ABSTRACT

Aim

Psychotic-like experiences (PLEs) may increase the risk of psychosis. Most of the research on PLEs focuses on their positive dimension—for example, hallucinatory-like experiences or delusion-like thoughts. Relatively little is known about the role of PLEs on the continuum of negative symptoms. The aim of this study was to examine whether negative symptoms, both in the experiential and expressive dimensions, could mediate the effects of temperament and character on the level of functioning of individuals with PLEs.

Methods

The study was conducted on 107 healthy young adults with the highest severity of PLEs, selected from a larger sample of 6722 people recruited for another study. Participants were examined using the Cloninger Temperament and Character Inventory, the Brief Negative Symptom Rating Scale, and the Social and Occupational Functioning Assessment Scale.

Results

Both functioning and certain personality traits, such as harm avoidance, persistence, self-directedness, and cooperativeness, were more strongly associated with the occurrence of experiential rather than expressive negative symptoms. We have developed four models, in which we have shown that the experiential negative symptoms mediated the impact of the temperament and character traits on socio-occupational functioning. In each model, negative symptoms weakened the direct effect of the personality trait on functioning.

Conclusions

These findings suggest that, like at the other stages of psychosis risk, a constellation of specific temperament and character traits is a risk factor for functional decline, which may be partly explained by the effect of experiential negative symptoms. The study also confirms the different impact of the two domains of negative symptoms on functional outcomes, suggesting the need for developing targeted interventions.

ABSTRACT

Background

Suicide is a public health problem worldwide, especially among adolescents. Chile is one of the Latin American countries with the highest suicide rates; however, few studies have investigated the risk factors for suicide attempts in this specific population. We aimed to describe the suicidal behaviour of Chilean adolescents and to explore the factors associated with suicide attempts and reattempts in this population.

Methods

Adolescents (10–19 years) with a diagnosis of psychiatric disorders were recruited in the Maule region, Chile, between 2018 and 2021. Sociodemographic and clinical variables were collected. Logistic regression was performed to explore the association between these variables and suicide attempts.

Results

Factors associated with increased odds of suicide attempts included age, sexual orientation, Adverse Childhood Events (ACEs) and past and current symptomatology. Factors that decreased the odds of suicide attempts were previous psychotherapy or pharmacological treatment, responsiveness and warmth from mother and father. Active symptoms at the time of assessment increased the odds of reattempting suicide.

Conclusions

In our sample, clinical and trauma-related factors emerged as the most important factors in predicting suicide attempts. Although age, sexual orientation and family dysfunction also played a notable role, positive relationships with parents seemed to be protective. In addition, current symptoms of stress, anxiety and depression significantly increased the likelihood of reattempts. These findings provide valuable knowledge about suicidality in Chile, although further research is needed to expand the evidence in our media.

ABSTRACT

Aim

Treatment for youth who are at clinical high risk for psychosis (CHR-P) presents an opportunity for early intervention with the capacity to decrease the burden associated with a potential psychotic disorder later in life. However, significant barriers prevent youth at CHR-P from accessing speciality mental health services. Few studies have examined the pathways to care for youth at CHR-P within the U.S. health system.

Methods

The present study reports the results of a codebook thematic analysis of qualitative interviews conducted with caregivers (primarily parents) of 15 youth (ages 12–25 years) who entered a CHR-P speciality program. Using a semi-structured interview, we inquired about their experiences navigating the health system to eventually arrive at the speciality program, including help-seeking events and referrals, caregivers' attributions for youths' CHR-P symptoms, and barriers and facilitators to care.

Results

Caregivers reported confusion and uncertainty regarding the causes of symptoms. They also disclosed the significant challenges to obtaining mental health care, including low mental health literacy, illness stigma, provider unavailability or appropriateness and adequacy of referrals. Most of the youth had encounters with emergency services during their help-seeking journey.

Conclusion

Our results help define targets for future policy, research and clinical efforts to improve access to speciality care for youth at CHR-P in the U.S.

ABSTRACT

Background

While third-level educational institutions have long provided counselling, a sharp rise in demand has led to limited access to mental health supports for many students, including those with ongoing difficulties. Digital mental health interventions represent one response to this unmet need, given the potential low cost and scalability associated with no-to-low human resources involved.

Objective

The aim of this study was to conduct a systematic review and meta-analysis of the literature examining effectiveness of digital mental health interventions for university students with ongoing mental health difficulties.

Methods

The following databases were searched: PubMed, EBSCOhost (CINHAHL/PsycINFO/PsycArticles) and Web of Science. Two-armed randomised-control trials were included in the meta-analysis. A random-effects meta-analysis was conducted and standardised mean differences were calculated. Effect sizes were then compared in terms of therapeutic approach, and whether interventions were fully automated or guided interventions. This study was registered with PROSPERO, CRD42024504265.

Results

Thirty four eligible studies were included in this narrative synthesis, of which 21 randomised-controlled trials were included in the meta-analysis. Random-effects meta-analysis indicated an overall medium effect size in favour of digital interventions for both depression (Cohen's d = 0.55), and anxiety (Cohen's d = 0. 46). Of note, for anxiety outcomes, fully automated interventions appeared more effective (d = 0.55) than guided interventions (d = 0.35).

Conclusions

Digital mental health interventions are associated with beneficial effects for college students when measured in terms of anxiety and depression symptom severity. For anxiety, fully automated interventions may be more effective than guided interventions to reduce symptom severity.

ABSTRACT

Introduction

Reducing the duration of untreated psychosis (DUP) is a cornerstone of effective early intervention for psychosis (EIP) services. Delays in help seeking are a significant component of DUP, particularly among youth. Given their role as trusted adults in young people's lives, youth workers are uniquely positioned to play a role in early detection networks. However, their views regarding this remain largely unexamined.

Aim

This study aimed to explore youth workers' perspectives on identifying and responding to psychosis in youth and the training needed to support them in this role.

Methods

A sequential-independent mixed methods design was employed. A brief questionnaire was given to youth workers (n = 86) who attended a 1-day EIP training session, followed by semi-structured interviews with a subset of participants (n = 10) 3 months later.

Results

Most participants (98.8%) expressed confidence in recognising psychosis; however, stigma and challenging relationships with mental health services emerged as systemic barriers. Although most participants (98.8%) found the EIP training relevant to their role, they suggested it should form part of a broader mental health curriculum. There was a clear consensus among participants that such training is necessary and should be accessible, practical and actionable.

Conclusion

Youth workers are uniquely positioned in identifying and supporting young people at risk of psychosis, and this study underscores their willingness to take on this role. To best support them, training efforts should focus on trans-diagnostic approaches that enhance mental health literacy, address systemic barriers and promote multidisciplinary partnerships.

ABSTRACT

Introduction

Suicidal behaviour in adolescents has increased considerably, so much so that it is the leading cause of death in this population. Associated risk factors include age, gender, or stressful life events, so their in-depth study is essential for prevention.

Objective

The main objective of this study was to study how certain stressful life events of a victimising nature (such as being a victim of abuse or violence) are related to the risk of suicide in adolescents, taking into account gender and the perceived impact of these events by the victims.

Method

The sample consisted of 147 people with a mean age of 15.34 years (SD = 1.316), who were administered the Stressful Life Events Scale, the Self-Injurious Thoughts and Behaviours Scale and an ad hoc semi-structured interview.

Results

The results showed a positive relationship between experiencing these events, perceived impact and suicidal risk, as well as a positive relationship between being a woman, a higher likelihood of being a victim of these events and a higher suicidal risk.

Conclusion

It is concluded that being a victim of stressful life events and their impact, as well as being a woman, are related to an increased suicidal risk. Therefore, it is recommended that these aspects be addressed early to reduce this risk.

ABSTRACT

Purpose

Physical activity could be associated with psychological symptoms in young people with major depressive disorder (MDD). Using actigraphy and ecological momentary assessment (EMA), we investigated the associations between physical activity and stress, anxiety and positive and negative affect in young people with MDD.

Methods

Actigraphy and EMA were collected daily in 40 young participants (aged 16–25 years) with MDD over 8 weeks. Multi-level linear mixed models were used to examine within- and between-person daily associations between physical activity and symptoms of stress, depression and positive and negative affect.

Results

Participants with at least 14 days of complete data were included in the analysis (n participants = 22; total days = 598). Typical (defined as average across the assessment period) vigorous physical activity was significantly associated with lower daily stress (β[95% CI] = −0.152 [−0.298, −0.007], p = 0.041) and higher daily positive affect (0.526 [0.061, 0.992], p = 0.028). Variability in daily light (0.004 [0.001, 0.006], p = 0.010) and moderate physical activity (0.004 [0.001, 0.007], p = 0.009) were positively associated with daily stress. Variability in daily light (0.003 [0.001, 0.006], p = 0.018) and moderate physical activity (0.004 [0.001, 0.007], p = 0.011) were positively associated with daily anxiety.

Conclusions

Various intensities of daily physical activities were associated with symptoms of stress, anxiety and positive affect in young people with MDD. Future research on larger samples should validate the causal and daily associations between physical activity and psychological symptoms to promote evidence-based behavioural strategies to improve psychological symptoms in young people with MDD.

Early Intervention in Psychiatry, Volume 19, Issue 3, March 2025.

ABSTRACT

Objective

Various factor structures have been suggested for the Davos Assessment of Cognitive Biases (DACOBS) and the Cognitive Biases Questionnaire for Psychosis (CBQ-P), assessing cognitive bias, necessitating additional validation in diverse languages to enhance the validity of the scales.

Method

Persian versions of these scales were validated within an Iranian cohort comprising 1719 individuals: patients with schizophrenia (n = 334) and major depressive disorder (MDD; n = 346) and a non-clinical group (n = 1039). The participants completed both self-report and clinician-administered assessments.

Results

The 18-item DACOBS version, comprising four factors, and the single-factor structure of the CBQ-P exhibited the optimal model fit, with confirmed reliability. Both scales showed significant correlations with constructs such as paranoid ideation, social cognition, schizotypal personality and positive symptoms. Additionally, the scales differentiated patients with schizophrenia and individuals at high risk for psychosis from those at low risk or patients with MDD. The CBQ-P and certain subscales of the DACOBS predicted susceptibility to psychosis, positive symptoms and psychosis-related manifestations.

Conclusions

The research highlights the validity and reliability of the Persian adaptations of the 18-item DACOBS and the CBQ-P for evaluating cognitive bias in individuals diagnosed with schizophrenia and for identifying individuals at an elevated risk for psychosis.

ABSTRACT

Background

Suicide rates are high among individuals in first episode psychosis and there is a critical need to better understand drivers of suicide risk to inform treatment efforts. This study identified profiles of psychosis symptoms and examined a mediation model of depression and distress as mechanisms in the relationships between psychosis symptoms and suicide ideation by latent profiles.

Methods

Data were obtained from the Human Connectome Project for Early Psychosis (n = 166) of individuals between 16 and 35 years of age who had onset of affective or non-affective psychosis within 5 years of consent. Data were analysed using Latent Profile Analysis (LPA) and Structural Equation Modelling in MPlus.

Results

LPA revealed the following groups: (1) relatively lower and more balanced levels of symptoms, (2) highest positive and general symptoms and (3) highest negative symptoms. Findings indicated the relationships in the model differed between by LPA groups. Distress and depression functioned as mediators between psychosis symptoms and suicide ideation for Groups 1 and 2.

Conclusions

A better understanding of the roles that distress and depression play in the relationships between psychosis symptoms and suicide ideation can help inform modifiable targets of early intervention and subsequently decrease risk for suicide.

ABSTRACT

Introduction

Previous work showed that young people prefer youth-oriented mental health services that offer individual help in houses in urban areas, with short wait times and low costs. The present paper aims to examine which service options professionals working in social welfare or mental health services prefer for addressing young people's mental health needs, comparing their views with those of young people.

Methods

Professionals (N = 176) and youth aged 16–24 years (N = 258) participated in a discrete choice experiment (DCE). Panel mixed logit (PML) models were used in both stakeholder groups to ascertain relative differences in attribute weights. We also estimated an overall PML model incorporating the effect of stakeholder group on the attributes.

Results

Professionals found the attributes ‘cost’ and ‘wait times’ most relevant to young people's mental health service needs, indicating a preference for services characterised by affordability and minimal wait periods. In contrast, young people adhered more importance to the attribute ‘format’ (individual rather than group therapy). Furthermore, professionals considered a café or youth centre the most suitable location for a service, rather than a house in the city, and they disfavoured care provision by professionals in adult mental health services more than young people did. Finally, the attributes ‘peer support’, ‘opening hours’ and ‘anonymity’ were deemed relevant by professionals but not by young people.

Conclusion

The perspectives of both professionals and young people offer a unique point of view on care provision, stressing the importance of integrating them in preference-based research and service design.

ABSTRACT

Introduction

The effects of cognitive remediation therapy (CRT) in adults with mental health disorders have been widely documented, but its effects in adolescents with mental health disorders remain poorly understood. This review aims to (1) determine the effects of CRT on cognition, symptoms and functioning for adolescents with mental health disorders and (2) evaluate the methodological quality of studies on CRT.

Methods

A systematic review and meta-analysis were conducted of randomised controlled trials of CRT involving adolescents with mental health disorders. Searches were conducted in databases for studies pertaining to CRT effects on cognition, social functioning and clinical symptoms. Methodological quality was assessed using the Clinical Trials Assessment Measure.

Results

Fourteen studies (N = 14) were included, with 11 independent samples (k = 11, 592 participants). Participants had various mental health disorders. CRT showed a small significant effect on cognition (g = 0.14, p = 0.02), particularly on processing speed, working memory and episodic memory. No significant effects were found for clinical symptoms (g = 0.04, p = 0.58) and social functioning (g = 0.06, p = 0.39). Methodological quality of included studies was variable, ranging from poor to good quality.

Conclusion

Included studies showed a small significant effect of CRT on cognition, and non-significant effects on clinical symptoms and social functioning in adolescents with mental health disorders. The lack of effects may be partly explained by limitations in the methodology of included studies. A critical analysis of current studies is presented and recommendations of core techniques to consider for future CRT studies are discussed.

ABSTRACT

Objective

This study investigated the perspectives of clients in early psychosis intervention programmes regarding the types, quality and relevance of information they desire and receive, particularly related to intimacy, romance and sexuality.

Methods

Participants (N = 35) rated the degree to which they desired and received information on topics related to treatment and recovery, as well as the quality and importance of that information.

Results

Between 25% and 50% of participants desired information on friendships, sexual functioning, sexual desire, sexual risk factors and romantic relationships. Less than half of participants who wanted information on romantic relationships, friendships, sexual desire and sexual functioning received this information. When this information was provided, however, participants reported it to be of high quality.

Conclusions

Findings demonstrate that intimacy, romance and sexuality remain areas of need that are relevant to recovery for people with psychosis, yet they continue to be insufficiently addressed in healthcare settings.

ABSTRACT

Introduction

Youth suicide is a concern worldwide, and suicidality—the presence of suicidal ideation or intent—is a critical risk for youth mental health services. This study aimed to determine the prevalence of suicidality in primary care, youth mental health services, along with its correlates and the course of treatment offered to clients.

Methods

Routinely collected data from Australia's headspace National Youth Mental Health Foundation, which has over 160 centres across Australia providing mental health care to young people aged 12–25 years, were analysed for new clients who started and completed their first episode of care between 1 July 2022 and 30 June 2023. This included 30 437 young people/episodes of care and 74 393 occasions of service.

Results

Results showed that suicidality was evident in almost one-quarter of young people, although it was rarely reported as a primary presenting issue. When present, it was usually identified at first visit. Those most at risk were young people in unstable accommodation, who identified as LGBTIQA+ or who were indigenous.

Conclusions

The findings show that suicidality should be anticipated in young people presenting to primary care mental health settings, and youth services need to be able to competently deal with suicide risk rather than using this as exclusion criteria.

ABSTRACT

Objective

Family history is amongst the most significant risk factors for psychotic and bipolar disorders. Despite being clearly defined, easily and early identifiable, familial high-risk status is minimally accounted for in mainstream prevention paradigms. This study reports on the demographics and clinical characteristics of youth with a first-degree relative affected by psychotic or bipolar disorders within a large academic healthcare system.

Method

In this quality improvement study, using electronic medical records, the authors examined demographics, psychiatric and medical diagnoses, substance use, service utilisation, and psychotropic medication use in children, adolescents and young adults (age 24 or younger) with and without a family history of psychotic or bipolar disorders within the Mass General Brigham (MGB) healthcare system.

Results

Family history-positive (FHP) youth demonstrated markedly higher rates of psychiatric problems (57.8%) compared to family history-negative (FHN) youth (8.5%), including higher rates of psychotic and bipolar disorders, as well as anxiety disorders and depression. FHP youth also had more frequent psychotropic medication use and medical problems. Additionally, FHP youth reported higher cannabis and alcohol use, along with higher rates of suicidal ideation and trauma. Despite this, only 4% of FHP youth visited an MGB psychiatry or psychology department within the six months preceding the analysis.

Conclusion

FHP youth constitute a distinct and practically identifiable risk cohort within a large academic healthcare system. Increased psychiatric and medical problems coupled with more prevalent risk factors amongst familial high-risk youth highlight the need for tailored clinical programmes to achieve both primary and secondary prevention.

ABSTRACT

Introduction

Dissociation is associated with clinical severity, increased risk of suicide and self-harm, and disproportionately affects adolescents and young adults. Whilst evidence indicates multiple factors contribute to dissociative experiences, a multi-factorial explanation of increased risk for dissociation has yet to be achieved.

Methods

We used multiple regression to investigate the relative influence of five plausible risk factors (childhood trauma, loneliness, marginalisation, socio-economic status, and everyday stress), and machine learning to generate tentative high-risk profiles for ‘felt sense of anomaly’ dissociation (FSA-dissociation) using cross-sectional online survey data from 2384 UK-based 16- to 25-year-olds.

Results

Multiple regression indicated that four risk factors significantly contributed to FSA-dissociation, with relative order of contribution: everyday stress, childhood trauma, loneliness and marginalisation. Exploratory analysis using machine learning suggested dissociation results from a complex interplay between interpersonal, contextual, and intrapersonal pressures: alongside marginalisation and childhood trauma, negative self-concept and depression were important in younger (16–20 years), and anxiety and maladaptive emotion regulation in older (21–25 years) respondents.

Conclusions

Validation of these findings could inform clinical assessment, and prevention and outreach efforts, improving the under-recognition of dissociation in mainstream services.

ABSTRACT

Introduction

Mental health conditions are prevalent among university students, putting them at elevated risk for dropout. Universities offer an array of peer programmes, and students often share their concerns with peers before professionals. A well-specified peer intervention to help sustain academic persistence that colleges can directly offer their undergraduates with mental health conditions should benefit this population. The Peer Academic Supports for Success coaching model was developed to address this need.

Objective

This study's goal was to conduct a feasibility and preliminary impact study of the Peer Academic Supports for Success model and feasibility of randomised controlled trial research methods.

Methods

Seventy-two undergraduate students with academically impairing mental health conditions were randomised to receive Peer Academic Supports for Success versus an active control condition. Survey data were collected at baseline and at the end of the next two semesters. Official transcripts were obtained. Intervention implementation data were assessed through coach and participant report.

Results

Peer Academic Supports for Success was delivered with fidelity, successfully attracted and retained students, and was safe. Randomised controlled trial methods proved feasible. Findings revealed significant treatment effects on several of the targeted proximal outcomes.

Conclusions

The findings suggest Peer Academic Supports for Success is a promising university-based intervention to support young adult students with mental health conditions and should be tested in a robust clinical trial.

ABSTRACT

Aim

Identifying young people in the early stages of psychosis identification is critical, since a longer duration of untreated psychosis is associated with poorer recovery outcomes. However, many mental health students and trainees do not receive training in this area. The aim of this study was to pilot test the effectiveness of an early-stage psychosis training program for mental health students and trainees.

Method

A pre/post matched sample of interdisciplinary mental health students and trainees (N = 21) attended a 75-min early-stage psychosis training program, and completed measures related to stigma, clinical training outcomes, and knowledge.

Results

There were significant improvements in psychosis-related stigma, intended clinical behaviour and knowledge. There was also high satisfaction with the training program.

Conclusion

This study suggests that a brief early-stage psychosis training program is acceptable to students and trainees and feasible to implement and may yield significant benefits regarding students and trainees' personal psychosis stigma, as well as improvements in clinical behaviour and psychosis knowledge.

ABSTRACT

Aim

Decreased motivation has been found to be the strongest predictor of poor work or school functioning among individuals with psychosis. Since motivation decreases immediately following onset of psychosis, it may be an ideal potential target for intervention. The aim of this study was to explore the specific barriers and facilitators to motivation through experiences of those living with first episode psychosis.

Method

A total of 40 individuals recently diagnosed with psychosis and receiving treatment within a coordinated specialty care program completed a semi-structured qualitative interview. Audio recordings were transcribed and independently coded by three reviewers.

Results

Themes emerged regarding barriers to work and school motivation, such as challenging mental health symptoms, discouragement resulting from negative perceptions/experiences, mental health treatment/side effects, uncertainty about the future, pressure of expectations from others, financial and legal concerns, and fear of symptom recurrence. Similarly, participants described several motivational facilitators for work and school including the opinions of others, financial needs and desires, career aspirations, beneficial mental health treatment, positive attitudes about mental illness, desire for autonomy and desire for meaning in daily life.

Discussion

Better understanding of the factors that drive motivation for work and school among those with first episode psychosis may facilitate identification of ways to optimise existing treatments and/or develop more targeted approaches.

ABSTRACT

Background

It has been over 20 years since a review of early psychosis services in New Zealand was completed, and it is unclear if services now meet international best practice. Furthermore, significant disparities in psychosis experiences exist in New Zealand, and it is unclear whether service structure might contribute to such disparities. Given the current restructuring of the health system in New Zealand, now is the optimal time to understand strengths and weaknesses in early psychosis care provision.

Methods

All early psychosis services in New Zealand (n = 12) were surveyed. Leads from each service completed a survey on the general elements of their service, alongside the First-Episode Psychosis Services Fidelity Scale, which allows comparison with international early psychosis services.

Results

Specific services are provided across 11/20 districts, leaving 9 without any dedicated early psychosis care. Service strengths included short wait lists, comprehensive assessments, good provision of case managers, team managers and psychiatrists and good length of care. Relative weaknesses included provision of therapy, limited age ranges, high numbers of inpatient referrals, poor Clozapine usage and limited family participation. There was also a lack of services for people at risk for psychosis. Lack of cultural support staff, models and confidence in meeting cultural needs was also evident.

Conclusion

While New Zealand early psychosis services are relatively comparable to international services, certain areas of weakness need to be addressed by decreasing variability in service eligibility, increasing care for those at-risk, wider availability of therapy and family involvement and improved cultural services.