Objective. To explore the impact of parent psychological distress and parental bonding on agreement between informants about adolescent emotional functioning. Methods. The study employed an observational design in which 87 pairs of mothers and their adolescent sons or daughters aged 12-17 completed proxyand self-report ratings on the Strengths and Difficulties Questionnaire. Mothers also completed the Depression, Anxiety and Stress scale as a measure of their own psychological distress, and adolescents completed the Parental Bonding Instrument as a measure of their parenting experience. Moderation analyses using multiple linear regression were used to assess whether the association between maternal psychological distress and mother-adolescent agreement changed as a factor of parental bonding. Results. Kappa values indicated that mother-adolescent agreement was ‘fair’ for emotional problems. Mothers’ psychological distress and sub-optimal parenting were both associated with greater reporting discrepancies. Maternal psychological distress and perceived maternal were unique and combined predictors of reporting discrepancies. Perceived care moderated the relationship between maternal distress and agreement such that when care was rated as low, higher levels of maternal distress predicted poor agreement, but when care was rated as high no significant relationship was found between distress and agreement. Conclusions. Increased mother-adolescent agreement was associated with lower maternal psychological distress and higher ratings of perceived care. The effect of psychological distress on informant agreement varied as a factor of perceived maternal care. Results of this study support the need for multiinformant assessment and suggest that enquiry about mothers’ own psychological functioning could facilitate accurate assessment and intervention for adolescents who present at psychology services.

Background There is substantial evidence of the protective influence of social support on psychological distress in adults. Yet, levels of social support and psychological distress vary by ethnicity. There is little research investigating prospective associations between social support and psychological distress in an ethnically diverse sample of adolescents. Methods This thesis is based on secondary analysis of data from 'Research with East London Adolescents: Community Health Survey' (RELACHS). RELACHS is a prospective cohort questionnaire study conducted in a representative sample of adolescents aged 11-14 years at baseline and 13-16 years at follow-up. The analyses address three questions: (a) Are there prospective associations between baseline social support and follow-up psychological distress and depressive symptoms? (b) Does a change in social support overtime influence psychological distress or depressive symptoms at follow-up? (c) Are the effects of social support and culturally similar friendship choices independent and can these account for ethnic variations in psychological distress or depressive symptoms at follow-up. Results Low levels of family social support were significantly associated with depressive symptoms for female pupils (adjusted analyses: OR= 2.70 95% CI 1.20,6.08). A decre~se in total and family support overtime was significantly associated with depressive symptoms for female pupils (adjusted analyses: OR= 0.96 950/0 CI 0.93,0.98 and OR=0.61 95% CI 0.47,0.79 respectively). Social support could not account for ethnic variations in psychological distress or depressive symptoms. Culturally similar friendship choices were protective for psychological distress at follow-up. Conclusion Explanations for these findings include the possibility that family members [and peers from the same cultural group] provide a more consistent and healthy source of support than peers overall. Loss of family support appears to be risk factor specifically for girls from diverse ethnic groups.

Chronic health problems are hypothesised to be a risk factor to child and adolescent mental health, due the consistent and continuing stress these health problems pose to normative patterns of development. However, this theory remains to be substantiated by empirical research. Moreover, a systematic review conducted as part of this research indicated that the empirical body is not one on which the validity of this theory can be adequately tested. The major question posed is whether the lack of high quality epidemiological data in the field is obscuring a true psychiatric risk associated with chronic illness in childhood and adolescence, or whether, in contrast, the theory of chronic health problems as a particular risk factor to child and adolescent mental health, is based on false premises. In order to provide a stronger insight into the association of chronic health problems to mental ill-health across the late childhood and adolescent period, this study used data from a large, representative British sample (the Avon Longitudinal Study of Parents and Children (ALSPAC)) and sensitive measures of mental health outcomes. Mediating factors in these associations were also identified, and a model of the association of chronic health problems to poor mental health outcomes in early adolescence was developed. In order to ensure that all findings were applicable across chronic health conditions, outcomes over this period for children with chronic illness more generally were compared to outcomes for children with asthma diagnoses. Children with chronic health problems presented with a disproportionate rate of psychiatric illness at 10 years, and these chronic health problems continued to be associated with poor mental health outcomes across the early to mid-adolescent period. The outcomes at 10 and 13 years were suggested to be mediated by factors non-specific to any diagnosis, specifically peer victimisation and health-related school absenteeism. Limitations to external validity in the research, and implications for public health and future research are discussed.

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

acase@tulane.edu

Thesis (M.S.P.H.)--University of Michigan, 1933.

Thesis (M.S.P.H.)--University of Michigan, 1933.

No description available.

Problem: A major gap in adolescent mental health services exists in the United States. Nearly 80% of children and adolescents who are defined as needing mental health services are not receiving mental health care. School-based services have demonstrated promise as a strategy to address this gap. The purpose of this dissertation is to determine how a large urban school system implemented and sustained an innovative service of care model in response to financial, human resource, and community constraints and opportunities. Methods: A case study of the San Diego Unified School District’s (SDUSD) Mental Health Resource Center (MHRC) was completed using Pettigrew and Whipp's Content, Context, and Process Model of Strategic Change (PWM) as the theoretical framework that guided the research. Three primary sources of evidence were collected covering a fifteen-year period of implementation (1999–2014): 1) documents; 2) archival records; and, 3) interviews. The interviews were conducted with local and state stakeholders (n=20) and with students who received MHRC services and their parents (n= 15). A chronological reconstruction was completed and all data underwent a content analysis to organize and identify emergent themes based on the PWM framework. Results: Eight factors were identified as critical to the implementation and sustainability of the MHRC: establishing the legitimacy of school as environment for the delivery of mental health services; aligning education and mental health policies; implementing cross systems collaboration; utilizing data to improve performance and prioritize services; strengthening parent and student involvement; commitment to lead; institutionalization of mental health training; and, investment in staff. Further analysis assessed potential system improvements and opportunities for new collaborations and produced sustainability recommendations for SDUSD and MHRC administration, staff, and stakeholders. Conclusion: The MHRC provides a unique systems model that can inform best practices and policy decisions regarding the implementation and sustainability of school-based mental health services. Lessons learned from the sustainability of the MHRC support schools as a legitimate environment for the delivery of mental health services and the integration of mental health services in schools as a feasible strategy to improve student academic and mental health outcomes.

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.