of the intervention on parenting risk and protective factors and symptoms of depression and anxiety in adolescent participants.Methods: We conducted a single-blind, parallel group, superiority randomized controlled trial comparing the intervention with a 3-month waitlist control. The intervention is fully automated and consists of two components: (1) completion of an online self-assessment of current parenting practices against evidence-based parenting recommendations for the prevention of adolescent depression and anxiety disorders and (2) an individually tailored feedback report highlighting each parent’s strengths and areas for improvement based on responses to the self-assessment. A community sample of 349 parents, together with 327 adolescents (aged 12-15 years), were randomized to either the intervention or waitlist control condition. Parents and adolescents completed online self-reported assessments of parenting and adolescent symptoms of depression and anxiety at baseline, 1-month (parent-report of parenting only), and 3-month follow-up.Results: Compared with controls, intervention group parents showed significantly greater improvement in parenting risk and protective factors from baseline to 1-month and 3-month follow-up (F2,331.22=16.36, P<.001), with a small to medium effect size at 3-month follow-up (d=0.33). There were no significant effects of the intervention on adolescent-report of parenting or symptoms of depression or anxiety in the adolescents (all P>.05).Conclusions: Findings suggest that a single-session, individually tailored, Web-based parenting intervention can improve parenting factors that are known to influence the development of depression and anxiety in adolescents. However, our results do not support the effectiveness of the intervention in improving adolescent depression or anxiety symptoms in the short-term. Long-term studies are required to adequately assess the relationship between improving parenting factors and adolescent depression and anxiety outcomes. Nonetheless, this is a promising avenue for the translation of research into a low-cost, sustainable, universal prevention approach.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12615000247572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000247572 (Archived by WebCite at http://www.webcitation.org/6v1ha19XG) [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking.Objective: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms.Methods: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents' risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent's strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children's Anxiety Scale (anxiety symptoms).Results: Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions.Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents' risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents' mental health.Trial Registration: Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj). [ABSTRACT FROM AUTHOR]

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents' mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents' needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes. [ABSTRACT FROM AUTHOR]

Despite growing recognition of childhood anxiety as a common and often debilitating clinical concern, we have limited knowledge of the particular ways in which anxiety interferes with daily life for young children who have not yet entered formal schooling. The present study evaluated the psychometric properties of the Child Anxiety Life Interference Scale – Preschool Version (CALIS-PV). The CALIS-PV is a brief (18 item) parent-report measure of the impacts of a young child’s anxiety on their own life and that of her or his parent. Participants were 784 parents of a child aged 3–7 years, who completed the CALIS-PV as a part of the follow-up assessment battery for two anxiety prevention trials targeted at preschool children with temperamental inhibition. Confirmatory factor analysis supported three CALIS-PV factors reflecting anxiety-related life interference at home, outside home and on parent life. The three factors showed good internal consistency and good convergent and divergent validity, and successfully differentiated children with and without an anxiety diagnosis. Findings provide initial support for the CALIS-PV as a reliable and valid measure of the daily life impacts of childhood anxiety for preschool-aged children and their parents. [ABSTRACT FROM AUTHOR]

Loneliness and social isolation are known to be associated with depression, general anxiety, and social anxiety. However, knowledge on the overlapping and unique features of these relationships, while differentiating between social loneliness (perceived absence of an acceptable social network) and emotional loneliness (perceived absence of close connections), is lacking. We constructed a network analysis to examine the relationships between self-reported social loneliness, emotional loneliness, social isolation, depression, general anxiety and social anxiety in a large sample of university students (N = 7314, 67.4 % female, range 16.3–75.8 years, M age = 23.9, SD age = 5.7). Hierarchical regression analyses were used to examine whether depression, general anxiety and social anxiety moderated the relationship between social isolation and loneliness types. As comorbidity between anxiety and depression is high, the role of anxiety as a moderator in the relationship between depression and loneliness types was also examined. The network analysis showed that social loneliness was most strongly explained by social isolation, whereas emotional loneliness was most strongly explained by social anxiety and depression. General anxiety was solely related to loneliness through depression. The regression analyses showed that general and social anxiety and depression did not moderate the relationship between social isolation and loneliness types. Differences found between loneliness types may be influenced by a methodological artifact of the DJGLS. These findings highlight the importance of social anxiety over general anxiety in relation to loneliness. Also, it showed unique relationships for social- and emotional loneliness with psycho-social variables, which has important implications for research- and clinical settings. • Emotional and social loneliness are strongly related. • The network shows the impact of social anxiety over general anxiety on loneliness. • Mental health does not moderate relation between social isolation and loneliness. • Unique relationships for loneliness types may be relevant for clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Transdiagnostic interventions present pragmatic benefits in treatment dissemination and training of mental health professionals when faced with emotional disorders such as anxiety and depression. Excessive worry is a common feature across emotional disorders and represents an ideal candidate target for transdiagnostic intervention. The current pilot trial examined the efficacy of a behavioural activation treatment for worry (BAW) in a community population. 49 individuals experiencing excessive worry were randomised to waitlist or BAW receiving an 8 week group based intervention. Results demonstrated that BAW was successful in reducing excessive worry, depressive symptoms, cognitive avoidance, Intolerance of Uncertainty and improving problem solving orientation. Twice as many individuals showed clinically significant reductions in excessive worry after treatment compared to the waitlist control. Despite limitations to sample size and power, this study presents promising support for BAW as a practical transdiagnostic treatment for worry. [Copyright &y& Elsevier]

Abstract: Cognitive Behavioural Group Therapy (CBGT) for social phobia has been shown to be efficacious within research units and effective within a variety of real world clinical settings. However, most effectiveness studies of CBGT for social phobia have (a) used protocols without demonstrated efficacy, (b) not included direct comparison groups, and/or (c) contained features of efficacy trials. This study addressed these limitations by using a benchmarking strategy to compare outcomes from the same CBGT protocol used in both a research unit and a community clinic. Research (N = 71) and community (N = 94) patients completed the same 12-session protocol, which resulted in significant reductions in social anxiety and life interference at post-treatment. Compared to research unit patients, community patients had more severe symptoms and life interference at pre-treatment, and were more likely to be male, use medication, have comorbid disorders, and have lower educational attainment. Importantly, degree of improvement on social anxiety symptoms and life interference did not differ across the treatment settings for either completer or intention-to-treat analyses. There was some evidence that being younger, single, and having a depression diagnosis were associated with dropout. Pre-treatment symptoms and number of diagnoses predicted post-treatment symptoms. Consistent with previous uncontrolled trials, it is concluded that CBGT is effective within community mental health clinics. [Copyright &y& Elsevier]

Anxiety disorders are among the most prevalent childhood psychological disorders. In addition to causing acute distress to the child, parent and school staff, anxiety disorders may also have a significant impact on a child's educational and social development and persist chronically into adulthood. Recent work has begun to identify the school as an important setting for both the treatment and prevention of anxiety disorders in children. This paper begins with a description of several prevalent anxiety disorders and their presentation in a school setting. It then describes some of the more common assessment tools designed specifically for the assessment of anxiety in children, as well as some of the advantages and limitations different methods of assessment offer. Three school-based treatment programs are reviewed; Cool Kids, Friends and Skills for Social and Academic Success (SASS). Both Cool Kids and Friends are suitable for the treatment of anxiety disorders broadly, whereas the SASS has been included in the review as an example of a program designed specifically for social phobia. Several practical issues such as universal versus targeted delivery, parental involvement and implementation are also discussed. [ABSTRACT FROM AUTHOR]

With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850). [ABSTRACT FROM AUTHOR]

• Adolescent males are often reluctant to seek help for symptoms of anxiety disorders. • Mental health literacy is associated with help-seeking attitudes in adolescent males. • Alignment with norms of hegemonic masculinity moderated this relationship. • Mental health initiatives may benefit from incorporating themes of masculinity. Poor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship between i) anxiety mental health literacy, ii) alignment with traditional masculinity norms and iii) help-seeking attitudes, intentions and behaviour in a sample of adolescent males. 1732 adolescent males (aged 12–18 years) participated online whilst at school. Participant attitudes towards formal help-seeking, intentions to seek help from a family member and from an online source were found to predict professional help-seeking behaviour by the adolescent and/or by their parents on the adolescents' behalf. In adolescents with a low or average personal alignment with norms of hegemonic masculinity, greater anxiety mental health literacy was positively associated with more favourable attitudes towards formal and informal help-seeking. However, this relationship was not found in adolescent males with a greater alignment with norms of hegemonic masculinity. The study had a correlational research design and used self-report measures. Mental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population. [ABSTRACT FROM AUTHOR]

Background: Despite considerable evidence on parenting risk and protective factors for child anxiety and depressive disorders, the development of interventions based on this evidence is still lagging behind. To address this gap, the web-based Parenting Resilient Kids (PaRK) program was developed to target these risk and protective factors. This study evaluated the effects of the program at 12-month follow-up.Methods: A randomized controlled trial was conducted with a community sample of 355 parents and 342 children (Mchild age = 9.79). Parents randomized into the web-based PaRK intervention condition received a personalized feedback report about their parenting and were recommended a tailored course of up to 12 interactive modules. Parents in the control condition received a standard set of web-based educational factsheets.Results: Parents in the intervention group demonstrated significantly greater improvement in self-reported parenting compared to control group parents from baseline to 12-month follow-up, d = 0.24, 95% CI [0.03, 0.45]. Both groups showed reductions in child anxiety and depressive symptoms, parental psychological control and unhealthy family functioning; and improvements in parental acceptance, child- and parent- health-related quality of life.Limitations: The PaRK intervention was tailored based on the parents' own report of their parenting behaviors. There was an over-representation of highly-educated mothers and only one parent-child dyad was included per family.Conclusions: PaRK improved parenting for up to 12 months, but had no superior effect on children's mental health outcomes compared with an educational-factsheet intervention. Further follow-up is needed to assess longer-term effects. [ABSTRACT FROM AUTHOR]

Background: Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan.Methods: Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework.Results: The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants.Limitations: We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture.Conclusions: When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD. [ABSTRACT FROM AUTHOR]