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Life-course theories on how social relationships affect mental health are limited in causal claims. The restrictions in social contact during the coronavirus pandemic provided a natural experiment that modified the frequency of in-person contact and allowed us to estimate the effect of changes in in-person social contact frequency on mental health in four large nationally representative age-cohorts of adults living in the UK. There was consistent evidence of a small but statistically significant effect of less frequent social contact on anxiety-depression. Online modes of social contact did not compensate for the restrictions in in-person social contact during the pandemic. Young adults who increased their online social media frequency during the pandemic experienced a deterioration in mental health. Life-course theories cannot ignore the importance of the mode of social contact for social relationships, especially during young adulthood. [ABSTRACT FROM AUTHOR]

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Solution-focused brief therapy (SFBT) is an empirically-supported psychotherapeutic intervention in treating mental health issues in the general population. When being delivered to adolescents and young adults (AYAs) diagnosed with cancer, specific techniques and skills of SFBT need to be tailored to meet the unique bio-psycho-social challenges of the AYA cancer population. Using a patient-centered approach, our team interviewed 14 AYAs with cancer who received SFBT for cancer (SFBT-C) to inform the tailoring and refinement of the existing SFBT intervention specifically for the AYA cancer population. Themes emerged within three broad categories that informed the tailoring and refinement of SFBT for AYAs with cancer, i.e., general experiences, strengths, and weaknesses of SFBT-C. AYAs with cancer found SFBT-C overall positively different from other approaches. Strengths include SFBT-C's collaborative nature, using positive emotion as an important change mechanism, and a good balance between being relevant to cancer and not focusing too much on their cancer. Areas of improvement include assignment flexibility and different strategies to address resistance. The findings of this paper significantly inform the delivery of SFBT-C to AYAs with cancer using patient-centered feedback and input. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate (a) the association between overparenting and emerging‐adult children's psychological maladjustment through basic psychological needs satisfaction (autonomy, competence, and relatedness) and (b) whether the associations, particularly the associations between overparenting and needs satisfaction, vary by cultures. Background: Research in Western countries suggests that overparenting may undermine emerging‐adult children's psychological well‐being. This raises the question of whether overparenting influences emerging adults in a similar way in the collectivistic cultures in Eastern countries where overparenting may be perceived differently. Method: Survey data were obtained from college students in the United States (N = 414, Mage = 20.38) and China (N = 612, Mage = 20.21). Results: Structural equation modeling yielded two major findings. First, largely in line with the view of cultural universalism, in both the United States and China, overparenting was linked to emerging adults' psychological maladjustment through lower basic needs satisfaction. Second, supporting the view of cultural relativism, the negative relations between maternal overparenting and needs satisfaction were stronger in the United States than in China. Conclusion: Overparenting was associated with emerging‐adult children's lower basic needs satisfaction and more well‐being problems; however, the strength of the association between overparenting and needs satisfaction varied across cultures. Implications.: The principle of universalism without uniformity applies to overparenting. [ABSTRACT FROM AUTHOR]

Objectives: We examined whether emerging adults' sense of intimate safety with their parents and their adult attachment style would predict emerging adults' social connectedness. Additionally, we investigated whether their social connectedness would mediate the association between emerging adults' sense of intimate safety with their parents and their rumination and anger expression. Background: Social connectedness is essential to the psychological and relational health of emerging adults, particularly during the renegotiation of their relationships with their parents. Method: Two hundred sixteen emerging adults (80% female; 61% non‐Hispanic White) completed a survey of close relationship variables. Results: The results suggest that emerging adults' adult attachment style mediated the relationship between emerging adults' intimate safety with their parents and social connectedness. Additionally, social connectedness mediated the relationship between emerging adults' intimate safety with their parents and their rumination and anger expression. Conclusion: This research highlights the importance of emerging adults' sense of safety to be their authentic and vulnerable selves in parent–child relationships on emerging adults' development of social connectedness and their mental and relational health. [ABSTRACT FROM AUTHOR]

The article presents a study by the U.S. Centers for Disease Control and Prevention (CDC) on the emergency visits due to mental health conditions (MHC), drug overdoses, and suicide-related behaviors among adolescents in the country from January 2019 to February 2023. Also cited are the differences with respect to sex in said cases and the recommendations to address the issue like early identification and evidence-based prevention programs.

This article provides an overview of some of the psychologically informed practice of supporting young people, their families and the people supporting them within Children and Young People's Services (CYPS) in Suffolk County Council (SCC). The overview outlines the approach and experiences of the Psychology Support Service (PSS; formerly known as Suffolk Family Focus Psychology Service). The PSS enables practitioners and managers across CYPS to access specialist psychological support to enable practitioners to support children, young people, and families with a range of needs. The PSS works closely with stakeholders including frontline practitioners, managers, and workforce development. The article, therefore, also includes reflections from practice management (Early Help) and workforce development management about psychological and trauma informed practice within CYPS. It is clear from the evidence, and from our own work within PSS, that working in a psychologically and trauma-informed way is important to meet the needs of vulnerable children and young people and those who are supporting them. The Psychology Support Service: Who we are, Why we do it and What we do. [ABSTRACT FROM AUTHOR]

Young people with eating disorders can present with physical health risks that require admission to a general hospital ward which can be a negative experience. As part of a service development initiative within the CAMHS Community Eating Disorder Service for Rotherham Doncaster and South Humber NHS Foundation Trust, we co-produced a Medical Admission Pack for Young People. It was designed based on assimilated data from a focus group, an interview and surveys, gathered from young people who had experienced an admission to a general ward, their parents/carers and ward staff. Thematic analysis was conducted to derive the three key themes: uncertainty, negative experiences and having a voice. The themes were used to guide the construction of The Medical Admission Pack, which was co-produced between the service and expert by experience service users, in line with the six principles of trauma-informed care (safety, trust, choice, collaboration, empowerment and cultural consideration). The packs were developed to help reduce the negative experiences during admissions by resolving uncertainty - to promote psychological safety and trust - as well as empowering young people. Anecdotal evidence suggests that the aims of the pack were met, however further evaluation is still needed. A further advancement of this pack was an edition for parents/carers, based on similar principles but suited to the needs of the parent/carer. The parent/carer pack is relatively new and requires evaluation to determine the effectiveness. [ABSTRACT FROM AUTHOR]

The aim of this project was to co-produce a new Patient Reported Experience Measure (PREM) with young people and parent/carers for a new Children and Young People's Mental Health (CYPMH) inpatient unit, to collect meaningful and actionable feedback that will support a trauma-informed approach in the service. Young people and parents/carers using the service reported that existing PREMs, such as the Experience of Service Questionnaire (CHI-ESQ) and CAMHS Satisfaction Scale (CAMHSSSUnit) were unsuitable. Focus groups were held with young people and their parents/carers to develop a new PREM specifically for CYPMH inpatient services. Young people and parents/carers reviewed the existing questionnaires and discussed which aspects of inpatient care they wanted to provide feedback about following their admission. Key themes from the focus groups included the importance of a variety of types of response scales and ensuring the questions captured a range of experiences. Two co-produced, distinct versions of the PREM for young people and parents/carers were constructed using the focus group feedback and were named the Re-QUEST (The Red Kite Questionnaire for Understanding Experiences of Services Together). Both versions of the Re-QUEST were then reviewed by a wider group of young people and parents/carers for acceptability and were unanimously approved. The Re-QUEST was piloted with young people and their parents on their discharge from the service. [ABSTRACT FROM AUTHOR]

Social Media usage has been growing rapidly, since the last decade. It still remains unclear whether social media usage is making people emotionally healthy or less. The purpose of the study was to understand the relationship between Social Media Usage, Social Anxiety and Social Comparison among young adults in Mumbai. The sample consisted of 148 people, 74 male and 74 female in the age group of 20 - 35 years of age in Mumbai, Thane and Navi Mumbai. The Social Networking Usage (Liyaqat Bashir & Savita Gupta, 2018), Liebowitz Social Anxiety Scale (Michael Liebowitz, 1987) and INCOM (Simone Schneider & Jurgen Schupp, 2011) were used in this study. A Pearson's Product Moment Correlation was computed between social media usage, social anxiety and social comparison. Results stated that there was a significant positive correlation found between social media usage and social anxiety (r=0.781, p<.01), social media usage and social comparison (r=0.683, p<.01) and social anxiety and social comparison (r=0.811, p<.01). Further, ttests were commuted to understand the differences between gender as well as student and working population. There was an insignificant difference found between gender and student & working population. These findings add knowledge on how social media usage is affecting an individual's physical and emotional wellbeing. Further implications of the study suggest that conducting workshops or awareness on self-acceptance, positive attitude towards oneself, proper social media usage will increase physical and emotional wellbeing. [ABSTRACT FROM AUTHOR]

This article investigates everyday geography of young adults and the unequal importance that spatial accessibility to a range of urban services might have for their mental health to identify those who are truly disadvantaged. Whereas the literature on the socially differentiated vulnerability to place effects has traditionally focused on the neighborhood of residence, we consider daily activity locations to explore whether socially disadvantaged populations are more exposed to (differential exposure) or more affected by (differential effect) low spatial accessibility to services compared to their more advantaged counterparts. Data came from 1,983 young adults (between eighteen and twenty-five years old) living in Montreal, Canada. We observed that less educated young adults had lower spatial accessibility to services in their activity space than their more educated counterparts but also that they were more vulnerable to having lower numbers of services in their surroundings: Lower service accessibility in the activity space was associated with poorer mental health among less educated young adults but not among the more educated. We suggest three sociospatial mechanisms related to (1) place experiences, (2) flexibility in spatial behavior, and (3) rules regulating actual access to services to explore why the "objective" lack of services close to residential and activity locations might represent a greater burden to more socially disadvantaged people. [ABSTRACT FROM AUTHOR]

Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient-clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children's mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorterand longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help-seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help-seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; X2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; X2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help-seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one's ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help-seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to examine the economic impact of COVID‐19 virus on family dynamics and college‐age children's mental health in China and to identity personal and social or relational resilience factors that could buffer the negative consequences of COVID‐19. Background: Since an outbreak of COVID‐19 was first reported in China in December 2019, it has profoundly changed the lives of families and children of all ages. In particular, it has created challenges among families with college‐age young adult children. Method: Using a sample of 484 college students from 21 universities in China, an online survey design was utilized to obtain information from these students on their family demographics and economic situation, parent–child interactions, and individual well‐being during COVID‐19. Results: Results from structural equation modeling suggested that family income loss due to COVID‐19 was related to economic pressure. Economic pressure was associated with negative interactions between parents and young adult children, which were associated with problems in young adult children's mental health (i.e., anxiety and depressive symptoms). Further, self‐control was found to buffer the association between family income loss and economic pressure, and respect for family was found to weaken the association between economic pressure and negative parent–child interactions. Conclusion: Findings supported the hypotheses of the negative impacts of COVID‐19 on young adult children's mental health and the resilience factors that buffered the negative impacts. Implications: Implications to family researchers, family life educators, practitioners, and policymakers were discussed. [ABSTRACT FROM AUTHOR]

Concerns about mental health difficulties in young people, mid-adolescent girls in particular, are on the rise. Many explanations ranging from peer pressure and bullying, to social media and gender inequality, have been offered for the rise in mental health problems. This study utilised data from the Millennium Cohort Study (Wave 6) to examine 14-year-olds' mental health and wellbeing in relation to familial and peer interactions, gender, socio-economic factors and social media use. Across measures of mental health and wellbeing, the findings showed that girls fared much worse than boys, particularly in experiencing negative feelings and low self-concept and life satisfaction and in self-harming. Teenage girls appeared to have become the new 'high risk' group. The findings from this study have implications for young people's mental health and wellbeing especially as seen through the lens of income and gender inequality. Given the current political concerns about young people's mental health, this study is hoped to contribute to an informed debate about individual wellbeing within a broader social milieu. [ABSTRACT FROM AUTHOR]

The association of leisure time activities with specific mental disorders has mainly remained unclear because of lack of such research. This study analyzed the association of different levels of social leisure time activity during adolescence (ages 15–16 years) with the incidence of mental disorders during adolescence and young adulthood between the ages of 16–33 years. The study population consisted of 6838 (females 51.5%) participants from the longitudinal follow-up study, the Northern Finland Birth Cohort 1986, covering 72% of the total 1986 birth cohort. Psychiatric morbidity of the participants was followed through nationwide health registers until the end of the year 2018 when the participants were 33 years old. High social leisure time activity in adolescence associated with lower incidence of psychiatric disorders in general, and specifically, with affective, anxiety, and substance use disorders. Low social leisure time activity was related to increased incidence of any psychiatric disorder in general, and particularly to anxiety and behavioral disorders. In terms of prevention of mental disorders, these study findings encourage families, schools and other communities to continue to enhance and develop community-based social leisure time activities for children and adolescents. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the debt burdens, perceived capabilities, and mental health of young adults. Panel data constructed from the 2009 to 2013 waves of the Panel Study of Income Dynamics (PSID) and its Transition to Adulthood (TA) supplement are used in this study. The multinomial logistic regression analysis findings showed that the amount of revolving debt was negatively associated with young adults' mental health. On the other hand, perceived abilities in acting responsibly, in solving problems, and in managing money were positively associated with the mental health of young adults. The fixed effects regression analysis results indicate that the amounts of credit card and student loan debt from the previous period were negatively associated with an increase in the mental health continuum scores of young adults over time. A discussion of the implications of this study's key findings for scholars, policymakers, and practitioners is included. [ABSTRACT FROM AUTHOR]

Studies suggest that more 30% of college students are currently depressed. A small but growing body of literature suggests that young adults' social media use correlates with their depressive and anxious symptomology. As many as 90% of young adults use social media currently, compared to just 12.5% in 2005. Further, more than a quarter of college students report spending at least six hours per week on social media, compared to only 18.9% in 2007. Smartphone use within young adult populations also is extremely high: estimates of undergraduate smartphone ownership appear to be as high as 97%. Collectively, these trends suggest that social media and smartphones play an integral role in the routines and culture of young adults. The authors present the existing research linking social media use with depression and anxiety and utilize a case study to illuminate the relationship between young adult depression, anxiety, and social media use. The article provides clear recommendations for the assessment and treatment of social media use in depressed and anxious young adults. [ABSTRACT FROM AUTHOR]

Background: The mental health of Asian and Pacific Islander (API) undocumented young adults has been understudied, despite an increasingly restrictive immigration climate that would ostensibly raise mental health risks. This study examined the role of social ties and depression among API undocumented young adults. We distinguished between two types of social ties, bonding and bridging, and additionally considered the absence of ties (e.g. isolation).Methods: We used primary data collected among 143 API undocumented young adults. We first identified correlates for each type of social tie and then examined the association for each measure with depression.Results: Higher levels of bonding and bridging ties were associated with lower odds of a positive depression screen. In contrast, isolation was associated with higher odds of a positive depression screen. There were no significant associations between total social ties and depression.Conclusions: Our findings suggest that both bonding and bridging ties are important factors in the mental health of API undocumented young adults. Factors that facilitate these types of ties, such as DACA, can be effective interventions for improving mental health among this population. [ABSTRACT FROM AUTHOR]

Background: Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included in 2013 Internet gaming disorder (IGD) as a condition for further study, and in 2018, the World Health Organization included gaming disorder (GD) as a mental disorder in the International Classification of Disease (ICD-11). We aim to compare disorders of gaming in both diagnostic systems using a sample of young adults in Mexico.Methods: Self-administered survey to estimate the prevalence of DSM-5 IGD and ICD-11 GD in 5 Mexican universities; 7,022 first-year students who participated in the University Project for Healthy Students, part of the World Health Organization World Mental Health International College Student Initiative. Cross-tabulation, logistic regression, and item response theory were used to inform on 12- month prevalence of DSM-5 IGD and ICD-11 GD, without and with impairment.Results: The 12-month prevalence of DSM-5 IGD was 5.2% (95% CI, 4.7 to 5.8), almost twice as high as the prevalence using the ICD-11 GD criteria (2.7%; 95% CI, 2.4 to 3.1), and while adding an impairment requirement diminishes both estimates, prevalence remains larger in DSM-5. We found that DSM-5 cases detected and undetected by ICD-11 criteria were similar in demographics, comorbid mental disorders, service use, and impairment variables with the exception that cases detected by ICD-11 had a larger number of symptoms and were more likely to have probable drug dependence than undetected DSM-5 cases.Conclusion: DSM-5 cases detected by ICD-11 are mostly similar to cases undetected by ICD-11. By using ICD-11 instead of DSM-5, we may be leaving (similarly) affected people underserved. It is unlikely that purely epidemiological studies can solve this discrepancy and clinical validity studies maybe needed. [ABSTRACT FROM AUTHOR]

Background: Syndemic theory highlights the potential for health problems to interact synergistically, compounding impact. Young adults not in education, employment or training (NEET) are more likely to experience disadvantage and poorer general health outcomes. However, there is little research on their sexual health, or the extent to which this clusters with mental and physical health outcomes.Methods: Analysis of data from 16 to 24 year olds (1729 men, 2140 women) interviewed 2010-12 for Britain's third National Survey of Sexual Attitudes and Lifestyles. Natsal-3 is a national probability sample survey using computer-assisted personal interviewing with computer-assisted self-interviewing. Participants were classified as workers, students or NEET. We used multivariable logistic regression to examine associations between being NEET (relative to worker or student) and risk behaviours and outcomes in physical, sexual and mental health domains. We then examined how risk behaviours and poor health outcomes cluster within and across domains.Results: 15% men and 20% women were NEET; 36% men and 32% women were workers; and 49% men and 48% women were students. Young people who were NEET were more likely to report smoking and drug use (men) than other young people. There were few differences in sexual health, although NEETs were more likely to report condomless sex, and NEET women, unplanned pregnancy (past year). Risk behaviours clustered more within and across domains for NEET men. Among NEET women, poor health outcomes clustered across mental, physical and sexual health domains.Conclusions: Harmful health behaviours (men) and poor health outcomes (women) clustered more in those who are NEET. This points to a possible syndemic effect of NEET status on general ill health, especially for women. Our paper is novel in highlighting that elevated risk pertains to sexual as well as mental and physical health. [ABSTRACT FROM AUTHOR]

Background: Mental health disorders such as high levels of anxiety, isolation, depression and suicide ideation reported among young people living with HIV (10-24 years;YPLHIV) contribute significantly to poor medication adherence and retention in care. While there is evidence supporting the role of psychosocial support interventions in promoting adherence and retention in antiretroviral treatment (ART) among adults living with HIV, there is little evidence on the role of psychosocial support on medication adherence among YPLHIV. This scoping review was designed to identify and classify the types and effects of psychosocial support interventions designed to improve adherence and retention in ART among YPLHIV globally.Method: We searched six electronic databases (i.e., Scopus, Pubmed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline). Six relevant articles published between 2011 and 2019 met our inclusion criteria. We extracted information relevant to the nature and outcomes of the reported interventions using thematic content analysis informed by the Population, Intervention, comparison, outcome, and time (PICOT) framework.Results: Four distinctive treatment modalities that focused on improving ART adherence and retention in care were identified: individual counselling, support groups, family-centered services, and treatment supporters.Conclusion: There is a dearth of psychosocial support interventions to improve adherence and retention in ART amongst adolescents and young adults living with HIV. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of YPLHIV.Trial Registration: PROSPERO: Registration CRD42018105057 . [ABSTRACT FROM AUTHOR]

We aimed to assess associations between parental social media comparison (PSMC)—the degree to which individuals compare their parenting with others on social media (SM)—and depressive symptoms. In March 2018 we conducted a survey of 528 parents ages 18-30 with children under the age of 18. Participants were asked about SM use, PSMC, and depressive symptoms. PSMC was measured with 7 Likert-type items that asked participants the extent to which they agreed or disagreed with statements such as "Based on their posts, other parents on social media appear to provide a better social life for their children than I do." Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Multivariable ordered logistic regression models were used to assess the association between PSMC and depressive symptoms while controlling for SM use, parent adverse childhood experiences, parent age, gender, race/ethnicity, relationship status, employment status and household income, age of oldest child, and number of children. The PSMC was internally consistent (α = 0.94). In multivariable models, after adjusting for all covariates, there was 51% greater odds of elevated depressive symptoms (AOR = 1.51, 95% CI [1.33, 1.71]) for every one-point increase on the PSMC scale. In conclusion, the PSMC is independently associated with elevated depressive symptoms among parents. Future research should assess directionality of these associations and further explore parents' experiences of comparison with others on SM. Highlights: We developed a Parental Social Media Comparison scale (PSMC) to assess how parents compare themselves on social media. We found that a one-point increase in PSMC was associated with 51% greater odds of elevated depressive symptoms. This association was apparent even after controlling for covariates associated with depression and social media use. [ABSTRACT FROM AUTHOR]

Sexual trauma (e.g., rape), is associated with dissociation and suicidal ideation (SI). Sexual trauma is additionally harmful when perpetrated by a person(s) who is close or trusted (known as high betrayal). With young adulthood as a high-risk period for mental instability, the purpose of the current study is to examine the roles of high betrayal sexual trauma and dissociation in SI among young adults. Participants (N = 192) were college students who completed the 30-minute online survey. A multivariate analysis of variance (MANOVA) found that high betrayal sexual trauma was associated with dissociation and SI. Moreover, there was an indirect effect of high betrayal sexual trauma on SI through dissociation. Empirical implications include examining these associations longitudinally, with a focus on the impact of revictimization over time. [ABSTRACT FROM AUTHOR]

Background: Young people face significant challenges when managing a mental illness, such as acquiring treatment autonomy, being inexperienced users of the healthcare system and associated peer-related stigma. While medication use can be challenging in its own right, there is comparatively little information about the associated experiences and needs of young people with mental illness, particularly in the Australian context. This exploratory study will provide valuable insight into how this group is currently supported in relation to medication use.Methods: Young people (aged 14-25 years) who had used a prescription medication for any mental illness for a minimum of 2 months were eligible to participate in this qualitative exploratory study. Semi-structured interviews were conducted between October 2017-September 2018 in consultation rooms at two youth-focused mental health support organisations in Brisbane, Queensland. Interview questions explored how participants managed their medication and related experiences. Interviews were transcribed verbatim and descriptively analysed using thematic analysis.Results: Eighteen young people discussed their lived experience during interviews averaging 50 min in duration. Finding the right medication that reduced symptom severity with minimal side-effects was identified as a complex experience for many, particularly when there was a lack of information, support or reduced financial capacity. Young people described a range of strategies to manage medication side-effects, changes and to support routine medication use.Conclusions: Young people persevered with taking medication to manage a mental illness within a healthcare system that does not adequately support this vulnerable population. There remains a clear directive for healthcare professionals to provide credible information that proactively engages young people as healthcare participants, and for policy makers to consider financial burden for this population with limited financial capacity. [ABSTRACT FROM AUTHOR]

Improving young people's mental health has become a priority for policy-makers in Norway as elsewhere. Although the evidence is limited, physical activity has been identified as having a role in mental health promotion with school physical education (PE) typically being presented as a suitable setting. Few studies, however, have explored young people's perceptions and experiences of PE and the possible consequences for their mental health – the departure point for this paper. We approach this issue sociologically by focusing on the processes through which PE is enacted. Qualitative data were generated by 31 focus groups involving 148 youngsters from the 10th grade (15–16-year-olds) in eight secondary schools in Norway. The overarching theme to emerge was that PE was valued by the students for what it was not as much as what it was. The appeal of PE often lay in being different and a break from 'normal' school lessons and, at the same time, an opportunity for informal social interaction and strengthening social bonds. Enjoyment of PE – even among those with limited sporting competence – was understood as giving rise to cathartic benefits and an antidote to their increasingly academic, routinized and performance-oriented school lives. However, processes relating to the organization, delivery and assessment of lessons meant that these benefits were sometimes compromised for some young people. We conclude that as far as the mental health of young people is concerned, the best justificatory defence for PE becomes physical recreation as a solution to (academic) schooling rather than PE as education. [ABSTRACT FROM AUTHOR]

Young adults experience social role transitions across multiple life domains, and a deeper understanding of the ways in which these simultaneous transition experiences are associated with substance use and mental health will inform targeted interventions for this population. Data from the current study include24 repeated monthly assessments of young adults (N = 778; 56% female; age range 18 to 24 at baseline; 60% White, 18% Asian, 12% Multiracial, 5% Black or African American, 1% American Indian, 1% Pacific Islander, 3% Other, 9% Latinx) and outcomes 6 months later. Monthly assessments across 2 years were used to identify latent classes of frequency of social role transitions in four key domains (education, residential, employment, and romantic relationships) and associations between these classes and later outcomes. Three classes of social role transitions were identified: Infrequent Transitions (30.4%), Transitions except in Relationships (38.5%), and Frequent Transitions (31.1%). Compared to the Infrequent Transitions class, the other classes had greater typical drinking and hazardous alcohol use six months later; the Frequent Transitions class also had more hazardous cannabis use, depressive symptoms, and anxiety symptoms. Young adults experiencing frequent transitions across multiple domains appear to be at risk for substance use and mental health problems and may benefit from targeted intervention to address substance use and mental health issues. [ABSTRACT FROM AUTHOR]

This study reviewed perceived changes to planning and management of transitions to adulthood for young people with special educational needs and disabilities in three local authorities in England, following implementation of the Children and Families Act (2014). Wenger's 'community of practice' theoretical framework was used to examine how groups of professionals and managers working in education, health and social care in three areas, set about implementing selected radical changes required by the legislation. Telephone interviews with sixteen participants were transcribed and subjected to thematic analysis. Themes identified related to professional activity, planning and organisation, implications for young people and families and outcomes. There were indications of shifts in professional conceptualisations and reported practices as a result of the Act. Participants described enhanced cross‐service communication and co‐ordinated working practices, achieved though service restructuring, co‐location and changed lines of accountability. An increased emphasis on long‐term planning and involving young people in planning and decision‐making was evident with regard to defining outcomes, and living and working as an adult. The results are considered in relation to the extent that mandated change can influence attitudes and cultures within communities of practice, contributing to the contemporary theoretical debate to incorporate issues relating to power. [ABSTRACT FROM AUTHOR]

Adolescence and early adulthood (collectively categorized as "young people") is a transitional period associated with a number of key physiological, social and psychological changes. Sleep difficulties, notable in this age group, may adversely affect physical and mental health. Of interest is the impact of the natural shift in young people towards a more evening-type sleep pattern (chronotype), whilst social constraints encourage early waking to fit with school/work timings. This leads to a misalignment in sleep timing between weekdays and weekends, known as social jetlag, which may contribute to emerging mental health difficulties seen during this age group. A systematic literature review was undertaken to investigate the association between social jetlag and mental health outcomes. Systematic searching of electronic databases (The Cochrane Library; PsycINFO; CINAHL; Scopus; and PubMed), grey literature and review of reference lists identified seven studies which assessed associations between social jetlag and mental health outcomes in young people. Quality appraisal was completed using the Appraisal Tool for Cross-Sectional Studies. Findings appeared equivocal; however significant associations were revealed with social jetlag associated with clinical depression and seasonal depression, in female participants and high latitude regions. Quality of included studies was moderate (10–13 criteria met). A lack of homogeneity between study methodologies precluded the conduct of a meta-analysis. The ambiguous results found may result from confounding factors including non-comparable methods of measuring social jetlag and mental health both in this age group and the selected studies. Future research should address a lack of homogeneity through the development of an interdisciplinary core outcome set, and agreement on a standardized measure and calculation for social jetlag. [ABSTRACT FROM AUTHOR]

There is a dearth of research examining the relation between adolescent peer victimization and internalizing symptoms during emerging adulthood. This retrospective study examined relations among offline and online peer victimization, internalizing symptoms, as well as offline and online social support. A sample of 416 participants aged 18–24 was recruited and self-report data on adolescent victimization, support, and internalizing symptoms were collected. The results showed that retrospective reports of peer victimization and social support predicted current internalizing symptomology. However, this varied as a function of online/offline context and symptomology. Specifically peer victimization was more predictive of depressive symptoms than social anxiety symptoms. Offline social support predicted fewer internalizing symptoms, but online support did not. Social support diminished the association between peer victimization and social anxiety. [ABSTRACT FROM AUTHOR]

Childhood bullying is a well-known public health problem world-wide. Research has described numerous health and mental health effects on victims, bullies, and bystanders. While there are studies of contemporaneous consequences, there is still much to be discovered in terms of the impact of childhood bullying lasting into adult life. This qualitative inquiry investigated the aftermath of childhood bullying for young adults in terms of their health, mental health, and relationship issues. Further, it asked participants for their definitions of bullying. The study was part of a mixed-methods inquiry. For the qualitative portion, 72 graduate and undergraduate students in the U.S., ages 18 to 29, participated as a purposive sample. The majority of participants were Caucasian and female, though 28% percent represented minority groups. Semi-structured interviews were conducted lasting approximately 1 h each. A participatory action research approach was taken to understand the lived experiences and perceptions of the young adults. Grounded theory was utilized in reviewing the data for thematic responses. Member checks and triangulation were employed to substantiate credibility, authenticity, and coherence of the data. Content analysis revealed lasting consequences in (a) mental and psychological well-being (b) eating disorders, weight, and body image, and (c) relationship and trust issues. Results are indicative of the need for further research on childhood bullying as it affects later adolescent and young adult development. Understanding the aftermath of childhood bullying is important in informing bullying interventions and maintaining a focus on early prevention efforts. [ABSTRACT FROM AUTHOR]

Do changes in health lead to changes in the probability of voting? Using two longitudinal datasets, this article looks at the impact of three measures of health – physical health, mental health and overall well-being – on voting trajectories in young adulthood. The results show that self-rated health is associated with a lower probability of voting in one's first election, depression is related to a decline in turnout over time and physical limitations are unrelated to voting. Some familial resources from childhood are also found to condition when the health–participation effect manifests. [ABSTRACT FROM AUTHOR]

HIV infections among adolescents and young adults continue to grow and clinical guidelines recommend the immediate start of life-saving antiretroviral therapy (ART). Unfortunately, suboptimal medication adherence among youth is common and can lead to poorer health outcomes as well as onward transmission of HIV to sexual partners. Clinical tools to assess treatment readiness are needed and can assist with adherence intervention strategies for youth. An assessment tool that we previously developed, the HIV Treatment Readiness Measure (HTRM), was administered to 595 HIV-positive youth ages 13–24 recruited from adolescent medicine clinics in the United States. Participants were followed for a minimum of 6 months and had to have at least one viral load test completed to be included in this analysis. The HTRM demonstrated high internal consistency (Chronbach's alpha = 0.86). For participants currently on ART at study entry, higher overall treatment readiness scores predicted future viral suppression (OR 1.52). Individual scores on three of the measure's factors (Psychosocial Issues, Connection with Care, and HIV Medication Beliefs) were also significant predictors of viral suppression. For those participants not on ART at study entry, the HIV Medication Beliefs factor significantly predicted who would eventually start ART (OR 2.26) but overall treatment readiness scores did not predict viral suppression in that group. [ABSTRACT FROM AUTHOR]

This article considers the potential development of mental health apps for LGBTIQ+ young people. It reports on data from an Australian study of LGBTIQ+ young people's mental health help-seeking experiences. Participants (aged 16–25 years) highlighted the potential value of mental health apps, yet also questioned the need for another digital intervention. Addressing stigma around mental health was seen as a greater priority for many, as was addressing the inadequate mental health information and support available to LGBTIQ+ young people through schools and mainstream health services. Participants noted that a mental health app must not only be useful, reliable and accessible but also actively sought, which was sometimes unlikely. This article questions a contemporary public health agenda for developing digital solutions to complex social problems. Furthermore, it asks whether health inequities and social stigma can be addressed by apps that typically prioritise the practice of individualised self-care. [ABSTRACT FROM AUTHOR]

Introduction: Children and adolescents living with parental mental illness (CAPRI) are at increased risk of behavioral, social and educational difficulties, mental and physical health problems and have poorer quality of life (QoL). Adverse outcomes can extend into adulthood but are not inevitable. Recent policy and stakeholder consultation recognize the urgent need for interventions that extend beyond objective, service-led measures of health. Systematic evidence synthesis has demonstrated a lack of evidence-based interventions for enhancing holistic, child-centered outcomes. We aimed to co-develop a manualised, community-based intervention to improve QoL in CAPRI. Precedence was given to the QoL domains that were prioritized by stakeholders and deemed feasible to modify within a health and social care context. We describe here the modeling phase of developing the intervention emphasizing co-production activities with CAPRI, their families and professionals who support them. Methods: Semi-structured interviews and focus groups with CAPRI (n = 14), parents (n = 7), and professionals from health, social and educational sectors (n = 31) in the UK. Topic guides qualitatively explored participants prior experiences, unmet needs, perceived barriers and facilitators to receiving/delivering support, and their ideals for a new intervention. Findings were synthesized with existing research evidence and presented to a mixed panel of clinical academics and health and social care professionals. A consensus exercise was used to identify the preferred structure, format and content of the manualised intervention. Results: An 8-week group intervention for 6–16 year olds and their parents, called Young SMILES, has been co-developed along with associated training materials for facilitators. Each session addresses an identified need, but is underpinned by cross-cutting themes pertaining to mental health literacy, parent-child communication, and problem solving skills. Sessions are delivered by two trained facilitators and held in accessible and acceptable community locations weekly for 2 h. Conclusion: Young SMILES captures a broad age range and level of need for CAPRI and can be evaluated with quantifiable child-centered outcomes. In line with current policy directives, this is the first UK-based, multi-context intervention to improve QoL in this population. Implementation and referral mechanisms are currently being evaluated in a multi-site feasibility trial. [ABSTRACT FROM AUTHOR]

Problematic Internet use (PIU) has been gradually recognized as a mental health issue among adolescents and young students. PIU shows many similarities with substance use disorders, but the shared and distinct mechanisms underlying them are unclear. The purpose of the current study was to explore the relationships between impulsive traits and PIU as well as cigarette smoking behaviors among young adults. Two independent samples of university students (N 1 = 1281, N 2 = 1034, respectively) over 3 years were assessed with multiple measurements of impulsivity, including the Barratt Impulsiveness Scale-11 (BIS-11), the UPPSP Impulsive Behaviors Scale (UPPSP), and the Delay-discounting Test (DDT). Logistic regression models revealed that across the two independent samples, BIS-11 Attentional Impulsiveness was the common trait positively predicting both PIU and cigarette smoking. While BIS-11 Motor Impulsiveness as well as UPPSP Lack of Perseverance, Lack of Premeditation, and Negative Urgency were the typical traits linked to PIU as positive predictors, UPPSP Sensation Seeking was the unique trait linked to cigarette smoking as a positive predictor. These results suggested that specific dimensions of impulsivity might be concurrently implicated in PIU and cigarette smoking among young adults, putatively representing important trait marks for addictive behaviors. [ABSTRACT FROM AUTHOR]

Objectives: The overall goal of this study was to develop a stronger understanding of the role of culture in shaping the experience of parental control and its mental health implications for emerging adults. Specifically, the study focused parental psychological and behavioral control, and their potential implications for emerging adults' hopelessness and depressive symptoms. A core hypothesis is that associations of parental control with mental health would differ between Latinas and non-Latinas because of cultural differences in parental expectations and parent-child dynamics. Additionally, similarities and differences in the role of mothers' and fathers' control were explored.Methods: The sample consisted of 330 female emerging adults, including 146 Latinas and 184 non-Latinas. Participants completed questionnaires assessing their perceptions of parental psychological and behavioral control, of mothers and fathers separately, and mental health indicators.Results: Results from path models demonstrated the relevance of mothers' psychological control for both Latinas and non-Latinas, while differential implications of mothers' behavioral control were found for Latinas and non-Latinas. In addition, mothers' psychological control appeared to be more salient than fathers' psychological control for female emerging adults' mental health.Conclusions: The role of culture in the function of parental control for emerging adults' mental health is discussed. [ABSTRACT FROM AUTHOR]

The authors examined leisure-time physical activity (LTPA), body mass index (BMI), and perceived physical ability as body dissatisfaction antecedents, and analyzed their relationship to well-being. The sample comprised 501 university students. Data were collected using a self-administered survey. Path analysis revealed that LTPA positively predicted perceived physical ability. BMI and perceived physical ability predicted body dissatisfaction (positively and negatively, respectively). Body dissatisfaction negatively predicted subjective vitality, whereas perceived physical ability positively predicted subjective vitality. These results support the inclusion of LTPA in intervention programs that seek to promote more satisfactory physical perceptions and psychological well-being. [ABSTRACT FROM AUTHOR]

Childhood polyvictimization is related to a heightened risk for mental health and functional problems in young adulthood, including posttraumatic stress symptoms, but little research has examined how perceptions of the prevalence of victimization may contribute to specific symptoms of posttraumatic stress. The primary aims of the current study were to (a) evaluate the accuracy of young adults' beliefs about the prevalence of multiple types of childhood victimization and (b) determine how inaccurate appraisals of victimization prevalence are associated with posttraumatic stress symptoms. College students (n = 369) drawn from two geographic regions of the United States responded to an online survey assessing their experiences of childhood victimization, perceptions about the prevalence of victimization, emotion regulation skills, and mental health. Childhood polyvictimization was significantly and positively related to distorted appraisals of the prevalence of victimization overall (r = .26, p < .001), and emotion regulation was associated with symptoms of posttraumatic stress in all domains. Distorted perceptions of the prevalence of victimization were linked to higher symptoms of hyperarousal, but not to higher symptoms of reexperiencing, avoidance, or negative mood/cognition. Results suggest that emotion regulation skills training is likely to be beneficial for many individuals experiencing posttraumatic stress, and intervention around perceptions of the prevalence of victimization may be useful for addressing symptoms of hyperarousal. [ABSTRACT FROM AUTHOR]

Aims: We tested the age‐varying associations of cannabis use (CU) frequency and disorder (CUD) with psychotic, depressive and anxiety symptoms in adolescent and adult samples. Moderating effects of early onset (≤ 15 years) and sex were tested. Design Time‐varying effect models were used to assess the significance of concurrent associations between CU and CUD and symptoms of psychosis, depression and anxiety at each age. Setting and Participants: Adolescent data (V‐HYS; n = 662) were collected from a randomly recruited sample of adolescents in Victoria, British Columbia, Canada during a 10‐year period (2003–13). Adult cross‐sectional data (NESARC‐III; n = 36 309) were collected from a representative sample from the United States (2012–13). Measurements Mental health symptoms were assessed using self‐report measures of diagnostic symptoms. CU was based on frequency of past‐year use. Past‐year CUD was based on DSM‐5 criteria. Findings For youth in the V‐HYS, CU was associated with psychotic symptoms following age 22 [b = 0.13, 95% confidence interval (CI) = 0.002, 0.25], with depressive symptoms from ages 16–19 and following age 25 (b = 0.17, 95% CI = 0.003, 0.34), but not with anxiety symptoms. CUD was associated with psychotic symptoms following age 23 (b = 0.51, 95% CI = 0.01, 1.01), depressive symptoms at ages 19–20 and following age 25 (b = 0.71, 95% CI = 0.001, 1.42) and anxiety symptoms ages 26–27 only. For adults in the NESARC‐III, CU was associated with mental health symptoms at most ages [e.g. psychotic symptoms; age 18 (b = 0.22, 95% CI = 0.10, 0.33) to age 65 (b = 0.36, 95% CI = 0.16, 0.56)]. CUD was associated with all mental health symptoms across most ages [e.g. depressive symptoms; age 18 (b = 0.96, 95% CI = 0.19, 1.73) to age 61 (b = 1.11, 95% CI = 0.01, 2.21)]. Interactions with sex show stronger associations for females than males in young adulthood [e.g. V‐HYS: CUD × sex interaction on psychotic symptoms significant after age 26 (b = 1.12, 95% CI = 0.02, 2.21)]. Findings were not moderated by early‐onset CU. Conclusions: Significant associations between cannabis use (CU) frequency and disorder (CUD) and psychotic and depressive symptoms in late adolescence and young adulthood extend across adulthood, and include anxiety. [ABSTRACT FROM AUTHOR]

The findings from a growing body of research reveal that incarceration is detrimental for both physical and mental health. Incarceration, however, is typically conceptualized and operationalized as a dichotomy; individuals either have, or have not, been incarcerated. Considering that incarceration can range from one day to several years, a dichotomous measure may be overlooking important variations across lengths of exposure. In addition, most inmates are incarcerated more than once. In this study, we help to fill this gap by examining the relationship between incarceration dosage, measured as time served and number of spells, and mental health among a sample of young adults from the National Longitudinal Study of Youth 1997. By using fixed‐effects modeling, we find that the number of spells and the months incarcerated are positively related to mental health symptoms and the likelihood of depression. The association, however, is contingent on whether a respondent is currently or formerly incarcerated. Among current inmates, more time served is expected to improve mental health and the number of spells is unrelated to either outcome. [ABSTRACT FROM AUTHOR]

Although there has been an increase in public health campaigns and initiatives aimed at preventing suicidal behaviors, suicide rates in Canada appear to be increasing particularly among young adults. Yet, few studies in Canada have examined the effect of suicidal ideation on unmet mental health needs among young adults. The objective of this study is to examine the association between suicidal ideation and unmet mental health needs, over and above predisposing, enabling, and need factors. This study uses data on 3393 young adults aged 20-29 years from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Binary logistic regression analysis was conducted with unmet mental health needs as the outcome variable and suicidal ideation as the main explanatory variable. Of the 3393 respondents, 8.8% had unmet mental health needs and 16.5% had suicidal ideation. In the multivariate logistic regression model, respondents who experienced suicidal ideation had 2.55 times higher odds of having unmet mental health needs. Respondents were also more likely to have unmet mental health needs if they are female, experienced childhood adversity, or were diagnosed with mental health disorders or cannabis abuse or dependence. Each additional unit increase in social support decreased the odds of unmet mental health needs by 11%. Community peer support programs for young adults may be beneficial in enhancing access to mental health particularly for at-risk individuals. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group.Method: A prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18-25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months.Results: 43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/ sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups.Limitations: The study was set in psychiatric emergency services, which limits the generalizability.Conclusions: Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt. [ABSTRACT FROM AUTHOR]

Middle adolescents' close friendship strength and the degree to which their broader peer group expressed a preference to affiliate with them were examined as predictors of relative change in depressive symptoms, self-worth, and social anxiety symptoms from ages 15 to 25 using multimethod, longitudinal data from 169 adolescents. Close friendship strength in midadolescence predicted relative increases in self-worth and decreases in anxiety and depressive symptoms by early adulthood. Affiliation preference by the broader peer group, in contrast, predicted higher social anxiety by early adulthood. Results are interpreted as suggesting that adolescents who prioritize forming close friendships are better situated to manage key social developmental tasks going forward than adolescents who prioritize attaining preference with many others in their peer milieu. [ABSTRACT FROM AUTHOR]

Borderline Personality Disorder (BPD) is on focus due to its intense and long-lasting symptoms. BPD is considered a psychological disorder of young adults, as its major symptoms start revealing at the beginning of young adulthood in the early 20s. The aim of this study was to assess BPD and its symptoms in the young population of students achieving higher education in private universities of Lahore, Pakistan. A stratified sample of 700 university going students was collected from three high ranked private universities of Lahore. The sample was collected and assessed through Borderline Personality Inventory (BPI-cut 20). The results obtained through the descriptive statistics revealed the high percentage of BPD in young adults (62%). Further, a high percentage of BPD was observed in a group of students ages 1821 years (63%). The four factors of BPD: Primitive Defense Mechanism, Identity Diffusion, Fear of Closeness, Self-Mutilation, and Impulsivity were equally found among the male and female samples. The independent sample t-test revealed the significant results obtained from the factor self-mutilation (Male: M=.21, SD=.405 and Female: M= .14, SD= .346, t=2.350, p=0.019) and impulsivity (Male; M=.35, SD=.479 and Female: M= .403, SD= .021, t= 4.482, p= 0.000). The results of this study concluded BPD and its factors were frequently being found in young adults studying in universities. Further, no significant gender differences were observed other than in two factors self-mutilation and impulsivity. It is recommended that there is an essential need to promote the health and wellbeing of the young population of students especially studying in universities because the evidence suggests that they are at risk. They further need assessment and intervention. [ABSTRACT FROM AUTHOR]