Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

The prevalence of childhood and adolescent obesity has tripled in the past three decades. This increase has been accompanied by a dramatic rise in obesity-related health complications among American youth. Thus, many obese youth are now experiencing illnesses that will threaten their life expectancy in the absence of significant weight loss. Despite these concerns, a relatively modest body of research has focused on the treatment of adolescent obesity. Results from trials investigating the efficacy of behavioral and pharmacological treatments, like studies of these interventions with adults, suggest that individuals typically lose 5–10% of their initial weight. Unfortunately, weight regain is common. Given the increase in the number of obese adolescents, coupled with the modest results from more conservative treatment approaches, it is not surprising that bariatric surgery for adolescents who suffer from extreme obesity has grown in popularity. The weight losses after surgery are impressive and many adolescents, like adults, experience significant improvements in their physical and mental health postoperatively. However, only a small fraction of adolescents and adults who are heavy enough for bariatric surgery present for surgical treatment. Among those who undergo surgery, a significant minority appear to struggle with a number of behavioral and psychosocial issues that threaten their lifelong success. With all of this in mind, the current obesity problem in the United States and other Westernized countries likely will present a significant challenge to both current and future medical and mental health professionals who work with adolescents and young adults.     

“Is There a Getting Better From This,or Not?” Examining the Meaning and Possibility of Recovery From Mental Disorder

The concept of “recovery” from mental disorder is widely used in the national conversation about youth and adult mental health treatment as if everyone is on the same page about what it means. Fundamental disagreements among researchers and practitioners exist, however, on a variety of issues related to the precise nature and meaning of recovery from mental, emotional, and behavioral disorder generally. Among these issues are: (a) The meaning of recovery; (b) The possibility of full recovery; and (c) Effective support for recovery. After reviewing diverging responses for each of these three issues, we then trace practical implications of competing interpretations for treatment and recovery itself. As demonstrated throughout, the stance taken on these questions can have profound and lifelong consequences for youth and children in treatment.     

Mental Health Professionals’ Perspectives of Family-focused Practice across Child and Adult Mental Health Settings: A Qualitative Synthesis

Abstract

The shift towards a family-focused approach to practice has been highly endorsed across child and adult mental health services, with increasing policy development and a growing evidence base. The aim of this review was to synthesize the qualitative evidence of professionals’ perspectives and experiences of implementing family-focused practice across these settings. Electronic databases were searched up to March 2018, with nine articles included. The synthesis produced two overarching challenges relating to the organizational and system issues of family-focused practice and clinicians’ attitudes, knowledge, and practice towards addressing the complexity of families’ needs. The findings point to a limited evidence of professionals viewing the benefits of family-focused practice and a lack of coherence relating to professionals’ investment in family-focused practice. These are discussed within policy and implementation factors.     

Filters of influence: The help-seeking process of African American single mothers living in poverty seeking mental health services for their children

There are a disproportionate number of African American children living in poverty who are in need of mental health services. African American children who live in poverty tend to underutilize mental health treatment due to the barriers their caregivers face; however, far less research has been conducted on the percentage of children who do access mental health treatment and the experiences of their caregivers in maneuvering through the barriers in their environments. This grounded theory study systematically generated a help-seeking theory that was constructed through the experiences of single African American mothers living in poverty who accessed mental health treatment for their children.     

Adolescent sexual activity and pregnancy: Socioenvironmental problems,physical health,and mental health

This paper examines the association between adolescent pregnancy and socioenvironmental, physical, and mental health problems in 1590 inner-city females aged 13–18 who use health clinics. Adolescents who have become pregnant, those who are sexually active but never have been pregnant, and those who are sexually inactive are compared. The sexually active youngsters come from more psychosocially disadvantaged backgrounds than their sexually inactive peers; the sexually active girls who become pregnant come from more psychosocially disadvantaged backgrounds than those who have never been pregnant. Despite this, the youths who have become pregnant do not have more current relationship problems, more stressful life events, or worse physical health than the never-pregnant sexually active youths. Although sexually inactive youths have the lowest rates of mental health problems, adolescents who have been pregnant have lower rates of anxiety and conduct disorder symptoms than those who are sexually active but never pregnant.Supported by the Robert Wood Johnson Foundation. Fieldwork conducted by Survey Research Associates.Research interests include adolescents and children, parenting, and families.Research interests include epidemiology of child and adolescent psychiatric disorder.Research interests include psychiatric epidemiology/deviant behavior.Research interests include mental health and statistical issues.Research interests include health behavior and mental health issues.     

Factors that Influence Mental Health Stigma Among 8th Grade Adolescents

Unmet mental health need is a significant problem for adolescents. Although stigma is identified as a major barrier to the use of mental health services among youth, there is limited research on this topic. In-depth interviews (n=57) among a sample of 8th grade students in a suburban, mid-Atlantic community portray adolescent mental health attitudes and how these views are shaped. Satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens. The anticipation of negative responses towards mental health care-seeking from family members, peers, and school staff are key factors in teens’ comfort and willingness to address mental health concerns. The research provides critical information on the factors that contribute to the development of stigma and emphasizes the need to address stigma in youth mental health education, programs, and treatment plans. Authors are affiliated with the Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences. Dr. Chandra has a background in adolescent health, and is particularly interested in improving the accessibility and appropriateness of youth mental health services and involving young people in the translation of research into practice. Dr. Minkovitz is interested in improving preventive service delivery, enhancing quality of care, and understanding maternal factors that influence children’s receipt of health care     

试论高校心理咨询工作的现状、问题及对策

社会经济迅猛发展 ,对当代大学生的综合素质要求也越来越高。但在压力之下 ,大学生心理障碍日益严重 ,而高校心理咨询在帮助大学生纠正心理偏常、缓解心理压力、开发自身潜能方面起着任何其它形式的教育都无法替代的作用。然而 ,根据大量的心理调查表明 ,目前高校在心理咨询方面还存在不少问题和误区 ,在宣传普及、资金投入、队伍建设、理论研究方面远远不能满足素质教育的要求 ,亟待加强和完善。     

Expanded School Mental Health: Challenges and Opportunities in an Emerging Field

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school–community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.     

Qualitative Evaluation of a High School Mental Health Program

Expanded school mental health (ESMH) programs offer a comprehensive range of mental health services (evaluation, therapy, case management) to youth in special and regular education. Research is needed to document that these programs are in fact providing quality care to youth and leading to enhanced outcomes. In this exploratory study, focus groups were conducted with high school students receiving mental health services and students not receiving services, therapists, parents, administrators, and health care staff to gauge the quality and effectiveness of an ESMH program. It was difficult to schedule parents for group sessions; thus, interviews also were conducted with this group. Focus groups and interviews were effective methods for understanding strengths, areas for improvement, and outcomes for our ESMH program. Participants reported that therapy served as a protective factor, enhancing physical and mental health and reducing risk for teenagers. Ideas for improving clinical practice were developed from study results.     

五级机制:高校心理危机预防干预工作的创新

心理危机预防干预是以人为本教育思想的体现,是学校人才培养的重要任务。五级机制是高校心理危机预防干预工作的创新,它体现了全体教职员工对学生生命的全面关怀,可以有效地促进学生心理健康,守护学生生命安全。     

De/valuing youth work: Revealing tensions in professional identity development while enhancing and applying mental health literacy

Thirteen preservice youth work students participated in learning experiences designed to enhance literacies in mental health. The aim of this grounded theory study was to explicate the process of mental health literacy enhancement and application to child and youth care practice. Sixty-two unique sources of data were used in analyses. Findings suggest that mental health literacies are intertwined with the process of developing a professional identity. In this article, the subcategory de/valuing youth work is explained and involves participants managing a confusing role, adopting a misfit stance, battling and building a seat at the interprofessional table, and valuing professional contributions. Implications for professional identity development, professionalization and mental health education are offered.     

Examining Multiracial Youth in Context: Ethnic Identity Development and Mental Health Outcomes

Although multiracial individuals are the fastest growing population in the United States, research on the identity development of multiracial adolescents remains scant. This study explores the relationship between ethnic identity, its components (affirmation, exploration), and mental health outcomes (anxiety, depressive symptoms) within the contexts of schools for multiracial adolescents. The participants were multiracial and monoracial minority and majority high school students (n = 4,766; 54.6 % female). Among the participants, 88.1 % were Caucasian, 7.4 % were African American, and 4.5 % were multiracial. The research questions examined the relationship between ethnic identity exploration and affirmation on mental health outcomes and explored the role school context plays in this relationship. The findings suggested that multiracial youth experience more exploration and less affirmation than African Americans, but more than Caucasians. In addition, multiracial youth were found to have higher levels of mental health issues than their monoracial minority and majority peers. Specifically, multiracial youth had higher levels of depressive symptoms than their African American and Caucasian counterparts. Multiracial and Caucasian youth had similar levels of anxiety but these levels were significantly higher than African Americans. School diversity did not influence mental health outcomes for multiracial youth. These findings provide insight into the experiences of multiracial youth and underscore the importance of further investigating factors that contribute to their mental health outcomes.     

Rationale and Strategies for Central Involvement of Educators in Effective School-Based Mental Health Programs

Unfortunately, for many mental health professionals classroom teachers and other educators are, at best, viewed primarily or solely as useful sources of information about a child, and their broader, invaluable roles as members of the mental health team are diminished or dismissed. This article examines the conceptual rationale and empirical support for central involvement of educators (especially classroom teachers) in effective mental health services, and in effective expanded school-based mental health programs. The importance of partnerships with educators for school-wide mental health promotion efforts, as well as for the success of primary and secondary prevention initiatives, are highlighted. Effective strategies and recommendations for enhancement of educator-mental health professional collaboration are included.     

Women and Mental Health A Feminist Review

This article contextualizes some of the more specifically focused articles in this Special Issue of ‘Women and Mental Health’ by reviewing general historical and political currents structuring contemporary discussions around questions of models, treatment and provision for women within British mental health services. We highlight some particularities of the current British context (in relation to other national scenes) in terms of the forms and expressions of feminist activity around mental or emotional distress. While not absolute mirrors of each other, resonances between general trends in feminist debates and organizational forms within feminist mental health work give rise to a wide spectrum of sites of intervention. We discuss some of the conditions that gave rise to these forms of (visible) feminist intervention within mental health service provision, focusing particularly on women's counselling and therapy services, and we offer an analysis of the range and conceptual tensions within which such interventions may be situated, including contested perspectives on power and empowerment. We also consider ways in which women's political activity around mental health issues is likely not to be noticed as such, given women's prototypical positions as patients and practitioners. We end by identifying what we see as current challenges for feminist activism around distress and its links with the conditions of women's lives and oppression more generally, not only as instances of more general tensions and challenges within contemporary feminisms, but also as offering an arena of opportunity for broader alliance and coalition-building.     

Overcoming Challenges to Using Evidence-Based Interventions in Schools

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.She received her doctorate in childclinical psychology from the University of Missouri-Columbia. Her research interests are in the area of the development, prevention, and treatment of juvenile delinquency and youth externalizing disorders.who does research in the area of childrens mental health services and the implementation of wraparound services in real-world settings.University of Maryland School of Medicine. His research is in the area of testing the effectiveness of School Mental Health Programs and the effects of community violence on youth mental health.involved in research related to school mental health, school-based health centers, and prevention of risky behavior among adolescents.Postdoctoral fellow at the time of the study.Postdoctoral fellow at the time of the study.     

Facilitating Help Seeking Behavior and Referrals for Mental Health Difficulties in School Aged Boys and Girls: A School-Based Intervention

Although the need for early intervention for mental health difficulties is widely acknowledged, few studies have attempted to explicitly increase actual help seeking behavior for mental health difficulties. Students in intervention classrooms received two one-hour, in-class workshops on distress and help seeking and were compared to students in non-intervention classrooms in a 2-level hierarchical model. More frequent help seeking behavior and more mental health referrals were observed among students in the intervention group than among students in the comparison group. Effects were moderated by the level of distress experienced by students, but not by help seeking attitudes, and could not be accounted for by school staff referrals or website utilization. Results showed that help seeking behavior for mental health difficulties and mental health referrals can be increased with only a moderate investment in time, but that benefits of school-based intervention may be greatest among students with specific needs, such as high levels of distress.

Adolescents’ Suicidal Thinking and Reluctance to Consult General Medical Practitioners

Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13–18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.     

School-based health services for urban adolescents: Psychosocial characteristics of clinic users vs nonusers

Evaluated psychosocial differences between adolescent users and nonusers of an urban school-based health clinic, considering the influence of gender. As expected, a number of gender differences were found (e.g., girls reported more fear, were rated as more likeable by peers than boys). Examination of differences based purely on clinic use indicated that nonusers were rated as more socially withdrawn by their peers than clinic users; otherwise, these two groups did not differ on psychosocial measures. Gender by clinic-status interaction effects were found for academic measures (e.g., nonusing boys had more absences and lower grades than boys who used the clinic). A group of intensive clinic users (n=14) reported higher levels of emotional distress than other students, and surprisingly, most of these students were not receiving mental health services.Received Ph.D. from Virginia Polytechnic Institute and State University in 1991. Research interests include evaluation of school mental health services, empirical development of interventions for children, and the impact of violence on urban youth.Received B.A. from Loyola College. Interested in applied work with adolescents and adults.Received B.A. from Cornell University. Interests include stress and coping in children, identification of resilience factors, and evaluation of child mental health systems of care.Received Ph.D. from the University of Oklahoma in 1967. Research interests in psychophysiology, sleep disorders, and biofeedback and instrumentation.Received M.D. from Duke University in 1968. Research interests include training in child and adolescent psychiatry, adolescent psychopathology, and the development of school mental health programs.     

The stress of secondary school for vulnerable students

An assessment of the stress of junior high/middle school (JH/MS) can be made by comparing overall behavior and academic student patterns in JH/MS with those in elementary school (ES), and by evaluating the differential educational consequences experienced by JH/MS students who had varying degrees of maladjustment in ES. Specific numeric data indicate that the environment is far more open, combative, frightening, impersonal, and academically taxing in JH/MS than in the ES. Partly as a result, suspensions, unexcused absenteeism, and grade failure occur at a much greater overall rate in JH/MS. Also, the immediate aftermath of these school adversities is significantly more deleterious in JH/MS than in ES. An analysis of the differential outcome data reveals that JH/MS students who had prominent ES maladjustments have a 5–13-fold greater rate of grade failure, suspension, and undue absenteeism than do students without such ES difficulties, and that generally students without major ES malajustment patterns continue to perform well after their entry to secondary school. In effect, then, JH/MS is primarily a stressful environment for students who are vulnerable on entry.Reveived M. D. from University of Wisconsin. Research interests include school mental health, hyperactivity, and psychopharmacology.     

Associations between Cultural Stressors,Cultural Values,and Latina/o College Students’ Mental Health

Latina/o college students experience cultural stressors that negatively impact their mental health, which places them at risk for academic problems. We explored whether cultural values buffer the negative effect of cultural stressors on mental health symptoms in a sample of 198 Latina/o college students (70?% female; 43?% first generation college students). Bivariate results revealed significant positive associations between cultural stressors (i.e., acculturative stress, discrimination) and mental health symptoms (i.e., anxiety, depressive, psychological stress), and negative associations between cultural values of familismo, respeto, and religiosity and mental health symptoms. Several cultural values moderated the influence of cultural stressors on mental health symptoms. The findings highlight the importance of helping Latina/o college students remain connected to their families and cultural values as a way of promoting their mental health.