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Aims: Amid the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk of digital exclusion. This risk might not abate by the end of the pandemic. This article seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion. Methods: Two hundred and forty-nine adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time that the EDS is benchmarked in people with SMI. Results: 42.2% had no Foundation Skills, and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home. Conclusion: A significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support to ensure people retain access to key services and develop digital skills and confidence. To our knowledge, this is the first time this has been described using the EDS framework. Services, including the National Health Service (NHS), need to be aware of and mitigate the risks.

PurposePopulation surveys underrepresent people with severe mental ill health. This paper aims to explore perceived social support and loneliness and factor associations during the Covid-19 pandemic in a sample of individuals with severe mental ill health.Design/methodology/approachWe sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.FindingsIn the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91).Practical implicationsIntervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.OriginalityLoneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

Although UK clinical guidelines make tentative recommendations for “harm minimization” strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability...

We examine psychological distress and mental health help-seeking in UK university students via an online survey of 461 students, of whom 273 reported having psychological distress. We examined the prevalence and predictors of help-seeking in students with psychological distress, with a focus on the role of adult attachment styles along with social support and perceived stigma. Overall, 22% of the sample reported severe psychological distress and 37% reported mild/moderate psychological distress. Of students reporting severe psychological distress, 58% sought help in the past year and 30% were receiving counselling or therapy. In the group with mild/moderate psychological distress, 30% reported help-seeking and 17% were receiving counselling or therapy. For students with psychological distress, being older, having more psychological distress, and higher anxious attachment predicted mental health help-seeking. Social support and perceived mental health stigma did not predict help-seeking in the regression model. There was some evidence that the relationship between avoidant attachment style and help-seeking may depend on level of psychological distress experienced (moderating role). Overall, the results point to considerable unmet mental health needs in the UK university environment. Targeted strategies to promote mental health help-seeking in younger students may be beneficial.

BackgroundRestrictions due to the COVID-19 pandemic have led to everyday reliance on digitalisation of life, including access to health care services. People with severe mental ill health (SMI – e.g., bipolar or psychosis spectrum disorders) are at greater risk for digital exclusion and it is unknown to what extent they are able to adapt to online service delivery. This cross-sectional survey study explored use of the Internet and digital devices during the pandemic restrictions and its association with physical and mental health changes.Methods367 adults with an SMI diagnosis completed a survey (online or offline) and provided information on access to Internet connection and devices, internet skills, online activities, and barriers to using the Internet. They also self-reported changes in mental and physical health.ResultsDuring the pandemic restrictions 61.6% were limited or non-users of the Internet. The majority had access to the Internet and digital devices but around half reported knowledge deficits. Most common activities were accessing information and entertainment (88.9%), staying in touch with friends and families (84.8%), and purchasing goods (other than food) (84.3%). Most common barriers were finding the Internet ‘not interesting’ (28.3%) or ‘too difficult’ (27.9%), as well as ‘security concerns’ (22.1% to 24.3%). Using the Internet ‘a lot’ (vs ‘just a bit or not at all’) during the pandemic was associated with younger age (Adj ORs = 4.76 – 6.39, Ps < .001), having a diagnosis of bipolar disorder (compared to psychosis; Adj OR = 3.88, P < .001), or reporting a decline in mental health (compared to no decline; Adj OR = 1.92, P = .01).ConclusionMost people with SMI were limited or non-users of the Internet during the pandemic, which seems to be mainly attributable to lack of interest and skills, rather than lack of devices or connectivity. Older adults with psychosis should be the focus of interventions to support digital engagement in people with SMI.

AimsTo explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services.Materials and MethodsA representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically.Results367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person.DiscussionAlthough most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

BackgroundPeople with severe mental ill health (SMI) experience a mortality gap of 15-20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities.MethodsWe sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic.Outcomes367 people provided health risk data. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health and younger age were significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22-2.07; adjusted OR for Age 0.99, 95%CI 0.98-1.00).InterpretationCOVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.FundingMedical Research council, Yorkshire and Humber Applied Research Collaboration, Wellcome and UKRI.

Background People with severe mental ill health (SMI) experience a mortality gap of 15–20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. Methods We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. Outcomes 367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22–2.07; adjusted OR for Age 0.99, 95%CI 0.98–1.00). Interpretation COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

SummarySmoking rates are higher for people who use mental health services which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with SMI before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Whilst some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.

Between 1958 and 1961, the drug Thalidomide was prescribed in the UK as a treatment for morning sickness. It caused severe birth defects. Thalidomide survivors are now experiencing a range of secondary health problems, including depression and anxiety. Internationally, it is estimated that 40% to 50% of Thalidomide survivors have recently experienced common mental health problems. The aim of this study was to gather information about the pattern of symptoms of depression and anxiety amongst UK Thalidomide survivors. A cross-sectional postal survey of 182 UK Thalidomide survivors, which used Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder Scale (GAD-7) to measure self-reported depression and anxiety, was conducted. Data were first analysed using descriptive statistics. A point-biserial correlation was used to examine whether being unable to work was associated with higher depression and anxiety scores. Prevalence of all levels of depression and anxiety was higher amongst the Thalidomide survivors than the general UK population but broadly similar to other groups of adults with disabling conditions. Being unable to work was associated with higher depression and anxiety scores. More research is needed to understand the relationship between early acquired physical disability and depression, in particular the implications, over the life course, of secondary health problems and changing social roles.

Rationale: Self-harm in young people is of significant clinical concern. Multiple psychological, social and clinical factors contribute to self-harm, but it remains a poorly understood phenomenon with limited effective treatment options. Objective: To explore young women’s experience of self-harm in the context of interpersonal stressors and supports. Method: Fourteen adolescent females (13 – 18 years) who had self-harmed in the last six months completed semi-structured interviews about self-harm and supports. Interpretative phenomenological analysis was undertaken. Results: Themes identified were: 1) Arguments and worries about family breakdown; 2) Unhelpful parental response when self-harm discovered and impact on seeking support; 3) Ongoing parental support; 4) Long-term peer victimization/bullying as a backdrop to self-harm; 5) Mutual support and reactive support from friends (and instances of a lack of support); 6) Emotions shaped by others (shame, regret and feeling ‘stupid to self-harm’); and 7) ‘Empty promises’ - feeling personally let down by clinical services. These themes were organised under two broad meta-themes (psychosocial stressors, psychosocial supports). Two additional interconnected meta-themes were identified: Difficulties talking about self-harm and distress; and Impact on help-seeking. Conclusion: Parents and peers play a key role in both precipitating self-harm and in supporting young people who self-harm. The identified themes, and the apparent inter-relationships between them, illustrate the complexity of self-harm experienced in the context of interpersonal difficulties, supports and emotions. This has implications for improving support from both informal and clinical sources.

Young people in the public care system ('looked-after' young people) have high levels of self-harm.This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS).Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months.Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm.Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended.Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this. Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm. Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm. Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted. The CaTS would have clinical utility as an assessment tool Recruiting participants can be a significant challenge in studies with looked-after children and young people. Future research with larger clinical samples would be valuable.

Purpose Team formulation, used to understand patient problems and plan care, is a growing practice in adult mental health and learning disability services. The purpose of this paper is to explore definitions applied to team formulation (as distinct to therapy formulation), its underpinning theories, and the inter-relationship between the team and the process of formulation. Design/methodology/approach A database search (main search term of team formulation) of peer-reviewed studies was conducted using PRISMA guidelines. A main and second reviewer conducted quality appraisals and thematic analysis. Data were analysed by convergent qualitative synthesis design using thematic analysis to transform evidence from quantitative and qualitative studies into qualitative findings. Findings Initial searching produced 4,532 papers, 10 of which were eligible for inclusion. Team formulation has no distinct definition. Theories underpinning the practice of therapy formulation emanating from general psychological theory underpin team formulation. Seven studies applied psychological theories to the examination of team formulation. No studies examined the impact of the team on the formulation. Six themes were generated regarding the impact of team formulation on the team; “increased knowledge and understanding”, “altered perceptions, leading to altered relationships, feelings and behaviours”, “space to reflect”, “useful when stuck or challenged”, “perceived increase in effectiveness” and “improved team working”. Research limitations/implications Limited evidence and variable quality compromised the availability of review evidence. Originality/value This is the first review to examine team formulation through the context of the team. The authors argue that a conceptual framework to encompass team inputs, processes and outputs in team formulation practice should guide future research.

Prevalence of mental health problems in university students is increasing and attributable to academic, financial and social stressors. Lack of social support is a known determinant of mental health problems. We examined the differential impact of sources of social support on student wellbeing. University students completed an online survey measuring depressive symptoms (Patient Health Questionnaire (PHQ-9)), social support (Multidimensional Perceived Social Support (MPSS)), and quality of life (WHOQOL-BREF). The sample was 461 students (82% female, mean age 20.62 years). The prevalence of depressive symptoms was 33%. Social support from family, and friends was a significant predictor of depressive symptoms (p = 0.000*). Quality of life (psychological) was significantly predicted by social support from family and friends. Quality of life (social relationships) was predicted by social support from significant others and friends. Sources of social support represent a valuable resource for universities in protecting the mental health of students.

Background Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. Methods Forty-five young people (aged 13–21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). Results A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. Limitations Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. Conclusions The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions., Highlights • We have developed the Card Sort Task for Self-harm (CaTS). • Sequence analysis revealed important transitions in the pathway to self-harm. • Factors most proximal to self-harm are amenable to intervention. • For recent episodes, hopelessness and suicidality emerged as significant factors. • First ever self-harm (but not most recent) was associated with feeling better afterward.

Six young adults (aged 19–21 years) with repeat self-harm for over 5 years were interviewed about their self-harm, why they continued and what factors might help them to stop. Interpretative phenomenological analysis identified six themes: keeping self-harm private and hidden; self-harm as self-punishment; self-harm provides relief and comfort; habituation and escalation of self-harm; emotional gains and practical costs of cutting, and not believing they will stop completely. Young adults presented self-harm as an ingrained and purposeful behaviour which they could not stop, despite the costs and risks in early adulthood. Support strategies focused on coping skills, not just eradicating self-harm, are required.

Objectives: We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Methods: Qualitative interviews with 24 looked-after young people. Results: Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronised, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Conclusions: Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation and increasing support during placement changes.

Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada.To investigate the knowledge and practice of health care providers at Alberta Children's Hospital (Calgary, Alberta), and to inform practice about the adolescent's right to confidentiality.The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility's electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding.A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents' comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents.While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors' recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals' examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy.Le respect de la confidentialité des adolescents peut présenter des problèmes dans le cadre de la pratique des dispensateurs de soins auprès de la famille et des processus médicaux, éthiques, juridiques, sociaux et bureaucratiques. On ne sait pas comment les dispensateurs de soins comprennent et exercent la confidentialité auprès des adolescents au Canada.Examiner les connaissances et les pratiques des dispensateurs de soins de l’La présente étude a pris la forme d’un sondage virtuel anonyme et volontaire. Les invitations à participer ont été expédiées par la liste de courriels de l’établissement pédiatrique à tous les dispensateurs de soins détenant un poste et susceptibles de participer aux soins d’adolescents. Le sondage se composait de 15 questions fermées et de sept questions ouvertes. Les chercheurs ont analysé les questions fermées au moyen de statistiques descriptives, et les questions ouvertes au moyen d’un code thématique manifeste.Les chercheurs ont reçu un total de 389 réponses, représentant des dispensateurs de soins de diverses disciplines. Ils ont constaté diverses pratiques liées au respect de la confidentialité des adolescents et une incompréhension généralisée de la question. Les commentaires des répondants ont révélé des lacunes de la part des individus et des équipes au sujet des droits des adolescents et des parents ou des tuteurs, et une différence entre les concepts de consentement au traitement et la prestation de soins confidentiels aux adolescents.Les dispensateurs de soins considèrent la confidentialité comme fondamentale, mais le sondage a révélé une vaste variation de la compréhension et des pratiques quant à la confidentialité des soins des adolescents, tant dans les données qualitatives que quantitatives. Les auteurs recommandent des stratégies pour améliorer la compréhension et les pratiques en matière de respect de la confidentialité chez les adolescents, soit encourager les individus à examiner leurs croyances et favoriser les études postsecondaires, les stratégies de transfert du savoir au sein des programmes et les directives et politiques établies par l’établissement.

BackgroundIn the late 1950s and early 1960s the drug Thalidomide was marketed across the world as a non-addictive tranquilizer. Despite being given to pregnant women as a safe treatment for morning sickness, Thalidomide caused serious damage to the unborn child. Much has been written about the drug and the birth defects it caused but evidence about the health of Thalidomide survivors as they age is limited.AimThe aim of this study was to: explore the health and wellbeing UK Thalidomide survivors; document the health problems experienced by them as they reach their mid-50s; and examine the impacts on their health-related quality of life and employment.MethodsA health and wellbeing survey of 351 UK Thalidomide survivors, which gathered information about home and employment circumstances, recent health problems, and health related quality of life (using SF12 Health Survey). Overall analysis focused on descriptive statistics; the association between respondents' health related quality of life and original impairment was examined using Pearson Correlation; and a three step Hierarchical Regression was used to explore the influence of five factors which narrative responses suggested might be important.ResultsAs Thalidomide survivors reach their mid-50's they are experiencing a wide range of secondary health problems, in particular musculoskeletal problems, and depression and anxiety, with multimorbidity a growing issue. These health problems are having a negative impact on their employment (two fifths are unable to work) and their physical health related quality of life, which is significantly poorer than the general population.DiscussionHaving lived relatively independent lives, many Thalidomide survivors are now having to adjust to growing disability. The study provides further evidence of the accumulative impact of disability over peoples' lifetimes and highlights the value of a life course perspective in understanding the complex experience of growing older with a disability.

IntroductionWith most mental health disorders emerging in the later teenage years, university students are arguably an at-risk population with increased mental health support needs. This population is characterised by important, life-changing transitions (moving away from home, friends and family) and new potential stressors (including increased academic pressures and relational challenges). Research to examine determinants of mental health help-seeking behaviours in university students is needed to ensure emotional health needs are being met at this critical time.ObjectivesTo examine levels of psychological distress and mental health help-seeking behaviours in a sample of UK university students. By identifying factors associated with help seeking, we can better understand the mental health needs of this population and inform support provision.MethodsThis study draws on data from the social and emotional well-being in university students (SoWise) study, an online survey which aimed to examine risk and resilience for social and emotional well-being in young people attending a UK university.ResultsWhole sample analysis (n = 461) showed help seeking was significantly associated with psychological distress, current life stressors and anxious attachment and not associated with perceived mental health stigma. Sub-group analysis (n = 171) suggests being female and older significantly predicted help seeking in students with mild/moderate psychological distress.ConclusionsYounger males with mild/moderate psychological distress are less likely to seek mental health support and represent an “invisible” at risk group. Results also suggest that global anti-stigma campaigns in universities may not prove effective in encouraging help seeking.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background: Adolescents and young adults with specific language impairment (SLI) are at risk of experiencing emotional health symptoms, in particular depression and anxiety disorder. However, there is a dearth of research examining issues of stability versus change in symptomatology across time. Aims: To examine depressive and anxiety symptoms reported by adolescents with and without a history of SLI at 16 years, and a year later. Methods & Procedures: Depressive and anxiety symptoms were examined in 90 adolescents with SLI and in 91 adolescents with typical development (TD) initially at 16 years and again at 17 years. Outcomes & Results: Participants with SLI experienced significantly more depressive and anxiety symptoms than participants with TD at 16 years, and continued to experience significantly more anxiety symptoms at 17 years. Females, regardless of language status (SLI versus TD), were more vulnerable than males. The group with SLI evidenced a significant drop in depressive symptoms over the year. A similar change in anxiety symptoms was not apparent. Regression analyses revealed that for individuals with SLI peer problems at 16 years predicted concurrent depressive symptoms, but behavioural factors did not contribute significantly to depressive symptoms at 17 years. For individuals with typical development, hyperactivity at 16 years predicted depressive symptoms at both 16 and 17 years. Language ability and non-verbal IQ did not predict depressive symptoms. Adolescents who experienced more bullying at 16 years were more likely to become, or remain, at risk for depression at 17 years. Conclusions & Implications: Anxiety symptoms appear to be a consistent feature of some individuals with SLI in young adulthood whilst depressive symptoms can diminish.

Tourette syndrome is a neurological condition involving involuntary movements and sounds (tics) and is thought to affect as many as 1% of school aged children. Some young people with Tourette syndrome experience educational difficulties and social difficulties. Current clinical guidelines suggest educators can play an important role in maximising learning potential and reducing the negative impact of this condition on students’ social adjustment. Secondary school staff (N = 63) with responsibilities for special educational needs or disabilities completed a survey about support strategies for students with Tourette syndrome. Participants were first asked to suggest potentially helpful strategies and then rated how easily 17 recommended strategies could be implemented in school. The survey participants suggested a range of support strategies that were categorised as (1) promoting knowledge and understanding in school, (2) helping the student to cope with his/her tics, (3) supporting the student’s learning and (4) providing social and emotional support. All the recommended support strategies were rated as being easy to implement (or already in place) by the majority of respondents (e.g., increasing staff awareness and regular communication with home). The strategies that were identified as being least easy to implement were those requiring extra staff input (support from teaching assistants and individual/small group working). Additional challenges to providing support were also identified by the participants (e.g., getting input from outside agencies).

Background Research suggests Tourette syndrome (TS) can have a negative impact on quality of life. To date, little research has examined the perspectives of young people with this condition in depth. Methods Six 14- to 16-year-olds with TS took part in semi-structured interviews to explore the perceived impact of this condition on self and on relationships with others. The transcripts were analysed using interpretative phenomenological analysis. Results The young people felt that TS was a constant presence in their lives, but one they have learnt to cope with well. Most had developed supportive friendships but encountered problems when interacting with the wider peer network. Specific concerns around meeting new people and future employment were voiced. Conclusions The adolescents described specific ways in which TS affects quality of life and social interactions, and the effort it can take to cope effectively with this condition.

Adolescents and young adults with specific language impairment (SLI) are at risk of experiencing emotional health symptoms, in particular depression and anxiety disorder. However, there is a dearth of research examining issues of stability versus change in symptomatology across time.To examine depressive and anxiety symptoms reported by adolescents with and without a history of SLI at 16 years, and a year later.Depressive and anxiety symptoms were examined in 90 adolescents with SLI and in 91 adolescents with typical development (TD) initially at 16 years and again at 17 years.Participants with SLI experienced significantly more depressive and anxiety symptoms than participants with TD at 16 years, and continued to experience significantly more anxiety symptoms at 17 years. Females, regardless of language status (SLI versus TD), were more vulnerable than males. The group with SLI evidenced a significant drop in depressive symptoms over the year. A similar change in anxiety symptoms was not apparent. Regression analyses revealed that for individuals with SLI peer problems at 16 years predicted concurrent depressive symptoms, but behavioural factors did not contribute significantly to depressive symptoms at 17 years. For individuals with typical development, hyperactivity at 16 years predicted depressive symptoms at both 16 and 17 years. Language ability and non-verbal IQ did not predict depressive symptoms. Adolescents who experienced more bullying at 16 years were more likely to become, or remain, at risk for depression at 17 years.Anxiety symptoms appear to be a consistent feature of some individuals with SLI in young adulthood whilst depressive symptoms can diminish.

Purpose Engagement in close friendships and romantic relationships becomes particularly salient in adolescence. This study examined the influence of language, behavioral, and social variables on the level of emotional engagement experienced by adolescents with and without a history of specific language impairment (SLI). Method Ninety adolescents with SLI and 91 adolescents with typical language abilities (TD) completed two assessment sessions between the ages of 16 and 17. Results The group with SLI had significantly lower emotional engagement scores than the TD group. Some 24% of adolescents with a history of SLI were judged to have poor emotional engagement in close relationships, compared to only 2% of the TD adolescents. A regression analysis found that language ability, prosocial behavior, and shyness were concurrently predictive of level of emotional engagement in close relationships. Conclusion Some adolescents with SLI may be less emotionally engaged in their close relationships than their TD peers.

Social interactions can be a source of social stress for adolescents. Little is known about how adolescents with developmental difficulties, such as specific language impairment (SLI), feel when interacting socially. Participants included 28 adolescents with SLI and 28 adolescents with typical language abilities (TL). Self-report measures of social stress, social skills and social acceptance were obtained. Participants with SLI reported experiencing significantly more social stress than did participants with TL. Both groups judged themselves as having adequate social skills and positive social acceptance. Expressive language ability was negatively associated with social stress, but did not predict social stress when social factors were included in the regression model. Perceived social skills and social acceptance scores predicted social stress, in that poorer scores predicted more social stress. Despite perceiving themselves as having adequate social skills and as being socially accepted, social interactions are nonetheless a source of stress for adolescents with SLI.

Purpose To determine if lower global self-esteem, shyness, and low sociability are outcomes associated with SLI in adolescence. Possible concurrent predictive relationships and gender differences were also examined. Method Fifty-four adolescents with SLI, aged between 16 and 17 years, were compared with a group of 54 adolescents with typical language abilities on the Rosenberg Self-Esteem scale (Rosenberg, 1965) and the Cheek and Buss Shyness and Sociability scales (Cheek & Buss, 1981). Results The SLI group had significantly lower global self-esteem scores than the group with typical language abilities. The adolescents with SLI were more shy than their peers, but the groups did not differ in their sociability ratings. Regression analysis found that language ability was not concurrently predictive of self-esteem but shyness was. Mediation analysis suggested that shyness could be a partial but significant mediator in the relationship between language ability and global self-esteem. Conclusions Older adolescents with SLI are at risk of lower global self-esteem and experience shyness, although they want to interact socially. The relationship between language ability and self-esteem at this point in adolescence is complex, with shyness potentially playing an important mediating role.