Digital Mental Health Interventions for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.     

Alerting enhances attentional bias for salient stimuli: Evidence from a global/local processing task

The present study examined the role of alerting in modulating attentional bias to salient events. In a global/local processing task, participants were presented with a large arrow (global level) comprised of smaller arrows (local level) pointing in the same or opposite directions and had to indicate the direction of the large or small arrows in different blocks. Saliency of the global and local levels was manipulated, creating global-salient and local-salient conditions. Alerting signals were presented in half of the trials prior to the target. Results revealed a double dissociation in the effects of alerting on global/local interference effects. In a global salient condition, alerting increased global interference and decreased local interference. In a local salient condition, alerting reduced global interference and increased local interference. We demonstrate that within a single task, alerting can increase and reduce conflict based on perceptual saliency. These findings help to better understand disorders like hemispatial neglect in which both arousal and attention to salient events are impaired. These results also challenge previous theories suggesting that alerting acts to increase conflict interference. We argue that alerting is an adaptive mechanism that diverts attention to salient events, but comes at a cost when selective attention to less salient details is required.     

Theological Education in a New Missional Era: A Personal Journey with Seven Theses

The author's personal journey in discovering, developing, researching and practicing adult theological education in the church is rehearsed, pointing out key learning moments along the way. Out of this praxis seven theses are offered that set an agenda for theological education in the new missional era in which the church finds itself.     

Coping strategies: A prospective study of patterns,stability, and relationships with psychological distress

The aims of this article are: (1) to explore patterns (clusters) of coping strategies; (2) to examine the stability of individual coping strategies and patterns of coping over time; and (3) to establish long term associations between coping and psychological distress. Coping strategies were assessed with the Brief Cope questionnaire, whereas psychological distress was measured with the ten‐item version of the Hopkins Symptom Checklist, in a two‐year prospective sample comprising 3,738 employees. Based on TwoStep cluster analysis of the Brief Cope, three different coping patterns were identified: low coping, engagement coping, and disengagement coping. Analyses of long‐term stability indicated malleable properties for the individual coping strategies as well as the three clusters. Disengagement coping strategies in the form of self‐blame and self‐distraction were most strongly associated with distress at follow‐up, whereas baseline distress was related to increased use of these strategies two years later. Coping patterns at baseline had no main effects on later levels of distress, but levels of distress at baseline predicted subsequent use of engagement and disengagement coping patterns. The finding that specific coping strategies are malleable suggests that it is possible to modify and develop dysfunctional strategies. The associations between disengagement coping strategies and distress indicate that this kind of coping is especially problematic with regard to mental health problems. A main contribution of this study is that it establishes cluster analytic techniques as beneficial in the assessment of coping.     

A qualitative study of citizens' experience of participating in health counseling

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi‐structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short‐term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.     

Meaningfulness in Day Centers for People With Psychiatric Disabilities: Gender and Empowerment Aspects

This study investigated the experience of meaningfulness in occupations at day centers among people with psychiatric disabilities from an empowerment and gender perspective. One hundred eight participants, from eight day centers in Sweden, completed instruments measuring experienced meaning, empowerment, psychosocial functioning, and socio-demographic factors. Mixed methods were used, combining statistical analyses and content analysis. Gender differences were found concerning principal occupations performed. These confirmed traditional gender roles. The experience of meaning in day center occupations, particularly the domain of meaning pertaining to personal development, was significantly associated with empowerment. These results may be used in the future development of day centers.     

Health inequality and careers

Structural explanations of career choice and development are well established. Socioeconomic inequality represents a powerful factor shaping career trajectories and economic outcomes achieved by individuals. However, a robust and growing body of evidence demonstrates a strong link between socioeconomic inequality and health outcomes. Work is a key factor explaining differences in income and lifestyle. It seems unavoidable that inequality in careers has profound consequences for health and well-being, but this relationship is largely ignored by career scholars. Some implications of health inequality for career guidance interventions are suggested.