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Purpose: To explore the impacts of double minority status (ethnic and sexual/gender minority) and protective factors associated with the emotional wellbeing and mental health of Asian Rainbow (sexual/gender minority) youth in New Zealand., Methods: The data were extracted from the Youth19 Rangatahi survey, which surveyed 7,374 students from 45 mainstream secondary schools. The comparison groups were Asian non-Rainbow youth and Pākehā (New Zealand European) Rainbow youth. A secondary analysis was performed examining the associations between postulated protective factors and the emotional wellbeing and mental health outcomes of Asian Rainbow youth., Results: Asian Rainbow youth had higher odds of depressive symptoms, anxiety, and suicidal thoughts and attempts and lower odds of good emotional wellbeing compared to Asian non-Rainbow youth. However, Asian Rainbow youth had lower odds of anxiety compared to Pākehā Rainbow youth. Among Asian Rainbow youth, family acceptance and feeling safe at school were associated with higher odds of good emotional wellbeing, and lower odds of depressive symptoms, anxiety, and suicidal thoughts. Several other protective factors were also associated with 1 or more (but not all) of the emotional wellbeing and mental health indicators., Discussion: This study suggests that family acceptance and feeling safe at school may serve as important buffers mitigating risks of adverse emotional wellbeing experienced by Asian Rainbow youth., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

We explored progress on key indicators of adolescent health and wellbeing among New Zealand secondary school students over the last two decades. We analysed data from comprehensive surveys conducted in 2001, 2007, 2012 and 2019 (n = 9546, 9098, 8487, and 7311, respectively). Schools, and students within schools, were randomly selected. Prevalence estimates and adjusted odds ratios show large reductions in substance use (e.g. prevalence of past-month binge drinking declined from 41.5% to 21.8%), sexual experience (31.6% to 20.6%) and past-month risky driving (58.8% to 37.1%). However, from 2012-2019 there were rapid increases in symptoms of depression (13.0% to 22.8%; RADS-SF), suicide thoughts (15.3% to 20.8%) and suicide attempts (3.9% to 6.3%) and declines in emotional wellbeing (76.0% to 69.1%; WHO-5). Changes in family and school contexts were generally positive or minimal, although the proportion of students whose families worry about money for food increased from 2001 to 2019 (7.2% to 12.5%) and access to health services decreased from 2007 to 2019 (83.5% to 78.2%). This study demonstrates that health status and risks among New Zealand adolescents have changed dramatically over 20 years, with areas of large improvement. However, mental wellbeing requires urgent attention., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Aim: To examine the relationship between social support, safety, healthcare experience and forgone healthcare for Asian secondary school students in New Zealand by unmasking variations in aggregate Asian data., Methods: The study population included 1,911 Asians (1,272 East Asians and 604 South Asians) from the Youth19 survey. The reference group included 3,053 Pākehā., Results: We found disparities in family socioeconomic status (SES), social support, safety in school and neighbourhood, healthcare experience and forgone healthcare between East Asians and South Asians compared to Pākehā. One in five Asians (20%) reported forgone healthcare. Compared to their Pākehā peers (18%), Asian students (AOR=1.18, CI=1.04-1.33) and East Asian students (AOR=1.24, CI=1.06-1.45) were more likely to experience forgone healthcare, but South Asian students were not (AOR=1.05, CI=0.86-1.28). Important unique predictors of forgone healthcare for both East and South Asian students were: being discriminated against by health professionals due to ethnicity, not having a family member to talk about their worries with, and unfair treatment by teachers. Other unique predictors varied: lower community and family SES, not getting enough quality time with family, and being bullied at school were significant predictors for East Asian students; low perceived neighbourhood safety was a predictor for South Asian students., Conclusions: A complicated picture underlies the seemingly positive findings for the overall Asian group. We highlight the importance of disaggregating Asian youth data into East Asian and South Asian, to identify disparities in risk/protective factors and better inform targeted interventions., Competing Interests: Nil.

Background: Factors such as ethnicity, gender, and socioeconomic status may play a role in both access to and attrition from bariatric programs before surgery is undertaken. New Zealand (NZ) has high rates of obesity in its Pacific population and the indigenous Māori. These groups also experience poorer health outcomes and therefore have the greatest need for surgery., Methodology: A retrospective cross-sectional study of 704 people referred for and accepted onto a publicly funded bariatric surgery from 2007 to 2016. The demographic and clinical features of two groups were compared: those that completed surgery successfully (n = 326) and those that dropped out of the program before surgery (n = 378). We also attempted to identify factors associated with attrition., Results: The attrition rate was high (54%), with a significant difference according to gender (men 66% vs 45% women, p < 0.001) and ethnicity (39% in NZ Europeans, 50% in Māori, and 73% in Pacific patients, p < 0.001). Two out of three European women proceeded to surgery, but fewer than one in seven Pacific men. Attrition was associated with having a higher mean BMI and being a smoker. Logistic regression modeling showed that while employment seemed to be protective against attrition for NZ Europeans (p < 0.004), it was not for Pacific patients., Conclusions: While there was no obvious bias in rates of referral, there is clearly a need for better ways to support Māori and Pacific people, and men in particular, to complete bariatric surgery. Further research is needed to clarify the socio-economic and cultural barriers that underlie this phenomenon.

Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, ie, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported., Objective: This study aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter usage data or, for brevity, engagement) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood., Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions., Results: After the removal of duplicates, 970 papers were identified, of which 10 met the inclusion criteria. Hand searching identified 1 additional article. The included articles reported on 7 publicly available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from 8 to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (eg, used the intervention at least once or completed one module or assessment), whereas 7-42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after 4 weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%., Conclusions: Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs that have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health., (©Theresa Fleming, Lynda Bavin, Mathijs Lucassen, Karolina Stasiak, Sarah Hopkins, Sally Merry. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.06.2018.)

Computer games are ubiquitous and can be utilized for serious purposes such as health and education. "Applied games" including serious games (in brief, computerized games for serious purposes) and gamification (gaming elements used outside of games) have the potential to increase the impact of mental health internet interventions via three processes. First, by extending the reach of online programs to those who might not otherwise use them. Second, by improving engagement through both game-based and "serious" motivational dynamics. Third, by utilizing varied mechanisms for change, including therapeutic processes and gaming features. In this scoping review, we aim to advance the field by exploring the potential and opportunities available in this area. We review engagement factors which may be exploited and demonstrate that there is promising evidence of effectiveness for serious games for depression from contemporary systematic reviews. We illustrate six major categories of tested applied games for mental health (exergames, virtual reality, cognitive behavior therapy-based games, entertainment games, biofeedback, and cognitive training games) and demonstrate that it is feasible to translate traditional evidence-based interventions into computer gaming formats and to exploit features of computer games for therapeutic change. Applied games have considerable potential for increasing the impact of online interventions for mental health. However, there are few independent trials, and direct comparisons of game-based and non-game-based interventions are lacking. Further research, faster iterations, rapid testing, non-traditional collaborations, and user-centered approaches are needed to respond to diverse user needs and preferences in rapidly changing environments.

Dehydration is a common concern in palliative care, and can be an emotive issue for patients and their families (Patchett, 1998). Family members instinctively wish to continue caring for a dying relative, and no more so than by giving nourishment. When the time comes that food cannot be tolerated, giving fluid can seem to be the last way of providing the patient with comfort and nurture. Dehydration may be perceived as the reason for death, rather than a natural part of the dying process. Is it therefore reasonable to give patients fluid by an alternative method? Hypodermoclysis (HDC), or subcutaneous hydration, is sometimes used to administer fluids in the last days of life in a palliative care setting. This article aims to consider the benefits and problems associated with artificial rehydration in these circumstances.