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Funding: This work is financed by national funds through the Research 4 Covid-19 special support from the Foundation for Science and Technology, I.P, under the project nr.411. A.J.O.-M. is supported by Portuguese national funds from FCT through grant PTDC/MED-NEU/31331/2017. D.F., B.S., F.C. and A.J.O.-M. are supported by the BOUNCE project (grant agreement number 777167), and F.L.-F. and A.J.O.-M. are supported by the FAITH project (grant agreement number 875358), both funded by the European Union’s Horizon 2020 research and innovation programme The COVID-19 pandemic has important consequences for the mental health of populations. Patients with cancer, already at risk for poor mental health outcomes, are not expected to be spared from these consequences, prompting the need for health services to improve responsiveness. This article presents the research protocol for an implementation study designed to describe the uptake of a well-studied and recognized system for the treatment of depression and anxiety (Stepped-care) during the specific context of a Pandemic in an oncological site. The system set-up will be assisted by a digital platform (MoodUP), where patients undergoing cancer treatment will be screened for anxiety and depressive symptoms, triaged by severity level and algorithm-matched to recommended interventions. Patients undergoing cancer treatment at a cancer clinic in Portugal will be invited to subscribe to the MoodUP platform where they will complete a self-reported questionnaire (Hospital Anxiety and Depression Scale) to screen their anxiety and depressive symptoms. Data will be instantly collected, and an algorithm will activate severity-matched intervention suggestions, through a case manager that will coordinate care. The specific objectives of this study will be to describe the implementation and acceptability of the care system by patients and staff, the barriers to and facilitators of implementation, the proportion of patients accessing the system and their pathways through the various stepped-care interventions, and patient perceptions regarding the feasibility and appropriateness of the eHealth platform. Moreover, exploratory analyses will be conducted to describe patterns of anxiety and depression symptoms variation across all patients, as well as within sociodemographically, clinically and contextually characterized subgroups, to characterize their care needs and access, as well as to explore for whom the MoodUP care system may be more appropriate. This study is expected to improve processes for collaborative mental healthcare in oncology and accelerate the digitalization of services, towards the improvement of mental healthcare access, and management of high-risk patients, during the COVID-19 pandemic. publishersversion published

This study was funded by Swedish Research Council for Health, Working Life and Welfare, FORTE, Dnr 2015–00048; and also received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under grant agreement No 802631. The funding agencies had no role or influence in study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. The data collection in each country was funded at the national level. Background: Previous research shows that parental unemployment is associated with low life satisfaction in adolescents. It is unclear whether this translates to an association between national unemployment and adolescent life satisfaction, and whether such a contextual association is entirely explained by parental unemployment, or if it changes as a function thereof. For adults, associations have been shown between unemployment and mental health, including that national unemployment can affect mental health and life satisfaction of both the employed and the unemployed, but to different degrees. The aim of this paper is to analyse how national unemployment levels are related to adolescent life satisfaction, across countries as well as over time within a country, and to what extent and in what ways such an association depends on whether the individual's own parents are unemployed or not. Methods: Repeated cross-sectional data on adolescents' (aged 11, 13 and 15 years, n = 386,402) life satisfaction and parental unemployment were collected in the Health Behaviour in School-aged Children (HBSC) survey, in 27 countries and 74 country-years, across 2001/02, 2005/06 and 2009/10 survey cycles. We linked this data to national harmonised unemployment rates provided by OECD and tested their associations using multilevel linear regression, including interaction terms between national and parental unemployment. Results: Higher national unemployment rates were related to lower adolescent life satisfaction, cross-sectionally between countries but not over time within countries. The verified association was significant for adolescents with and without unemployed parents, but stronger so in adolescents with unemployed fathers or both parents unemployed. Having an unemployed father, mother och both parents was in itself related to lower life satisfaction. Conclusion: Living in a country with higher national unemployment seems to be related to lower adolescent life satisfaction, whether parents are unemployed or not, although stronger among adolescents where the father or both parents are unemployed. However, variation in unemployment over the years did not show an association with adolescent life satisfaction. publishersversion published

Introdução: A investigação mostra que, em períodos de recessão económica, a saúde mental da população é negativamente afetada, e que os países podem proteger a sua população destes riscos para a saúde mental se fortalecerem as suas políticas e reorientarem os seus serviços de acordo com recomendações baseadas na evidência disponível. Apesar de Portugal ter sido dos países europeus mais afetados pela crise económica que teve início em 2008, pouca atenção foi dada às potenciais consequências negativas delas resultantes para a saúde mental e bem-estar da população portuguesa. O Estudo MH-Crisis Impact foi promovido para colmatar esta lacuna e contribuir para a fundamentação de políticas que possam mitigar os efeitos da crise e prevenir os efeitos de crises futuras. Objetivos: Estudar os efeitos da crise económica na saúde mental dos portugueses e discutir as suas implicações a nível político. Métodos: Compararam-se dados epidemiológicos sobre as perturbações mentais, os seus determinantes e a utilização de serviços, antes e depois da crise, e realizou-se um estudo qualitativo a nível dos cuidados de saúde primários. Resultados: O estudo mostrou um aumento substancial da prevalência de sofrimento psicológico entre 2008 e 2015, particularmente relevante para quem já pertencia a um grupo vulnerável, bem como várias insuficiências na resposta do Serviço Nacional de Saúde ao aumento das necessidades de cuidados de saúde mental durante a crise. Conclusões: A discussão das implicações destes resultados permite concluir que a redução dos problemas de saúde mental das populações afetadas pela recente crise económica, e a preparação do país para uma melhor prevenção de problemas de saúde mental em futuras crises económicas, exige: 1. Uma estratégia geradora de maior compromisso político; 2. Uma atualização do plano nacional de saúde mental; 3. Estratégias abrangentes visando melhorar a proteção social, diminuir as desigualdades de rendimento e mitigar os impactos do desemprego; e 4. Assegurar a todas as populações o acesso a cuidados de saúde mental integrados., Psilogos, vol. 15 n.º 2 (2017)

Additional file 2: Table S1. Content (coding) of the variable for “Unemployed parents”, n = 386,402.

AA receives a grant from the Portuguese Foundation for Science and Technology (FCT) [ grant number PD/BD/105822/2014]. The Portuguese Mental Health Study was carried out by the Department of Mental Health, NOVA Medical School, NOVA University of Lisbon, with collaboration of the CESOP-Portuguese Catholic University and was funded by the Champalimaud Foundation, the Gulbenkian Foundation, the Foundation for Science and Technology (FCT) and the Ministry of Health. The Portuguese Mental Health Study was carried out in conjunction with the World Health Organization WMH Survey Initiative which is supported by the National Institute of Mental Health (NIMH; R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the U.S. Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. Background: Mental disorders are a major cause of disability with impacts on daily functioning and quality of life, which has been associated with socioeconomic disadvantage. The present study aims to assess how socioeconomic position is related to the disability reported by people with mental disorders, using data from the World Mental Health Survey (WMHS) Initiative Portugal. Methods: Using data from the Portuguese Mental Health Survey, a nationally representative cross-sectional study (n = 3849), several logistic regression models with interaction terms were performed to evaluate the effect of different indicators of socioeconomic position on the disability reported by people with any mental disorder (any 12-month mood or anxiety disorder). Odds ratios were estimated at the specific values of the main effects and interaction terms between the presence of any mental disorder and education, employment status, self-perceived financial deprivation and subjective social status. Results: The prevalence rate of any mood or anxiety disorder was 21.0% (n = 788), among which 14.7% (n = 115) reported disability. The results show that among people with any 12-month mental disorder, those in the employment category of “retired or others” had two times higher odds of reporting disability (OR = 2.19; 95%CI: 1.06-4.48) when compared to participants categorized as “working”. Likewise, individuals with financial deprivation had two times higher odds of reporting disability when compared to those non-financially deprived (OR = 2.36; 95%CI: 1.31-4.24). The odds ratios obtained for the specific years of education evaluated were not statistically significant but seem to suggest an educational gradient. Conclusions: The findings of this study indicate that the disability reported by people with mental disorders varies according to socioeconomic position and draw attention to the need to develop policies to address these inequalities. publishersversion published

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BACKGROUND: The economic recession produced a rapid rise of unemployment rates that was more visible in Southern European countries. There is evidence that unemployment correlates highly with individuals' poor life satisfaction. OBJECTIVE: To analyse the relationship between life satisfaction, household composition and socioeconomic deprivation in people facing unemployment during the economic recession. METHODS: A sample of 748 unemployed people from Lisbon (Portugal) completed a socio-demographic questionnaire, the Cantril's ladder of life scale, and the latent and manifest benefits of work scale (LAMB). Multiple regression analyses were used to test the associations between life satisfaction and all other variables. RESULTS: Partnered people report higher life satisfaction compared to singles. Financial deprivation and lack of structured time were the strongest factors negatively related to life satisfaction in both partnered and single people. Having children had a particular negative effect on the life satisfaction of partnered men; and living with an unemployed partner together with lack of social contact and high enforced activity had a negative effect on life satisfaction in partnered women. CONCLUSION: The heterogeneity of socioeconomic needs found by household composition bring practical policy implications for support actions targeting unemployed individuals in the unique context of economic recession. publishersversion published

O presente estudo tem como objetivo compreender de que forma os comportamentos de saúde e de risco dos adolescentes variam nas diferentes regiões geográficas de Portugal (Norte, Centro, Lisboa e Vale do Tejo, Alentejo e Algarve). Paralelamente, pretende-se analisar alguns fatores macroeconómicos das diferentes regiões de Portugal e sua relação com os comportamentos de saúde e de risco nos adolescentes. O estudo conta com a participação de jovens incluídos no estudo HBSC- Health Behaviour in School - Aged children, de 2014, em Portugal, sendo a amostra aqui analisada constituída por 6026 jovens do 6º, 8º e 10º ano de escolaridade. Os resultados obtidos indicam a existência de diferenças entre as diversas regiões de Portugal. Os jovens da região do Centro são os que apresentam mais comportamentos de saúde, mais expetativas de futuro e menos comportamentos de risco. Os jovens do Algarve, à semelhança do jovens da região de Lisboa são os que apresentam uma maior incidência em comportamentos de risco. Esta investigação vem reforçar a importância de compreender não só as diferença entre as diversas regiões de Portugal no que concerne aos comportamentos de saúde e de risco dos adolescentes, mas também se estas diferenças estão associadas a fatores macroeconómicos. Torna-se imperativo estabelecer prioridades na educação e saúde das crianças e jovens em tempos de recessão económica e adaptar as políticas de intervenção às necessidades de cada região do país. This study goal is to understand the health and risk behaviours in the Portuguese adolescents, across the most relevant Portuguese geographical regions (North, Central region, Lisbon and Great Lisbon, Alentejo and Algarve). Furthermore, we aim to analyse some macroeconomic factors in these different regions and it's relation with the health and risk behaviours in Portuguese adolescents. This study includes adolescents who are part of the HBSC project/study- Health Behaviour in School-aged Children from 2014, in Portugal, and the sample analysed has 6026 adolescents from the 6th, 8th and 10th grade. The results show the existence of key differences between the several regions that have been analysed. The adolescents from the central region of Portugal, for example, show a healthier behaviours, better expectations on their futures and less risk behaviours. The adolescents from the Algarve, like to ones from Lisbon area, show the higher percentage of risk behaviours. This research reinforces the importance of understanding not only the differences between the several Portuguese regions, in respect to the health and risk behaviours in the adolescents, but also if these differences are associated to macroeconomic factors. In times of economic downturn it is crucial to set priorities in the key areas of Education and health of children and adolescents to assure that the governmental intervention decisions are aligned with the real needs of every single region of the country.

Frasquilho D. receives a grant from the Portuguese Foundation for Science and Technology (FCT), reference SFRH/BD/80846/2011. This paper was also supported by the ECOP project "Support for creating excellent research teams and intersectoral mobility at Palacky University in Olomouc" ( reg. no. CZ.1.07/2.3.00/30.0004), and by the Czech Ministry of Education, Youth and Sport under contract no. LG 14043 and LG 14042. The authors wish to thank Dr. Sharon Leahy from the University of St. Andrews who assisted in the proof-reading of the manuscript. Background: Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations' health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes. Methods: Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered. Results: One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours. Conclusion: On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession. publishersversion published

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - v. 6, n. 2 (Julho-Dezembro 2015). - p. 47-58. O Dream Teens é um projeto que envolve jovens portugueses dos 11 aos 18 anos. Fornece uma formação e uma estrutura de apoio para que as suas vozes sejam ouvidas e promove a sua participação numa variedade de contextos e cenários na área da saúde, da educação e da cidadania ativa. O projeto Dream Teens (webpage: http://dreamteens.aventurasocial.com/; blog em inglês: http://www.dreamteens2014-2015.blogspot.pt; e blog em português: http://www.dreamteensaventurasocial.blogs.sapo.pt/) teve início em maio de 2014. O objetivo do presente estudo é compreender o conceito, a dinâmica, a extensão e alguns resultados preliminares do projeto Dream Teens, centrandose principalmente no estudo do processo e das experiências dos jovens. Este documento apresenta ainda um conjunto de recomendações para as políticas públicas. This article presents Dream Teens, a project which involves Portuguese adolescents from 11 to 18 years and provides a specific training and a support structure that allows their voices are heard and promote their participation in a variety of contexts and policy arenas in the areas of health, education and active citizenship. The Dream Teens project (webpage: http://dreamteens.aventurasocial.com/http://dreamteens.aventurasocial.com; blog in English: http://www.dreamteens2014-2015.blogspot.pt/; blog in portuguese: http://www.dreamteensaventurasocial.blogs.sapo.pt/), begun in May, 2014. The objective of this article is to understand the concept, the dynamic, the extent and some preliminary results of the Dream Teens project, focusing mainly on the process and on the experiences of young people. This paper also presents a set of recommendations concerning public policies.