Centre for Youth Mental Health - Research Publications
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ItemNo Preview AvailableTrauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for Interpersonal Trauma in Transitional-Aged Youth(EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC, 2021-03)OBJECTIVE: Posttraumatic stress disorder (PTSD) following interpersonal trauma in transitional-aged youth (TAY), aged 15 to 25, is highly prevalent; however, evidence-based interventions have rarely been studied. METHOD: A single-group pre-/posttest study was conducted at headspace Sunshine, Melbourne, Australia, evaluating the feasibility, acceptability, safety, tolerability, and potential clinical effectiveness of trauma-focused cognitive-behavioral therapy (TF-CBT). RESULTS: An intent-to-treat analysis was conducted for N = 20 participants (65% female, n = 13) who attended a mean of 15 TF-CBT sessions over 25 weeks. At the end of treatment, only 1 of the 16 participants with a baseline PTSD diagnosis still met diagnostic criteria. Significant improvements were also noted for self-report measures of PTSD (d = -.83), anxiety (d = -.74), and depression (d = -.76). A minority of participants reported a brief exacerbation in symptoms of PTSD (n = 8) and anxiety and depression (n = 5) during stabilization and directly before and/or after the trauma-narration phase. However, all symptoms resolved at the end of treatment. The majority of participants (85%, n = 17) rated the intervention as helpful. CONCLUSION: Regardless of the expected temporary symptom exacerbation, the results indicated that TF-CBT was safe, tolerable, and acceptable. Transitional-aged youth is an emerging area of research. With limited research available on this age group to inform evidence-based practice, it is recommended that a randomized controlled trial is conducted to determine if TF-CBT (Cohen et al., 2017) can be effectively translated to this underresearched age group. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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ItemNo Preview Available"Like a huge weight lifted off my shoulders": Exploring young peoples' experiences of treatment in a pilot trial of trauma-focused cognitive behavioral therapy(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2021-08-18)Background: The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) is well-established, yet little work has been done to understand how young people experience this intervention.Method: Semi-structured interviews were conducted with 13 young people aged 17-25 years (M = 20.0, SD = 2.61) who received TF-CBT as part of a pilot trial. Transcripts were analyzed via interpretative phenomenological analysis.Results: Four super-ordinate themes were identified: (i) experience of authentic care, (ii) personal role in therapy and recovery, (iii) talking about trauma is difficult but important, and (iv), transformative change. Young people described authenticity on behalf of the therapist, which seemed to foster emotional connection and comfort discussing trauma. They emphasized the importance of retaining autonomy and control during therapy, and a degree of personal responsibility in their recovery. Talking about trauma was described as difficult and potentially distressing, but also as critical for recovery. Transformative life changes were noted, which had a significant impact on young peoples' future outlook and self-perception.Conclusions: This study suggests that therapists should be attuned to the interpersonal needs of clients, attempt to foster self-determination throughout therapy, and simultaneously recognize the difficulty and importance of trauma work for young people when delivering TF-CBT.
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ItemValidating a Japanese Version of the Athlete Psychological Strain Questionnaire(SPRINGER, 2021-12)BACKGROUND: There is increasing international interest in clinical practice and research related to mental health in the international sports society. The athlete-specific psychological distress assessment tool that addresses potential mental health needs can help promote early detection and recovery of mental illness, as well as physical illnesses. Currently, little is known about the applicability of the useful assessment tool for Japanese elite athletes. The Athlete Psychological Strain Questionnaire (APSQ) is a brief, effective and reliable screening tool to identify early signs of athlete-specific distress and potential mental health symptoms. We examined the applicability and reliability of a Japanese version of the APSQ (APSQ-J) in a Japanese elite athlete context. Further, we examined the construct validity of the APSQ-J. METHODS: We collected web-based anonymous self-report data from 219 currently competing Japanese professional male rugby players. A two-stage process was conducted to validate the factor structure of the APSQ-J using exploratory factor analysis (EFA) in a randomly partitioned calibration sample and confirmatory factor analysis (CFA) in a separate validation sample. Cronbach's alpha is used to assess internal consistency. Pearson product-moment correlation coefficients were calculated to determine if the APSQ-J was significantly associated with measures of psychological distress and well-being using Kessler-6 (K6) and the WHO-5 Well-Being Index, respectively. RESULTS: We identified a one-factor structure for the APSQ-J. Confirmatory factor analysis supports this one-factor model, revealing good model fit indices. The standardized path coefficients for each of the items were β = 0.41-0.83 (p < 0.001). A Cronbach's alpha of 0.84 was obtained for the APSQ-J. The APSQ-J demonstrated significant correlations with the K-6 (r = 0.80, p < 0.001) and WHO-5 (r = -0.58, p < 0.001). CONCLUSION: The APSQ-J can be an appropriate and psychometrically robust measure for identifying athlete-specific distress in elite athletes in Japan. Widely disseminating and utilizing this scale in Japanese sports society may support athletes' mental health via early detection of symptoms of psychological distress.
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ItemReflective functioning and men's mental health: Associations with resilience and personal growth initiative(WILEY, 2021-10)Mentalizing, or reflective functioning, refers to the capacity to reflect on one's own and others' mental states in terms of desires, intentions, and feelings. Reflective functioning in men's mental health is poorly understood, particularly in reference to men's resilience and motivation for personal growth. Using a cross-sectional design, the present study investigated impaired reflective functioning in relation to resilience and personal growth initiative among men with mental health concerns. An online sample of 1065 men self-reporting mental health concerns completed measures of reflective functioning, psychological distress, resilience, and personal growth initiative. Logistic regression examined reflective functioning in relation to likely serious mental illness, including interaction with age. Subsequent regression analyses controlled for distress severity in examining associations with resilience and personal growth initiative, and in examining the potential mediating role of reflective functioning. Impaired reflective functioning was significantly associated with serious psychological distress irrespective of age and, after controlling for distress severity, with resilience and personal growth initiative. Moreover, impaired reflective functioning was a significant mediator of the relationship between resilience and personal growth initiative. Findings provide preliminary support for reflective functioning as salient to men's resilience and agency for personal change, indicating a potentially important target in men's mental health work.
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ItemDevelopment of a graphic medicine-enabled social media-based intervention for youth social anxiety(TAYLOR & FRANCIS LTD, 2021-05-28)Objective: The objective of the Entourage project was to develop an innovative digital mental health intervention addressing key barriers experienced by young people in accessing evidence‐based therapy for social anxiety. In particular, Entourage takes a specific focus on reaching young men, given their lower rates of service engagement. Method: This article discusses the theoretical underpinnings, therapeutic mechanisms, persuasive technology elements, and development process of a novel approach incorporating graphic medicine, clinical and peer support, and social networking. Results: Based on an integrated cognitive model of social anxiety disorder and consistent with the principles of cognitive behavioural therapy (CBT), a novel digital intervention for social anxiety was developed (Entourage). Using the moderated online social therapy (MOST) model, Entourage provides young people with a digital strengths‐based platform to overcome social anxiety symptoms. Designed in close partnership with young people with a lived experience of mental ill‐health, and overseen by a steering group of young men, Entourage applies graphic medicine through bespoke therapy comics to help users understand and overcome symptoms. Program e‐mentors (expert clinicians and trained peer workers) work in tandem to maintain engagement, support participant skill acquisition, and promote opportunities for social connectedness. Behavioural experiments and in‐vivo exposure activities facilitate restructuring of maladaptive social anxiety‐focussed cognitions. Conclusions: Entourage represents an innovative approach to managing social anxiety in young people. Intervention elements seek to ensure longer‐term engagement of users, in particular young men, who have unmet service needs. Results of a single‐group clinical trial of Entourage are forthcoming.
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Item"Eventually, I Admitted, 'I Cannot Do This Alone'": Exploring Experiences of Suicidality and Help-Seeking Drivers Among Australian Men(FRONTIERS MEDIA SA, 2021-10-01)While research has explored the intersection between masculinities and men's experiences of suicidality, comparatively little attention has been paid to the stories surrounding suicidal men's decision to seek help. The ways in which men experiencing suicidal thoughts and behaviors embody masculinities alongside their enlistment of mental health services remains largely unknown. The present study explored 262 Australian men's stories surrounding the impetus for help-seeking for suicidal thoughts and behaviors. The sample comprised men ranging in age from 17 to 74 years (M = 40.99; SD = 15.92 years), with most participants residing in a metropolitan area (55.3%), employed full time (43.1%), non-indigenous (95.4%) and heterosexual (73.7%). Participants elaborated on their reasons for help-seeking via an open-text qualitative survey, delivered as part of a larger study exploring help-seeking experiences of Australian men. Thematic analysis of responses generated four themes highlighting the diversity of experience across men, with some highlighting impacts of emasculating early trauma(s) on their suicidality, while others reflected an impulsiveness tied to situational stressors that fractured their masculine identity (e.g., relationship breakdown; job loss). Many men had epiphanies as they reached the limits of their self-reliance and came to terms with their need for help. As their suicidality was witnessed by-and began to impact-those around them, the sight of their previously masked pain by others often facilitated their help-seeking journey. The present findings underscore the complex and multifactorial role of masculinities in men's suicidality and their paths to help-seeking. Important inroads for future public mental health promotion efforts are discussed, in terms of leveraging self-reliant and caring masculinities in helping men to develop healthy coping in the context of suicidality.
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ItemPromoting Healthier Masculinities as a Suicide Prevention Intervention in a Regional Australian Community: A Qualitative Study of Stakeholder Perspectives(FRONTIERS MEDIA SA, 2021-12-08)Regionally-based Australian men have a higher risk of suicide than those in urban centers, with similar trends observed internationally. Adopting a place-based approach to understanding men's suicide and harm prevention provides contextual insights to guide localised opportunities for the development of tailored gender-specific interventions. Men in rural Australia are typically portrayed as embodying idealized masculinity-dominant and tough, upholding strength and stoicism in the face of hardship. Such values can increase suicide risk in men by reducing help-seeking. The Macedon Ranges Shire is an inner regional municipality with a population of approximately 50,000 people spanning across 10 regional towns and surrounding farming areas in Victoria, Australia. Understanding the influence of masculinities on men's wellbeing and help seeking behaviours in a regional context is vital in order to inform effective local suicide prevention efforts. The present research involved in-depth qualitative interviews with 19 community stakeholders (M = 49.89 years, SD = 11.82) predominantly working in healthcare and community services including emergency services and education. Using thematic analysis, interview transcripts were coded and themes inductively derived. Stakeholders identified three key areas for understanding suicide risk and wellbeing for local men; 1) localizing masculinities, 2) belonging in community, and 3) engaging men. Findings illustrate that addressing men's wellbeing in regional areas requires a multifaceted whole-of-community approach. While diverse, local expressions of masculinities were seen as contributors to men's challenges understanding their emotional worlds and reticence for help-seeking. Of vital need is to provide diverse opportunities for men to connect with others in the region, and offer inclusive spaces where men feel accepted, welcomed and able to meaningfully contribute to the community. Not only will this assist by bolstering men's sense of self, identity, and mental wellbeing, it may also provide valuable informal inroads to normalizing healthy communication around mental health and seeking mental health care. These findings offer important suggestions for the promotion of healthier masculinities in regionally-based Australian men, which may help to improve wellbeing of these men and their entire communities.
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ItemIntegrating family work into the treatment of young people with severe and complex depression: a developmentally focused model(WILEY, 2018-04)AIM: Although models of family intervention are clearly articulated in the child and early adolescent literature, there is less clarity regarding family intervention approaches in later adolescence and emerging adulthood. METHODS: This study provides the rationale and intervention framework for a developmentally sensitive model of time-limited family work in the outpatient treatment of complex youth depression (15-25 years). RESULTS: Derived from current practice in the Youth Mood Clinic (YMC) at Orygen Youth Health, Melbourne, a stepped model of family intervention is discussed. YMC aims to provide comprehensive orientation, assessment and education to all families. For some, a family-based intervention, delivered either by the treating team or through the integration of a specialist family worker, offers an important adjunct in supporting the recovery of the young person. Developmental phases and challenges experienced by the young person with respect to family/caregiver involvement are discussed in the context of two case studies. CONCLUSIONS: A developmentally sensitive model is presented with particular attention to the developmental needs and preferences of young people. Formal evaluation of this model is required. Evaluation perspectives should include young people, caregivers, the broader family system (i.e. siblings) and the treating team (i.e. case manager, doctor and family worker) incorporating outcome measurement. Such work determines how best to apply a time-limited family-based intervention approach in strengthening family/caregiver relationships as part of the young person's recovery from severe and complex depression.
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ItemModerated online social therapy for depression relapse prevention in young people: pilot study of a "next generation' online intervention(WILEY, 2018-08)AIM: Implementation of targeted e-mental health interventions offers a promising solution to reducing the burden of disease associated with youth depression. A single-group pilot study was conducted to evaluate the acceptability, feasibility, usability and safety of a novel, moderated online social therapy intervention (entitled Rebound) for depression relapse prevention in young people. METHODS: Participants were 42 young people (15-25 years) (50% men; mean age = 18.5 years) in partial or full remission. Participants had access to the Rebound platform for at least 12 weeks, including the social networking, peer and clinical moderator and therapy components. RESULTS: Follow-up data were available for 39 (92.9%) participants. There was high system usage, with 3034 user logins (mean = 72.2 per user) and 2146 posts (mean = 51.1). Almost 70% of users had ≥10 logins over the 12 weeks, with 78.5% logging in over at least 2 months of the pilot. A total of 32 (84%) participants rated the intervention as helpful. There was significant improvement between the number of participants in full remission at baseline (n = 5; none of whom relapsed) relative to n = 19 at 12-week follow-up (P < 0.001). Six (14.3%) participants relapsed to full threshold symptoms at 12 weeks. There was a significant improvement to interviewer-rated depression scores (Montgomery-Asberg Depression Rating Scale (MADRS); P = 0.014, d = 0.45) and a trend for improved strength use (P = 0.088, d = 0.29). The single-group design and 12-week treatment phase preclude a full understanding of the clinical benefits of the Rebound intervention. CONCLUSIONS: The Rebound intervention was shown to be acceptable, feasible, highly usable and safe in young people with major depression.