Literature Collection

BACKGROUND: The clinical profiles of youth presenting to early intervention mental health services are heterogeneous, with various sub-groups proposed and little information about the longitudinal stability of profiles, especially those associated with bipolarity. METHODS: 802 youth aged 12-25-years (Mean = 18.26; 66 % females) accessing primary-care based mental health clinics were assessed at baseline and 417 were re-assessed after 12-months. An exploratory factor analysis of 62 items from six validated rating scales of the severity of mental and physical ill-health was conducted. Seven factors (anxiety, sleep, depression, restlessness, distress, activation, somatic complaints) were derived and modelled using latent profile analysis. Associations between profile membership, clinical outcomes and functioning were examined. Conditional probabilities of shifting to a different profile longitudinally were computed. RESULTS: Three profiles were revealed which were psychometrically invariant across baseline and follow-up: (1) 'High distress with high activation' (32 % baseline, 25 % follow-up); (2) 'High distress without activation' (31 % baseline, 26 % follow-up); and (3) 'Moderate distress' (37 % baseline, 33 % follow-up). A fourth profile, 'Low distress' (16 %), emerged at follow-up. Profiles did not differ by age at baseline or sex. 'High distress with high activation' was more likely to be impaired longitudinally, and to meet criteria for a full-threshold mental disorder at follow-up. About 39 % of youth retained the same profile longitudinally, while 16 % shifted to lower distress, and 13 % shifted to higher distress. CONCLUSION: These findings suggest that activation is a marker of poorer clinical and functional outcomes in youth presenting for mental health care.

Youth internalizing symptoms (i.e., depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical.; Mental health symptoms and suicide ideation and attempts have been increasing for several years. Disparities in quality and access to mental healthcare indicate that Hispanic and socioeconomically disadvantaged youth need accessible and targeted interventions, ideally preventive and early interventions. Our team adapted an existing, evidence-based prevention program for Hispanic families to specifically and directly address youth mental health to be delivered in primary healthcare settings. This paper describes the adaptation framework and steps taken to adapt the original program that was developed and tested for drug use and sexual risk behaviors, with the purpose of additionally addressing depression, anxiety, and suicide ideation and attempts. We subsequently describe the adapted program- eHealth Familias Unidas Mental Health- and discuss how it is currently being implemented and evaluated in primary healthcare settings. The paper provides information and an example of how other research teams can systematically adapt an intervention using insights from the peer-reviewed literature, participants, primary care clinic staff, and experts in youth mental health.; eng