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School refusal is a complex problem that refers to difficulty attending/remaining at school due to emotional distress about attendance. Despite its occurrence being associated with negative outcomes, many are unresponsive to the current treatment options. While parent factors have a key role to play in school refusal, they are not adequately addressed in existing treatments. Further research is needed to consolidate understanding and implement new treatments. Employing the PRISMA method, this review aims to identify modifiable parent factors associated with child and/or adolescent school refusal. Eight studies met inclusion criteria from which nine factors were identified. Factors found to be associated with school refusal included: parent psychopathology, family functioning and maternal overprotection (communication subdomain). Other factors such as maternal overprotection (affection, assistance and travel subdomains) and parental self-efficacy had weak or inconsistent results warranting further investigation. Overall, findings call for action in this field that has sparse and dated literature.

Although parents’ engagement in parenting programmes has frequently been posited to influence the efficacy and dissemination of these programmes, its relationship with intervention outcomes in parenting programmes is understudied. This study examined the predictive value of parental engagement on preventive parenting outcomes in a tailored online parenting programme aimed at enhancing parental protective factors and reducing risk factors for child depression and anxiety disorders. The present study also explored the associations between parental engagement and other parent, child and family outcomes. Data were collected from a community sample of 177 parents who received a tailored online parenting programme (‘Parenting Resilient Kids’; PaRK) and their children as part of a randomised controlled trial. Participants completed measures on parenting, child anxiety and depressive symptoms, health-related quality of life and family functioning on three occasions. Multiple regressions showed that parental engagement explained additional variance in preventive parenting (most proximal outcomes) at post-intervention and 12-month follow-up. Indicators of higher levels of parental engagement, operationalised by greater proportions of recommended programme modules and intended goals completed, uniquely predicted higher levels of preventing parenting. Higher levels of parental engagement also predicted higher levels of parental acceptance and parental psychosocial health-related quality of life, lower levels of parental psychological control and lower levels of impairments in child health-related quality of life. However, parental engagement did not explain additional variance in parent or child reported anxiety or depressive symptoms. This study provides support for the role of parental engagement in facilitating parenting changes in parenting-focused interventions.

Stigma is a well-documented concern of people living with mental illness. Through the use of novel exploratory structural equation modelling (ESEM) methods, we aimed to elucidate the structure of stigma as measured by two stigma scales (the Depression Stigma Scale and the Social Distance Scale), to establish dimensions of stigma towards a range of disorders and to compare levels on these dimensions between disorders and respondent subgroups. We used data from two Australian national surveys, one of the general community aged 15+ and another of youths aged 15-25. Stigma responses were elicited using a range of mental illness vignettes: depression, schizophrenia, social phobia and post-traumatic stress disorder (PTSD). ESEM revealed that the structure of stigmatizing attitudes in young people and adults is comparable in personally held attitudes and those perceived in others. Personal and perceived stigma formed distinct dimensions with each comprising \"Weak-not-sick\" and \"Dangerous/unpredictable\" components. The social distance dimension of stigma was separate from other components of stigma, supporting the appropriateness of the existing Social Distance Scale. Scales reflecting these dimensions had different patterns of association with respondent age and gender, and the type of mental disorder portrayed in the vignette. Copyright © 2014 John Wiley & Sons, Ltd.

This study examined the relations among maternal socialization of positive affect (PA), adolescent emotion regulation (ER), and adolescent depressive symptoms. Two hundred early adolescents, 11 — 13 years old, provided self-reports of ER strategies and depressive symptomatology; their mothers provided self-reports of socialization responses to adolescent PA. One hundred and sixty-three mother — adolescent dyads participated in 2 interaction tasks. Adolescents whose mothers responded in an invalidating or \"dampening\" manner toward their PA displayed more emotionally dysregulated behaviors and reported using maladaptive ER strategies more frequently. Adolescents whose mothers dampened their PA more frequently during mother — adolescent interactions, and girls whose mothers reported invalidating their PA, reported more depressive symptoms. Adolescent use of maladaptive ER strategies mediated the association between maternal invalidation of PA and early adolescents' concurrent depressive symptoms.

Purpose In this study, we examined whether young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents’ stigmatising attitudes towards young people with mental disorders. Methods A national telephone survey was conducted with 3,746 Australians aged 12–25 years and 2,005 of their parents. Stigmatising attitudes, help-seeking intentions, and perceived helpfulness of various sources of help were assessed in relation to four vignettes of a young person with a mental disorder (psychosis, depression, depression with alcohol misuse or social phobia). Results Unlike ‘stigma perceived in others’, the ‘weak-not-sick’, ‘social distance’ and ‘dangerous/unpredictable’ dimensions of young people’s stigma were associated with both help-seeking intentions and helpfulness beliefs about various sources of help. Attributing mental disorder to a personal weakness rather than an illness was associated with less intention to seek help from a doctor and less positive beliefs about professional sources (including doctors, counsellors, and psychologists). In contrast, young adults aged 18–25 years who perceived the vignette character as more dangerous or unpredictable had greater intention to seek help from a psychiatrist and a helpline, and more positive beliefs about psychiatrists. Greater social distance was associated with less intention to seek help from informal sources and less positive beliefs about these sources. No consistent pattern of associations was found for parent stigma. Conclusions The findings suggest that different dimensions of youth stigma differentially influence help-seeking intentions and beliefs about the helpfulness of different sources of help.

Background: Adverse childhood experiences (ACEs) are a major risk factor for mental disorders in children. Parenting interventions can mitigate the impact of family-level ACEs and subsequently improve young people’s mental health. However, a substantial research-to-practice gap hinders access to, and uptake of, available interventions. Aim: This study aimed to develop actionable strategies to support the implementation of an evidence-based, co-designed, technology-assisted parenting intervention by understanding potential barriers and facilitators from the perspectives of service providers working with families of children experiencing ACEs. Methods: We conducted one-on-one interviews with 14 staff at a community health service (six managers, eight service providers). A theoretical thematic analysis was used. The Consolidated Framework for Implementation Research (CFIR) guided the data collection and analysis of barriers and facilitators. Pre-implementation strategies were informed by The Expert Recommendations for Implementing Change (ERIC) compilation. The CFIR–ERIC matching tool was used to match the CFIR barriers identified by participants in this study with ERIC strategies to overcome these barriers. Results: Fourteen CFIR constructs were identified as facilitators, and eleven as barriers. By using the CFIR–ERIC tool, eleven strategies to mitigate the barriers were identified. Most strategies were aligned to the ERIC clusters Use evaluative and iterative strategies (n = 4) and Develop stakeholder interrelationships (n = 3). Conclusions: The CFIR–ERIC approach offered relevant and concise pre-implementation strategies for addressing potential barriers to implementing a novel, co-designed, technology-assisted parenting intervention for parents of children with ACEs. The identified facilitators support the utility of co-designing interventions as an initial phase in bridging research-to-practice gaps. Healthcare settings aiming to innovate services with technology-assisted parenting interventions to improve child mental health can draw on findings from the current study to guide pre-implementation plans for innovative, technology-assisted parenting interventions to improve child mental health.

Background There is well-established evidence that Mental Health First Aid (MHFA) training improves knowledge about how to support someone developing a mental health problem, but less evidence that this support improves the mental health of the recipient of aid. This randomised controlled trial aimed to assess the long-term effects of MHFA training of parents on the mental health of their adolescent children. Methods 384 Australian parents of an adolescent aged 12–15 were randomised to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. Outcomes were assessed at baseline, 1-year, and 2-year follow-up in both parents and adolescents. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems. Results Parent and adolescent reports showed no significant difference between training groups in the proportion of cases of adolescents with a mental health problem over time (ps > .05). There was also no significant difference between training groups in the quality of parental support provided to their adolescent at 1- or 2-year follow-up (ps > .05). In contrast, some secondary outcomes showed benefits from the Youth MHFA training relative to the control, with increased parental knowledge about mental health problems at 1-year (d = 0.43) and 2-year follow-up (d = 0.26), and increased confidence to help a young person (d = 0.26) and intentions to provide effective support (d = 0.22) at 1-year follow-up. Conclusions The study showed some improvements in mental health literacy in training recipients, but could not detect changes in the mental health of adolescents and the support provided to them by their parents if they had a mental health problem. However, there was a lack of power to detect primary outcome effects and therefore the question of whether MHFA training leads to better outcomes in the recipients of aid remains to be further explored. Trial registration ACTRN12612000390886 , registered retrospectively 5/4/2012.

Background Monitoring of adverse events to protect clinical trial participants is imperative but can be challenging for interventions delivered remotely via digital channels. We report our experience of monitoring participant safety in a trial of a web-based parenting intervention to prevent affective disorders in high-risk adolescents. Methods In the PIPA trial, parents/carers of at-risk adolescents (aged 11–15 years) randomly received either a web-based personalised parenting programme or online parenting factsheets. Interventions were delivered electronically, and study data were collected remotely. To address challenges of monitoring adverse events, we defined any adolescent participant as requiring a duty of care response if they met specific criteria in their responses to the Short Mood and Feelings Questionnaire (SMFQ) or the Development and Well-Being Assessment (DAWBA) scale. Where a duty of care incident was identified, the family or school were contacted to communicate safety concerns and suggest sources of support. Duty of care responses were compared across trial arms and follow-points using Z-tests to assess whether the intervention, or study participation, were causing participant harms. Results Two hundred thirty-one (45%) of respondents met the duty of care criteria at baseline, 84 of whom met two or more criteria. This fell to 52 (20%) at six months, of whom 41 (78%) had met duty of care criteria at baseline. The corresponding figures at fifteen months were 72 (29%) and 52 (72%) respectively. Duty of care responses did not differ significantly across arms at any time point. Approximately 100 h of researcher time was spent overall on engaging with those who indicated a duty of care need. Discussion More participants required a duty of care response from the study team at baseline than anticipated, reflecting lack of mental health service capacity and probable after-effects of COVID-19 on adolescent mental health. Duty of care data provided reassurance that neither the intervention nor study participation caused harm. It also guided targeted direct contact from study researchers, which was welcomed by participants, but added to study team workload. Conclusion Studies evaluating digital mental health interventions delivered remotely should consider how they identify those who might require direct support and ensure study processes and resources are able to accommodate this need. In such studies, a duty of care management-based approach can be a useful way to monitor potential harms. Trial registration ISRCTN63358736. Registered 18 September 2019.

Background There has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people’s (10–25 years) and carers’ experiences of mental health services, focusing on barriers and facilitators to services supporting young people’s psychosocial functioning. Methods This study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10–25 years with experience of mental illness, and 29 carers ( n  = 12 parent–child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level. Results Young people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people’s psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments. Conclusions This study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.

Background Mental Health First Aid (MHFA) training teaches community members how to provide initial support to someone with a mental health problem. Key gaps in the evidence base supporting the training are the longevity of effects beyond 6 months, effects on mental health first aid behavior, and the impact of support on the recipient of aid. This study aimed to evaluate the effect of the Youth MHFA course 3 years after training. Methods 384 Australian parents of an adolescent aged 12–15 were randomized to receive either the 14-h Youth MHFA course or the 15-h Australian Red Cross Provide First Aid course. This paper reports outcomes at baseline and 3 years later. Primary outcomes were cases of adolescent mental health problems, and parental support towards their adolescent if they developed a mental health problem, rated by the parent and adolescent. Secondary outcomes included parent knowledge about youth mental health problems, intentions and confidence in supporting a young person, stigmatizing attitudes, and help-seeking for mental health problems. Data were analyzed with mixed-effects models with group by measurement occasion interactions. Results 3-year follow-up data was obtained from 149 parents and 118 adolescents, who were aged 16.5 years on average. Between baseline and 3-year follow-up, there was a non-significant reduction in adolescent cases of mental health problems relative to the control group (odds ratios (OR) 0.16–0.17), a non-significant improvement in parental support reported by adolescents with a mental health problem (OR 2.80–4.31), and a non-significant improvement in the quality of support that parents reported providing to their adolescents with a mental health problem (d = 0.38). Secondary outcomes that showed significant improvements relative to the control group were parental knowledge about youth mental health problems (d = 0.31) and adolescent perceptions of general social support from their parents (d = 0.35). Conclusions This paper reports on the longest follow-up of Mental Health First Aid training in a controlled trial. Three years after training, participants had maintained their improved knowledge about mental health problems. There were some indications of other positive effects, but the study was underpowered to clearly show benefits to mental health first aid skills and recipients of aid. Trial registration ACTRN 12612000390886 , registered retrospectively 5/4/2012, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347502