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INTRODUCTION: The mental health of young people (aged 16-25 years) is a growing public health concern in the United Kingdom due to the increasing numbers of young people experiencing mental health difficulties, with many not in contact with mental health services. To design services that meet the needs of all young people, a diversity of young people must be involved in mental health research, beyond being participants. This Delphi study aimed to identify different types of 'involvement' and to define and describe 'under-representation' in young people's involvement in mental health research. METHODS: Twenty-seven experts in young people's mental health research completed a series of online questionnaires. The experts were academic researchers, patient and public involvement (PPI) professionals and young 'experts by experience'. Round 1 generated panellists' views on 'involvement' and 'under-representation'. Round 2 summarised panellists' responses from Round 1 and sought consensus (minimum 70% agreement) in nine question areas. Round 3 validated the findings of the previous rounds. RESULTS: Consensus was achieved in eight out of nine areas, resulting in a matrix (with definitions) of the different types of young people's involvement in mental health research, from being advisors to involvement ambassadors. The findings generated an agreed-upon definition of under-representation, an identification of when in the research process there is under-representation and the characteristics of the young people who are under-represented. Experts further agreed on demographic data that should be collected to improve reporting on involvement. CONCLUSIONS: This study adds to our understanding of involvement and under-representation in the context of young people's mental health research through expert consensus. It provides a practical resource for researchers considering involving young people in the research process and suggests the data that should be collected to improve reporting on the diversity of the young people involved. PATIENT AND PUBLIC CONTRIBUTION: A research oversight group of five young people advised on this study. They contributed throughout the project-from endorsing the research question to commenting on the findings and dissemination. Two of the group reviewed all participant materials and piloted the initial questionnaire.

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BACKGROUND: Female genital mutilation (FGM) is a harmful practice that has long-lasting negative impacts on the physical and psychological health of victims. Deemed a global concern, this practice persists in high-income countries (HIC) among certain migrant communities. Given the deleterious effects of the practice, we conducted an updated systematic review of the facilitators and barriers associated with the prevention of FGM in HIC. METHOD: A systematic review of published qualitative studies of FGM in HIC was conducted from 2012 to 2022. The search resulted in 276 studies. Of these, the majority were from low- and middle-income countries (LMIC) and excluded. A total of 14 studies were deemed fit for inclusion and none were excluded during quality appraisal. Relevant data were extracted from the studies and thematically analyzed to identify prevalent themes. RESULTS: A total of 12 themes were identified and the majority reflected barriers to the prevention of FGM including beliefs about female virtue, beliefs about social sanctions, and the preservation of culture, among others. Facilitators to the prevention of FGM were fewer and included memory and trauma from experiencing FGM, knowledge and awareness of the female anatomy, and legislative protection from FGM due to migration. A few themes, such as religious beliefs, acted as both facilitators and barriers. CONCLUSION: Findings highlight the importance of shared cultural and social threads among FGM practicing communities in HIC. Interventions can use these findings to guide the development of sociocultural strategies centered on community-level prevention and reduction of FGM in HIC.

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BACKGROUND: Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. OBJECTIVE: The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. METHODS: Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. RESULTS: This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. CONCLUSIONS: Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior.

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Research has demonstrated a disproportionate reduction in the moderate-vigorous physical activity (MVPA) of young UK adults during the initial months of COVID-19. However, previous research has not examined the trajectory of MVPA for this demographic over subsequent phases of the pandemic. The present study investigated the trajectory of MVPA from April 2020 to January 2021 in young UK adults. Data were drawn from 18-29-year-old participants of the Understanding Society COVID-19 Survey (212 males, 542 females). Weekly MVPA was self-reported at three time points (April and September 2020; January 2021) using the International Physical Activity Questionnaire. After controlling for significant covariates, growth curve modelling revealed no variation in weekly MVPA, which remained higher than the UK Physical Activity Guidelines. Female gender; Asian, Black and Mixed ethnicity; lower income,; living with a partner; and no access to a private garden or other outdoor space were associated with lower MVPA in April 2020. Gender, however, was a significant moderator of the trajectory. Males' MVPA increased between April 2020 to August 2020, followed by a sharp decline; whereas females showed a steady rate of decline from April 2020 to January 2021. Despite the recurrent lockdowns, this study shows that young UK adults, on average, continued to engage in MVPA, above the recommendated amount. Nevertheless, significant variation associated with gender, ethnicity and income highlights the importance of providing accessible spaces for young adults to exercise, especially those with limited access to private gardens.

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Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.

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Current research indicates that young adults are at a higher risk of deteriorating wellbeing during the COVID-19 pandemic compared to older adults. Drawing upon the Understanding Society COVID-19 survey, this study examined the trajectory of life satisfaction in UK emerging adults from May 2020 to September 2021 with social, health, financial, and demographic factors as covariates. The analytic sample included 880 participants (612 females, 268 males) between the ages of 18-29. Growth curve modelling was used to estimate the trajectory of life satisfaction and examine whether the covariates account for variation in the mean level and/or slopes. The trajectory of life satisfaction declined slightly between May 2020 and January 2021 and then increased to September 2021, aligning with the tightening and easing of UK COVID-19 policies. Greater perceived current financial difficulties, pre-existing mental health and physical health conditions, and higher self-reported loneliness were associated with lower life satisfaction. Being female and living with a romantic partner, more face-to-face social interactions, and higher household income were associated with more life satisfaction. Gender interacted with pre-existing mental health conditions. Women with no pre-existing mental health conditions reported the highest level of life satisfaction, while women with pre-existing mental health conditions reported the lowest level, compared to men who reported a similar level of life satisfaction regardless of their mental health. The findings from the present study contribute toward the current understanding of changes in life satisfaction throughout the pandemic among emerging adults. Implications for intervention are discussed.

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This study systematically reviews and synthesizes evidence on parental risk and protective factors along with identifying differences in the presence of these factors based on maltreatment type. In all, 68 quantitative, published, empirical studies were included from electronic databases for the systematic review. Quality appraisal did not exclude any studies and data were extracted from all. Results were narratively synthesized using the Risk and Resilience Ecological framework. The findings revealed more risk factors on the micro (individual and family) ecological level compared to mezzo and macro levels. At the micro level, findings mirror results of prior systematic reviews such as parental substance abuse, history of childhood maltreatment, and intimate partner violence (IPV). Social support was the most significant protective factor across all ecological levels and across all maltreatment types except child sexual abuse but differed in definition widely across studies. Physical abuse had the most risk factors unique to this type followed by neglect, and IPV was a common risk factor across all maltreatment types. Fewer studies on emotional abuse, sexual abuse, and protective factors were identified. The findings of this review delineated key parental risk and protective factors at various ecological levels along with associations between distinct factors and types of maltreatment. Interventions working with parents to reduce child maltreatment risk can use these findings to guide development of targeted programs for families based on risk and maltreatment type. For researchers, the findings can guide further investigation in under-researched areas of parental sexual and emotional abuse and protective factors.

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Initial COVID-19 restrictions were associated with declining mental health, particularly in UK emerging adults. Prior research has yet to examine changes in mental health in this demographic over the entire course of the three UK national lockdowns. Drawing upon the Understanding Society COVID-19 Survey, this study examined the trajectory of mental health problems for emerging adults (18-29-year-olds) from April 2020-September 2021. Mental health problems were assessed at nine time-points using the General Health Questionnaire. The analytic sample included 1018 participants (304 males, 714 females). Growth curve modelling was used to examine the trajectory of mental health problems and the associated sociodemographic and health covariates. Females and those with fewer household members, lower income, no private garden, and pre-existing mental or physical health diagnoses reported more mental health problems. Gender differences were evident in the rate of change. Females' mental health problems declined from the first lockdown until just after the relaxation of initial restrictive measures (September 2020), increased until April 2021 (constituting lockdowns two and three), and then slightly decreased until September 2021 during the phased exit from restrictions. Males' mental health problems followed a similar trajectory, with a greater rate of increase in mental health problems from July 2020-April 2021, and a greater rate of decline from April-September 2021. Females reported more mental health problems throughout the three national lockdowns than males. These findings can inform public health policies targeted toward young adult populations and highlight sub-populations at greater risk of worsening mental health.

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BACKGROUND: Self-harm amongst young people in the United Kingdom is higher than in other European countries. Young people who self-harm are often reluctant to seek professional help, turning increasingly to the internet for support, including online forums. There are concerns about misinformation or harmful content being shared, potentially leading to self-harm contagion. Moderation of online forums can reduce risks, improving forum safety. Moderation of self-harm content, however, is an under-researched area. AIMS: Using the Behaviour Change Wheel (BCW), this study examines the barriers and enablers to moderation of self-harm content and suggests behaviour change techniques (BCTs) to address barriers. METHOD: Qualitative interviews with 8 moderators (of a total of 16) from the UK's leading young people's support service for under 25s, The Mix, were conducted. RESULTS: Thematic analysis identified eleven enablers, four barriers and one both an enabler and a barrier. Barriers included emotional exhaustion, working with partial information, access to timely support, vagueness within the guidelines and influence of community users. BCTs selected included increasing social support through a moderation buddy. CONCLUSIONS: Optimisation strategies focus on increasing the support and level of information available to moderators and could be considered by other organisations providing similar services.

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Objective: This qualitative study utilises the Behaviour Change Wheel (BCW) approach to identify barriers and enablers to the delivery of email communication in a mental health helpline service for young people, which are then linked to specific intervention strategies for improvement. Methods: Semi-structured interviews were conducted with ten volunteers working for a free online helpline service for young people. Transcripts of the interviews were coded according to deductive then inductive themes. Results: Ten core themes were identified. These were barriers or enablers, depending on the volunteers' level of experience with the email service. Enablers included the volunteers' skills, the resources and support offered to them. Barriers related to the asynchronous nature of email communication, need for additional training and volunteers' lack of confidence and motivation in responding to emails. Innovation: This study expands current research on online mental health support by showing how the BCW can be a useful tool to identify influences on email helpline provision and offer strategies for its optimisation. Conclusion: Offering training targeted to the email service, increasing the level of practice with mock-up emails, and introducing newsletters featuring positive feedback on the email service may improve the delivery of email helpline services for young people.

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A large body of literature has demonstrated that there are developmental differences in mental health problems. However, less is known about the development of mental health problems in ethnic minority children, particularly at the population level. Using a detailed ethnic classification and nationally representative data from the UK Millennium Cohort Study (n = 18, 521, 49% female, 18% ethnic minority), this study examines ethnic differences in children's mental health problems and trajectories of mental health from ages 3 to 14 years. Growth curve modeling revealed that ethnic minority children followed different developmental trajectories of internalizing and externalizing problems than white children, either in terms of the mean-level and/or rate of change across age. These differences were not explained by child sex, socioeconomic status, maternal depressive symptoms, and maternal immigrant status, highlighting the need for further research exploring the factors that underpin ethnic inequalities in child mental health.

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An increasing body of research indicates that, whilst young adults are at the lowest risk of becoming severely physically ill as a result of COVID-19, they are at the greatest risk of adverse mental health outcomes. Using data from the Understanding Society COVID-19 survey, the current study examined the mental health of 18-25-year-olds during the pandemic. Current mental health was measured at six time points using the 12-item General Health Questionnaire (GHQ-12), a validated measure for mental distress. The analytic sample included 880 young adults (292 = males; 588 = females). The trajectory of mental health was modeled from April to November 2020, using demographic information and health behaviors (physical activity, alcohol consumption, and smoking cigarettes) as covariates. Growth curve modeling indicated that alcohol consumption, smoking, being female, having a lower income, and having a pre-existing mental health condition were risk factors for worse mental health during the pandemic. For females, their mental health was lowest in April but gradually improved until September, when it began to decline again. Males, in contrast, had a relatively stable trajectory of mental health across the pandemic. These findings can help inform targeted interventions for at risk groups to minimize the adverse impact of the pandemic on young adults' mental health.

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Current research has shown that young adults are at the greatest risk of loneliness during the pandemic. Drawing upon the Understanding Society COVID-19 survey, this study investigated the trajectory of loneliness in young adults (aged 18-25) from June to November 2020 and its association with emotional support as well as demographic and health factors. The analytic sample included 419 young adults (296 females; 123 males). Growth curve modelling revealed a U-shape longitudinal trend in self-reported loneliness, with a sharp rise during the winter months under the national lockdown. Young adults with long-standing physical or mental health conditions were more likely to report feeling lonely. Those with a lower household income and who were unemployed or not in school reported higher levels of loneliness. Gender was found to moderate the association between self-reported emotional support and loneliness. While greater emotional support was associated with less loneliness in males, no association was shown for females. The current findings add to our understanding of how the pandemic has affected the mental health of young adults and the differential effect of emotional support as a potential coping strategy for males and females.

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AIMS AND OBJECTIVE: To characterise the intervention components, mechanisms of change and barriers to implementation of an intervention to improve communication behaviour of hospital staff surrounding mental health with children and adolescents. BACKGROUND: Healthcare professionals consistently report a lack of confidence and knowledge to care for young people experiencing mental health difficulties. We Can Talk is a one-day training, delivered to hospital staff, which provides tools to improve their communication with children and adolescents about mental health. Initial evaluation suggests the training improved confidence and skills regarding communication; however, the effective intervention components and mechanisms of change are not yet understood. DESIGN: A process evaluation was conducted using a qualitative research design. METHODS: Document analysis of the training manual, using the Behaviour Change Technique Taxonomy, characterised intervention components. Ten interviews with paediatric staff from an east London hospital were conducted post-intervention. Using the Theoretical Domains Framework, the mechanisms of change and remaining barriers to communication were coded thematically. COREQ checklist was used in the reporting of the study. RESULTS: Twenty behaviour change techniques were identified. Communication about mental health was mainly facilitated through improving the knowledge, cognitive and interpersonal skills, and beliefs about capabilities of healthcare professionals. A small number of staff continued to experience barriers to communication including a lack of opportunity for communication, beliefs that their professional role is not suited to supporting mental health and nervousness. Behaviour change techniques are highlighted to address remaining barriers reported post-intervention. CONCLUSIONS: Using validated and systematic behaviour change tools, this process evaluation contributes to the translation of evidence to clinical practice for more effective, sustainable and transparent mental health care, reducing the research-practice gap in this area. RELEVANCE TO CLINICAL PRACTICE: These findings can facilitate implementation of evidence-based practice and inform interventions, improving clinical practice and outcomes for children and adolescents.

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Despite trends indicating worsening internalizing problems, characterized by anxiety and depression, there is dearth of research examining gender differences in developmental trajectories of internalizing problems from early childhood to adolescence. Drawing on the UK Millennium Cohort Study (n = 17,206, 49% female), this study examines trajectories of parent-reported, clinically-meaningful (reflecting the top 10%) internalizing problems from ages 3 to 14 years and their early predictors and adolescent outcomes. Group-based modelling revealed three trajectories when examining boys and girls together, but there were significant gender differences. When examining boys and girls separately, four trajectories were identified including two relatively stable trajectories showing either high or low probabilities of internalizing problems. An increasing trajectory was also found for both boys and girls, showing an increasing probability of internalizing problems which continued to rise for girls, but levelled off for boys from age 11. A decreasing trajectory was revealed for boys, while a moderate but stable trajectory was identified for girls. Boys and girls in the increasing and high probability groups were more likely to report a number of problematic outcomes including high BMI, self-harm, low mental wellbeing, depressive symptoms, and low educational motivation than the low group. Girls on the increasing trajectory also reported more cigarette and cannabis use and early sexual activity at age 14 compared to girls on the low trajectory. Findings suggest that intervention strategies take a systemic view, targeting not only internal feelings, but also behaviours potentially associated with later negative outcomes.

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A substantial body of evidence has examined developmental pathways into and out of conduct problems. However, there is a dearth of research examining whether the same conduct problem pathways are evident in minority ethnic, as in white, populations. Drawing on the UK Millennium Cohort Study (MCS), a nationally representative longitudinal study of children born between 2000 and 2002, this study examines differences in group-based trajectories of conduct problems according to broad categories of ethnicity. Using pathways identified in a prior study (n = 17,206, 49% female, 18% ethnic minority), including persistently high (8%), childhood-limited (23%), adolescent-onset (13%), and low (56%), significant ethnic differences were found. As a result, trajectories of conduct problems were identified separately for Asian, black, mixed ethnicity, and white children. For Asian, black, and mixed ethnicity children, three trajectories were identified: persistently high, childhood-limited, and low, but not adolescent-onset. Although these pathways have similar labels, their patterns and shapes seem to differ among the three ethnic groups. For white children, the same four trajectory groups were identified as in the prior study. Risk factors also differed among the groups according to ethnicity, although a worse child-parent relationship was a significant predictor of the higher problem trajectories for all ethnic groups. Overall, the findings suggest that black and minority ethnic children may follow different developmental pathways of conduct problems than white children, particularly during adolescence, having implications for service use and early intervention.

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Pathways into and out of conduct problems differ by circumstances experienced since infancy. There is a research gap in understanding how these developmental patterns vary according to the timing and persistence of risk and whether there are differences across ecological domains. This study examines variations in trajectories of conduct problems between ages 3 to 14 years and associated child, family and socio-economic risk factors from ages 9 months to 14 years, drawing on the UK Millennium Cohort Study (n = 17,206, 49% female), a nationally representative longitudinal study of children born between 2000/02. Group-based modeling was used to identify four distinct trajectories of conduct problems: low (56%), persistent high (8%), childhood-limited (23%) and adolescent-onset (13%). All three problem pathways were associated with high levels of exposure to risk, particularly early socio-economic and persisting child and family risks. However, while for the persistent and adolescent-onset pathways, exposure to higher levels of family and child risks continued through adolescence, it receded for the childhood-limited trajectory. The effects of early socio-economic disadvantage persisted for those on the adolescent-onset trajectory, highlighting the importance of early markers for this later onset group. Maternal smoking in pregnancy continued to be a significant predictor for all three conduct problem groups, even up to age 14 years. The findings indicate that different influences and processes may explain diverse pathways of conduct problems. This offers insights into who and what might be targeted and when might be the most effective developmental window for intervention.

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Previous research has demonstrated the link between school engagement and academic attainment, but there is less understanding of the relationship between school engagement and educational aspirations. Using the Longitudinal Study of Young People in England (LSYPE), this study examines the association between emotional engagement and educational aspirations during secondary school, covering ages 14 to 16. On average, emotional engagement increased over time. A significant proportion of adolescents shifted from expressing uncertainty to aspiring to continue in education. Males were more likely than females to shift from aspiring to continue in education to planning to leave school early. Greater emotional engagement was associated with a lower likelihood of having low or uncertain aspirations, especially for high-achieving, ethnic minority, and male adolescents. Findings highlight the importance of emotional engagement, particularly for those at risk of uncertain educational aspirations and those least likely to continue in education following post-compulsory schooling.

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Gender-specific pathways of conduct problems (CP) from toddlerhood have received little attention. Using a nationally representative sample of UK children born in 2000-2001 (6458 boys and 6340 girls), the current study (a) identified subgroups of CP pathways separately for boys and girls from ages 3 to 11 and (b) examined early precursors (pregnancy to 9 months) of these trajectories. Group-based trajectory models identified four distinct trajectories for both boys and girls: each characterized as 'low'; 'early-onset, desisting'; 'early-onset, persistent' and 'school-onset'. This suggests that the taxonomic framework developed to conceptualise childhood-onset CP among males is also applicable to females, though needing some revision to capture heterogeneity identified during early and middle childhood. We also found significant precursors of the different trajectory groups with some variation by gender. Early socioeconomic deprivation was a significant risk factor of the early-onset pathways among both genders, but played no significant role for 'school-onset'. Childhood-onset trajectories of boys, but not girls, were predicted by parenting attitudes and behaviour.

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BACKGROUND: Previous evidence indicates that mental health problems are becoming more common for adolescents. Less is known about whether these trends have continued and there has been no study to date which has specifically focused on early adolescents over a sufficiently long period. This study examines changes in parent- and teacher-reported mental health problems among 10- and 11-year-olds in 1999, 2004 and 2012 in Great Britain. METHOD: Parent and teacher ratings of the Strengths and Difficulties Questionnaire were used to compare the prevalence of conduct problems, hyperactivity/inattention, emotional problems, peer problems and total difficulties among 10- and 11-year-olds in three nationally representative British samples assessed in 1999 (n = 1904), 2004 (n = 1348) and 2012 (n = 11,397). RESULTS: Teacher reports showed improving trends for boys' and girls' mental health from 1999 to 2012, particularly for externalizing behaviours (i.e. conduct problems and hyperactivity/inattention). Parent reports, on the other hand, identified only one area of sustained improvement between 1999 and 2012, namely hyperactivity/inattention among boys. Although parent reports of girls' mental health indicate improving trends from 1999 to 2004, they also suggest worsening mental health from 2004. CONCLUSIONS: These findings suggest that perceptions of emotional and behavioural problems vary by the gender of the adolescent, the context in which they are observed or by whom they are reported.