Stress and loneliness: exploring adolescents' use of social media as a coping strategy during COVID-19.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness. AIM: To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use. METHOD: A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used - the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale. RESULTS: A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants. CONCLUSION: Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic.

Social isolation among adolescents and its association with depression symptoms

BackgroundSocial isolation can be defined as the absence of social interactions, contacts, and relationships with family, friends, and neighbors. According to some studies, social isolation was associated with depressive symptoms. At least one out of every five teenagers suffer from a diagnosable mental health problem that impairs their function. Saudi Arabia has a significant adolescent population;however, there are few studies conducted in Saudi Arabia to assess social isolation and its psychological impact among adolescents. This research is intended to study the prevalence of social isolation among adolescents in Riyadh and its association with depression symptoms.MethodsA cross-sectional study was conducted among 483 adolescents living in Riyadh, Saudi Arabia. An online self-administered questionnaire was used, and it was composed of three sections which are sociodemographic characteristics, assessment of social isolation, and assessment of depression symptoms.ResultsThe study reported the prevalence of social isolation among adolescents was 10.14%. The prevalence of depression symptoms among adolescents was high (31.68%). There was a significant association between social isolation and symptoms of depression among the studied sample (χ2 = 12.3, p = 0.002). It was found that being a male, living with both parents, and having low income are significant predictors of social isolation among adolescents;with r2 = 0.08 and p-value < .0001. It was also found that low-income level had a more impact on social isolation among adolescents than other factors (estimate = 1.6).ConclusionsA total of 10% of adolescents in Riyadh are socially isolated. There is a significant association between social isolation and symptoms of depression among the studied adolescents. Symptoms of depression can be predicted by social isolation. RecommendationsThe Ministry of Health and the Ministry of Education in Saudi Arabia should work together to conduct educational intervention programs for adolescents about mental health, the importance of social interaction, and the drawbacks of social isolation. These topics should also be involved in the curriculum of secondary schools.

A Comparison of Pediatric Mental Health Diagnoses and Selective Serotonin Reuptake Inhibitor Prescribing Before and During the COVID-19 Pandemic.

PURPOSE: To assess the rate of mental health diagnoses and selective serotonin reuptake inhibitor (SSRI) prescribing before and during the Coronavirus Disease 2019 pandemic. METHODS: We conducted a cross-sectional study at an ambulatory pediatric clinic. A prepandemic (June 2018 to June 2019) and intrapandemic (June 2020 to June 2021) cohort were reviewed. The rate of mental health visits and new SSRI prescriptions were compared. Chi-squared analyses demonstrated a variance of statistical significance. RESULTS: From 15,414 encounters (9,791 prepandemic and 5,623 intrapandemic), 397 mental health encounters were identified. 231 (4.1%) encounters occurred during the pandemic (vs. 1.7% prepandemic) and 63 (27.3%) SSRIs were prescribed (vs. 5.4% prepandemic). Mental health encounters (prevalence ratio 2.42, 95% confidence interval, 1.99-2.95, p < .001) and SSRI prescriptions (prevalence ratio 5.03, 95% confidence interval, 2.58-9.82, p < .001) were higher during the pandemic. DISCUSSION: Our findings demonstrate increased rates of SSRI prescribing and mental health diagnoses during the Coronavirus Disease 2019 pandemic, suggesting an increased incidence of these conditions. Clinicians should be prepared to manage and screen for mental health conditions.

Depression, Anxiety and Stress of Adolescents before and during the Fourth Wave of the COVID-19 Pandemic

This cross-sectional trend study compared the intensity of internalised problems of adolescents in the City of Zagreb before the COVID-19 pandemic and during its 4th wave. Two groups of secondary school students participated in the research: (1) 1st grade secondary school students in 2016 (N=267, Mage= 15.16, SDage= 0.468, 61.6% females) and (2) 1st grade secondary school students in 2021 (N =353, M age =14.78, SDage= 0.468, 45.9% females). Using the DASS-21 questionnaire, a growing trend of internalised problems was identified. In December 2021, 20.6% of students had severe and very severe symptoms of depression compared to 15.0% of students in 2016. In 2016 and 2021, 13.4% and as many as 33.0% of students, respectively, had severe and very severe symptoms of anxiety. Symptoms of this level of stress were present in 20.2% of students in 2016, and in 25.4% in 2021. A higher level of depression, anxiety and stress was found in females, as well as in students whose families suffered material damage in the Zagreb earthquake. Students of lower financial status reported significantly higher levels of anxiety and stress. Maladaptive coping strategies are significant predictors of depression, anxiety and stress. A significant predictor of depression is also lower self-esteem, parental rejection and greater dissatisfaction with physical appearance predict higher anxiety, and female gender higher stress. The data show that the mental health of Zagreb secondary school students was at high risk even before the COVID-19 pandemic and earthquakes, and these adverse circumstances increased that risk.Copyright © 2023 Medicinska Naklada Zagreb. All rights reserved.

Impact of Covid-19 on Adolescents around the Globe

Adolescence is the most formative stage in the life of any human. As a result, adolescents are at an increased risk of developing mental health disorders. Even before the pandemic, the global incidence of mental health problems in the young teenage population rapidly increased. COVID-19 led to disruption in the lifestyle of adolescents, and identifying mental health problems and implementing timely interventions can reduce detrimental effects on adolescents' mental health.COVID-19 substantially impacted adolescents' mental health, and some studies report depression as high as 43.7%. This article describes the positive and negative effects of COVID-19 on adolescent mental health. Additionally, non-pharmacological interventions to help adolescents cope with the restrictions of COVID-19 were reviewed.

Neurotic Personality is a Stress Inducer during COVID-19 among Adolescents with the Prediction of Anxiety and Depression

The most complex health-relevant personality trait, neuroticism involves a pattern of anxiety, worrying, moodiness, and propensity to experience negative affective states. It is also linked to increased exposure to stressful life events and increased susceptibility to the negative effects of stress. Adolescents especially who have neurotic personality traits were the victims of higher psychological distress due to confinement, social exclusion and reduced peer support during COVID-19. This has triggered a wide range of psychological distress among adolescents. This study aims to explore the correlation and prediction of neurotic personality and psychological distress among adolescents aged 15-19 during the COVID-19 pandemic. A cross-sectional predictive research method was used to collect data from adolescents in Kerala, India. BFI (Big Five Inventory), DASS-21 (Psychological Distress Scale), and PSS 10C (Perceived Stress Scale related to COVID) were used as measurement tools. The researcher recruited a sample of 300 adolescents from different schools in Kerala and assessed through these measurement tools. High Neuroticism was found in 24.17 % of the study sample of adolescents in Kerala, India. Psychological distress was found in 86 % of the adolescents in Kerala. These findings showed that neuroticism has a significant correlation with psychological distress during this pandemic among the adolescents and Neuroticism predicts 50 % of Psychological Distress and 73.4 % COVID19 Stress in the Kerala adolescents during COVID 19 pandemic. Conclusion: this study reveals that Neuroticism Personality trait significantly influences adolescent's mental health and due to their negative affectivity and emotional instability they are more prone to Psychological Distress and worse to Stressors.

A phenomenological investigation of the lived experiences of middle school professional school counselors in addressing student mental health, during the COVID-19 pandemic, after a return to in-person instruction

This study is positioned to contribute to our growing understanding of how COVID-19 has impacted our students and the individuals tasked with promoting their mental health and wellness. The overarching aim was to understand the lived experiences of middle school professional school counselors (PSCs) in addressing student mental health, during the COVID-19 pandemic, after a return to in-person instruction. The study strived to learn, if and how, the PSC's role has changed since returning to in-person instruction and to gauge the kind of support, if any, that they received with their counseling program. The researcher utilized convenience sampling from the Counselor Education and Supervision NETwork-Listserv, the American School Counselor Association listserv and Facebook. The study involved interviews with 10 participants who were employed as a middle school PSC, served in at least the fourth year as a PSC, held a master's degree in counseling, and had internet access. The researcher used Giorgi's descriptive method of phenomenology to analyze the data, which yielded three themes and three subthemes: 1) Awareness and Psychoeducation on the Mental Health Impact of COVID-19, 2) Adapting to Meet the Needs of Students (Utilizing Innovation;Structure and Intention with Direct Service Delivery;Shift to Reactive Services), and 3) Emotional Impact of Being a Helper During the Pandemic. The findings provide stakeholders, PSCs, and school counselor educators with a deeper understanding of factors related to addressing student mental health after a return to in-person instruction and how to better support PSCs in addressing these mental health concerns. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic.

PURPOSE: This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. METHODS: Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. RESULTS: Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic. DISCUSSION: Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Barriers and facilitators to training delivery and subsequent implementation of a localised child and adolescent mental health initiative: a qualitative content analysis.

BACKGROUND: Ensuring that children and young people (CYP) can obtain mental health support from a broad variety of sources is of upmost importance. This is especially true given the increasing prevalence of mental health difficulties in this population, and the associated challenges with receiving support from specialised healthcare services. Equipping professionals, from a wide range of sectors, with the skills needed to provide this support is a vital starting point. This study explored the experiences of professionals who had participated in CYP mental health training modules that related directly to the local implementation of the THRIVE Framework for System Change in Greater Manchester, UK (GM i-THRIVE) to establish the perceived barriers and facilitators behind the implementation of this training programme. METHODS: Directed qualitative content analysis of semi-structured interview data from nine CYP-facing professionals was conducted. Both the interview schedule and initial deductive coding strategy were developed using the findings of a systematic literature review by the authors, that was conducted to explore wider CYP mental health training experiences. This methodology was used to establish the presence or absence of these findings within GM i-THRIVE, before generating tailored recommendations for their training programme. RESULTS: When the interview data were coded and analysed, a strong level of thematic similarity with the authors' review was found. However, we deduced that the emergence of additional themes might reflect the contextual uniqueness of GM i-THRIVE, that is likely to be further compounded by the COVID-19 pandemic. Six recommendations were made for further improvement. These included the facilitation of unstructured peer interaction during training, and ensuring that jargon and key words are fully clarified. CONCLUSIONS: Methodological limitations, guidance for usage, and potential applications of the study's findings are explored. Whilst the findings were largely akin to those of the review, subtle yet important differences were found. These are likely to reflect the nuances of the training programme discussed, however, we tentatively suggest that our findings are transferable to similar training interventions. This study provides a valuable example of how qualitative evidence syntheses can be used to aid study design and analysis: an underused approach.

Social media use and juvenile incarceration: Perspectives from mental health professionals and staff of juvenile correctional facilities

Social media has become pervasive in the lives of modern adolescents. Although social media may provide individuals with many positive opportunities for communication and learning, social media sites also may provide an outlet for youth conduct problems, such as bullying, harassment, and intentional hostility and aggression toward others. In recent years, more and more research has shown that overuse of social media can lead to negative mental health outcomes( Khine et al., 2020;Andreassen, 2015;Lin et al., 2016). Research also suggests that more childhood conduct disorder symptoms are significantly associated with greater daily social media use during emerging adulthood (Galica, 2017). Yet, the relationship between social media use and adolescent delinquent behavior has remained clear. At the same time, according to a 2016 nationwide study, U.S. law enforcement arrested around 1.3 million adolescents each year (Puzzanchera, 2014). To this end, countless juvenile detention counselors, probation officers, unit counselors and other staff have treated and rehabilitated youths who were criminal offenders in an effort to prevent future crimes. This study aimed to better understand how these professionals considered and potentially addressed social media use in their everyday work with adolescents within the juvenile justice system. This researcher developed a brief survey which explored correctional staff's perspectives on the impact of social media use on the adolescents with whom they worked;and ways in which they could intervene. Data was collected from February 2021 to October 2021, which was longer than expected as it occurred amid the COVID-19 pandemic. The study sample consisted of 28 juvenile correctional facilities staff members (ages 18 or older), primarily mental health counselors, who were currently working with or previously worked with juveniles within the criminal justice system. Participants were acquired through multiple outreach attempts via phone and email to various juvenile correctional facilities throughout California. A majority of participants agreed that social media played a pertinent role in juvenile delinquency where it acted as a facilitator or platform for criminal behavior, and many disclosed a willingness to intervene or had previously attempted to intervene around social media use in some capacity. This included (a) directly communicating with adolescents, (b) communicating with their parents/caregivers about social media use, (c) recommending social media restrictions as a condition of probation, or (d) simply monitoring or limiting social media use in their general recommendations. This study offered a modest preliminary effort to explore and highlight the need to better understand the connection between social media use and juvenile criminal behavior as well as to develop and enhance ways to intervene with respect to this connection. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Adolescents' mental health during the COVID-19 pandemic: Do loneliness, family, and online friends matter?

The COVID-19 pandemic has impacted every element of adolescent life worldwide, including Indonesia. This study intended to examine how adolescents' loneliness and mental health during the COVID-19 pandemic are affected by their family relationships and online friendships. This study collects data using an online questionnaire. The Mental Health Continuum-Short Form, the UCLA Loneliness Scale Version 3, the Brief Family Relationship Scale, and the Online Friendship Scale were used to collect the data. Two hundred ninety-two students aged 12-18 participated in data gathering in Jakarta, Indonesia, between March and April 2021. Descriptive, correlation and Structural Equation Modeling (SEM) analyses were conducted using SPSS 25.0 and LISREL 8.80. This research revealed that family relationships and online friendships had a negative effect on loneliness. Family relationships favorably impact adolescent mental health, but loneliness negatively impacts it. Furthermore, family relationships and online friendships indirectly affect adolescents' mental health through loneliness. These findings may implement in developing interventions to assist adolescent mental health during the COVID-19 pandemic in Indonesia.

Inequalities in children's mental health care: Analysis of routinely collected data on prescribing and referrals to secondary care

Background: One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched. Methods: We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. Results: We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years. Conclusions: The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Mental Health of Russian Adolescents during the COVID-19 Pandemic

Background: the COVID-19 pandemic and associated restrictions may be particularly harmful for adolescents;however, evidence about changes in adolescent mental health during the pandemic is inconsistent. The aim was to examine changes in levels of Russian adolescent mental health and rates of substance use during the COVID-19 pandemic. Participants and methods: two cohorts of 11–18-year-old adolescents were recruited from Siberian cities in 2015–18 (n = 1774, 47% male) and in 2020–21 (n = 1747, 43% male). Participants completed identical sets of questionnaires: the Strengths and Difficulties Questionnaire, Body Image and Eating Distress scale and items on tobacco, alcohol and drug use. We examined the effect of cohort, gender and age using linear models. Results: in the 2020–21 cohort, depression, anxiety and psychosomatic symptoms, total mental health problems and levels of substance use were higher than in the 2015–18 cohort. Increases in emotional symptoms and total mental health problems were similar in both genders, whereas increases in rates of smoking and alcohol use were significant only among girls. Conclusions: the present findings indicate that the COVID-19 pandemic experience was likely to be stressful for adolescents. Therefore, more research on risk and protective factors of Russian adolescent mental health is needed. The findings also suggest that preventative interventions should be based on gender-specific patterns of adolescent substance use © 2023, Psychiatry (Moscow). All rights reserved

Personality assessment usage and mental health among Chinese adolescents: A sequential mediation model of the Barnum effect and ego identity.

Introduction: Adolescence is a crucial period for establishing ego identity and becoming a social individual. However, numerous adolescents suffer from mental health problems, especially after the conditions surrounding the COVID-19 outbreak. Personality assessments are often used when adolescents look for psychological self-help services. However, the meaning and mechanism of these personality assessments remain unknown. Taking the increasingly popular MBTI personality assessment as an entry point, the current study examined the potential sequential mediation relationship of Barnum effect - ego identity on the link between personality assessment usage and mental health. Methods: The current study surveyed 308 Chinese high school students, including 109 males and 199 females. MBTI use, Barnum effect, ego-identity, and mental health (subjective well-being, depression, and anxiety) were measured by seven questionnaires, respectively. Sequential mediation models were constructed to analyze the relationship. Results: The results indicate that the Barnum effect and ego identity together function as a sequential mediation path between personality assessment use and teenagers' mental health, including subjective well-being, depression, and anxiety. Specifically, a higher level of MBTI use triggers a stronger Barnum effect. The Barnum effect then promotes adolescents' ego identity, ultimately increasing subjective well-being levels and reducing anxiety and depression. Discussion: Our findings suggest that by properly using personality assessment and stimulating the Barnum effect, we can enhance adolescents' mental health. The theoretical and practical implications of our findings are discussed.

The impact of the COVID-19 pandemic on psychiatric emergency consultations in adolescents.

BACKGROUND: There is growing evidence that the COVID-19 pandemic, and its associated social distancing measures, affect adolescents' mental health. We wanted to examine whether and how the number and characteristics of adolescents' psychiatric emergency presentations have changed throughout the pandemic. METHODS: We extracted data from the records of 977 psychiatric emergency consultations of adolescents aged 12- 19 who had been referred to the mobile psychiatric emergency services in Rotterdam, the Netherlands between January 1st 2018 and January1st 2022. Demographic, contextual, and clinical characteristics were recorded. Time-series-analyses were performed using quasi-Poisson Generalized Linear Model to examine the effect of the first and second COVID-19 lockdown on the number of psychiatric emergency consultations, and to explore differences between boys and girls and internalizing versus externalizing problems. RESULTS: The number of psychiatric emergency consultations regarding adolescents increased over time: from about 13 per month in 2018 to about 29 per month in 2021. During the COVID-19 pandemic, the increase was tempered. In the second wave a pronounced increase of psychiatric emergencies among adolescents with internalizing problems but not with externalizing problems was found. CONCLUSION: Despite the reported increase of mental health problems in adolescents during the COVID-19 pandemic, we did find a smaller increase in psychiatric emergency consultations in this group then would be expected considering the overall trend. Besides changes in help-seeking and access to care, a possible explanation may be that a calmer, more orderly existence, or more parental supervision led to less psychiatric emergency situations in this age group. In the second wave the number of emergency consultations increased especially among girls with internalizing problems. While there has been a particular fall in emergency referrals of adolescents with externalizing problems since the start of the pandemic it is still too early to know whether this is a structural phenomenon. It would be important to elucidate whether the changes in emergency referrals reflect a true change in prevalence of urgent internalizing and externalizing problems in adolescents during the pandemic or a problem related to access to care.

A Climbing (Bouldering) Intervention to Increase the Psychological Well-Being of Adolescents in the Bekaa Valley in Lebanon-Study Protocol for a Controlled Trial.

(1) Background: Adolescent refugees in Lebanon and Lebanese youth are both at high risk of suffering from reduced psychological well-being. Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms (K-6 Distress Scale), self-efficacy (General Self-Efficacy Scale; GSE), and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform (current-controlled trials). ISRCTN13005983.

Utilization of adolescent health services during the COVID-19 pandemic: evidence on impact and adaptations from a rapid assessment survey in the Philippines.

BACKGROUND: Due to the COVID-19 pandemic, many challenges in adolescent health have been exacerbated including increased cases of early marriages, domestic violence, higher rates of anxiety and depression, and reduced access to sexual and reproductive health services for adolescents. This study examines the impacts of the pandemic on adolescent health services utilization and potential adaptations in the Philippines. METHODS: The data used in this study was from a rapid telephone assessment survey of 148 adolescent-friendly health facilities (rural health units) in the Philippines. We employed a mixed-methods research approach comprising both quantitative and qualitative analyses in three phases. First, we conducted a descriptive analysis of the status of adolescent healthcare access and utilization during COVID-19. Next, we examined using multivariate ordered logistic regressions how staff availability and adolescent health (AH) service provision modalities influenced AH service utilization in terms of the average number of adolescents served per week during compared to before the pandemic. We also conducted a complementing qualitative analysis of the challenges and corresponding adaptive solutions to ensuring continuity of AH services in facilities. RESULTS: We find that two months into the pandemic, 79% of adolescent-friendly trained staff were reporting for duty and 64% of facilities reported no staff disruptions. However, only 13% of facilities were serving the same number of adolescents or greater than before COVID-19. The use of more modalities for AH service provision (including telehealth) by facilities was significantly associated with increased likelihood to report serving the same number of adolescent or greater than before COVID-19 compared to those who used only one modality. CONCLUSION: Investments in multiple modalities of care provision, such as telehealth could improve AH services utilization and help sustain connection with adolescents during shocks, including future outbreaks or other stressors that limit physical access to health facilities.

Reasons and trends in youth's suicide rates during the COVID-19 pandemic.

Background: The COVID-19 pandemic posed many mental health challenges to youth through unprecedented infection control measures such as nationwide school closures. Despite this, few studies have investigated trends in suicide among youth during the pandemic, let alone their reasons. Methods: Population-level data on crude monthly suicide rates (2016-2021) and reasons of suicide (2018-2020) among youth aged 10-19 years were obtained from the Japanese Ministry of Health, Labour and Welfare and the National Police Agency, respectively. Using an event study design (with a Poisson regression model to calculate changes-in-changes (CiC) estimates) and interrupted time series analysis, we investigated changes in monthly suicide rates during the first 12 months of the pandemic (May 2020 to April 2021) compared to pre-pandemic levels (May 2016 to March 2020). Additionally, we investigated the changes in reasons of suicide (family-related, mental illness, social concerns, and academic concerns). Findings: In the event study analysis, suicide rates among youth increased during the pandemic relative to pre-pandemic levels, especially between August-November 2020 (e.g., ratio of the suicide rate in November 2020 relative to previous years, 1.86; 95% confidence interval (CI), 1.30 to 2.66). Though suicide levels returned closer to pre-pandemic levels by December 2020, they remained slightly elevated into 2021. In the interrupted time series analysis, suicide rates increased from May to August 2020 (0.099 cases per 100,000 youth per month; 95% CI, 0.022 to 0.176), followed by a decrease from September to December 2020 (-0.086 cases per 100,000 youth per month; 95% CI, -0.164 to -0.009). We observed elevated suicide rates for all major reasons from summer to autumn 2020, especially suicides attributed to family-related problems and social concerns. Furthermore, rates of suicides attributed to mental illness remained higher than pre-pandemic levels into December 2020. Interpretation: Suicide rates among youth remained slightly elevated compared to pre-pandemic levels into 2021. The reasons of the increase in suicide rates were multifactorial, including mental health issues and disruptions in social relationships. During a pandemic, interventions that provide mental support as well as opportunities for regular social interactions to youth may be beneficial. Funding: Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education.

Nasogastric tube feeding under restraint: practical guidance for children's nurses.

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

Supporting children's nurses to deliver trauma-informed care.

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.