Staff and client preferences for the design and delivery of an outcomes monitoring system in a mental health service.

BACKGROUND: Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders. OBJECTIVE: Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families. METHOD: Twenty-nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi-structured interviews. Thematic analysis was used to develop themes from the data. RESULTS: Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework. CONCLUSIONS: Findings suggest that an effective outcome monitoring framework should be client-led, tailored to the individual's needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing.

Lost in translation: a narrative review and synthesis of the published international literature on mental health research and translation priorities (2011-2023).

BACKGROUND: Priority setting in mental health research is arguably lost in translation. Decades of effort has led to persistent repetition in what the research priorities of people with lived-experience of mental ill-health are. AIM: This was a narrative review and synthesis of published literature reporting mental health research priorities (2011-2023). METHODS: A narrative framework was established with the questions: (1) who has been involved in priority setting? With whom have priorities been set? Which priorities have been established and for whom? What progress has been made? And, whose priorities are being progressed? RESULTS: Seven papers were identified. Two were Australian, one Welsh, one English, one was from Chile and another Brazilian and one reported on a European exercise across 28 countries (ROAMER). Hundreds of priorities were listed in all exercises. Prioritisation mostly occured from survey rankings and/or workshops (using dots, or post-it note voting). Most were dominated by clinicians, academics and government rather than people with lived-experience of mental ill-health and carer, family and kinship group members. CONCLUSION: One lived-experience research led survey was identified. Few studies reported lived-experience design and development involvement. Five of the seven papers reported responses, but no further progress on priorities being met was reported.

This review followed PRISMA guidance for search strategy development and systematic review and reporting. This was not a systematic review with or without meta-analysis and the method did not fit for registration with PROSPERO.

Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study.

BACKGROUND: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. OBJECTIVE: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. METHODS: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. RESULTS: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. CONCLUSIONS: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.

Understanding suicidal transitions in Australian adults: protocol for the LifeTrack prospective longitudinal cohort study.

BACKGROUND: The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. AIM: The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. METHODS: A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. CONCLUSION: This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. STUDY REGISTRATION: Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606.

Anxiety management in Australian general practice: an analysis of encounters from 2006 - 2016.

BACKGROUND: Anxiety disorders are highly prevalent mental health conditions managed predominantly by general practitioners (GPs). This study aimed to examine the management of anxiety by Australian GPs since the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative in 2006. METHODS: We conducted secondary analysis of Bettering the Evaluation and Care of Health data on GP encounters for anxiety from 2006 to 2016 (N = 28,784). We calculated point estimates and used multivariate logistic regression to explore the effect of GP and patient characteristics on rates and types of management. RESULTS: The management rate of anxiety increased from 2.3% of GP encounters in 2006 to 3.2% in 2016. Over the 10-year period, increases were seen in referrals to psychologists (AOR = 1.09, 95%CI = 1.07-1.11, p < .0001) and selective serotonin / serotonin-noradrenalin reuptake inhibitors (AOR = 1.05, 95%CI = 1.03-1.06, p < .0001), and benzodiazepines decreased (AOR = 0.94, 95%CI = 0.92-0.95, p < .0001). Systematic differences in management were found for patient and GP characteristics, including high rates of benzodiazepines in certain groups. CONCLUSIONS: Anxiety is accounting for more of the GP workload, year on year. GP management of anxiety has become more closely aligned with practice guidelines since 2006. However, high rates of benzodiazepine prescribing in certain groups remains a concern. Further research is needed into GP treatment decision making for anxiety.

Active involvement of people with lived experience of suicide in suicide research: a Delphi consensus study.

BACKGROUND: The importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them. METHODS: The Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines. RESULTS: Panellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure. CONCLUSIONS: This study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines.

Co-ideation and co-design in co-creation research: Reflections from the 'Co-Creating Safe Spaces' project.

INTRODUCTION: Numerous frameworks for defining and supporting co-created research exist. The practicalities of designing and conducting co-created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well-researched. METHODS: Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co-creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co-ideation and co-design. RESULTS: Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within co-creation processes. Co-creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders. CONCLUSION: The findings highlight the iterative, fluid and deeply relational nature of co-created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co-created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co-created research. PATIENT OR PUBLIC CONTRIBUTION: People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, service and peer workers, carers and advocates were involved in the co-ideation and co-design of this research. All authors identify as people with lived experience, from both academic and nonresearch backgrounds.

Cancer Survivors' Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs.

People living with cancer experience many impacts on their health and mental health, and are thus likely to require ongoing health care. The aim of the current study was to investigate the health and mental health care experiences and needs of Australian cancer survivors. A total of 131 people (119 female, 12 male) with lived experience of a cancer diagnosis (at least 12 months ago) participated in an online survey collecting qualitative and quantitative data, advertised via social media groups and paid advertising. Analysis of the written responses was conducted using inductive qualitative content analysis. The findings showed that a major issue facing cancer survivors was difficulties around access to and management of services for both their mental and physical health. There was also a strong preference for increasing access to allied health care, such as physiotherapy, psychology, and remedial massage. There appear to be some inequities in the experiences of cancer survivors, particularly in accessing care. Improving the experiences of health care for physical and mental health cancer survivors should focus on increasing access to and improving the management of services, specifically allied health, through a variety of avenues, including reducing costs, increasing transport, and providing closer and more co-located services.

The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey.

BACKGROUND: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. OBJECTIVE: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. METHODS: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. RESULTS: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. CONCLUSIONS: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.

Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis.

INTRODUCTION: Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences. MATERIAL AND METHODS: We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives. DISCUSSION: This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

Peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders: systematic review and meta-analysis.

OBJECTIVES: To evaluate the efficacy of peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders. STUDY DESIGN: Systematic review and random effects meta-analysis of peer-facilitated interventions for people with serious mental illness, including schizophrenia spectrum disorders, in which physical health outcomes were assessed. DATA SOURCES: MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus, CENTRAL, and PubMed. In addition, reference lists of reviews were examined for further relevant studies published to 10 November 2021. DATA SYNTHESIS: We included fourteen publications (thirteen randomised controlled trials of ten peer-facilitated interventions, and one secondary analysis; total of 2099 participants) that assessed physical health outcomes for people with mental health conditions, including schizophrenia spectrum disorders. Intervention duration ranged from three to eighteen months; peers were involved as sole or co-leaders of the programs in group or individual sessions. Meta-analysis identified a statistically significant pooled effect on physical activity and capacity (various measures; six studies; 468 intervention, 461 control participants; standardised mean difference, +0.19 standard deviation [SD]; 95% CI, +0.06-0.32 SD; I2  = 0%); overall GRADE certainty of evidence was low. Marked study heterogeneity precluded secure conclusions regarding intervention effects on self-rated physical health, healthy eating, and body mass index. CONCLUSIONS: Peer-facilitated interventions for improving physical outcomes are feasible for people with schizophrenia spectrum disorders, a group at particular risk of certain physical health conditions. Further research is required to assess the effects of such interventions on other health-related parameters. PROSPERO REGISTRATION: CRD42021283578 (retrospective).

Keeping the Agenda Current: Evolution of Australian Lived Experience Mental Health Research Priorities.

The value of including consumers' and carers' views at the early stages of study design is increasingly being recognised as essential to improving the relevance and quality of research. One method of achieving this is by actively seeking and regularly updating consumer and carer priorities for mental health research. The current study presents priorities for mental health research collected from two virtual World Cafés with consumers and carers (n = 4, n = 7) held in 2021. Over 200 priorities were identified (13 themes, 64 subthemes), which were then compared with two combined data collection activities from 2013 (face-to-face forum; n = 25), and 2017 (online survey; n = 70). There appears to be some evolution in consumer and carer priorities over time. A key difference was that in the previous studies, mental health service issues were at the individual service delivery level, whereas in the current study, a broader focus was on mental health systems of care and issues around service funding, accessibility, and equity of access. It is possible these changes may also have resulted from key differences between the studies, including the methods, setting, and participants. Overall, similar to our previous studies no clear priorities were identified; however, a significant number of important research topics were identified by consumers and carers, providing a rich agenda from which to improve the management of mental health.

Risk tolerance and changes in coronavirus disease (COVID) related health behaviors: A longitudinal study.

OBJECTIVE: The present study examined behavioral responses during the coronavirus disease 2019 (COVID-19) pandemic and the role of dispositional risk tolerance in the Australian context. METHOD: The study involved a six-wave longitudinal investigation with a nationally representative sample of Australians (N = 1,296). Dispositional risk tolerance was measured at Wave 1 and participants' anxiety level and self-report implementation of 10 COVID actions was assessed in each wave. Autoregressive multinomial regression models were estimated to assess the unique contribution of risk tolerance to the longitudinal change of participants' implementation of COVID actions. RESULTS: The results revealed a high implementation rate for protective actions when Australia had a peak in the severity of the COVID-19 pandemic and subsequently declined with the easing threat of the pandemic. Individuals' dispositional risk tolerance significantly predicted transition to, and endorsement of, protective actions. Participants who had low risk tolerance were more likely to remain at the state of implementing COVID-19 measures than being in, or transitioning to, other states. CONCLUSIONS: The findings suggest that when encouraging protective actions, governments and public authorities should acknowledge variability in the community in responding to risk and consider measures in addition to risk messaging to encourage protective actions among individuals with a high level of risk tolerance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Consumer Perspectives on Anxiety Management in Australian General Practice.

The aim of the current study was to explore consumer views on the management of anxiety in general practice, which is often the first service from which a consumer seeks professional support. We used a mixed methods survey to explore three broad research questions: (1) what are consumer experiences of anxiety management in general practice, (2) what do consumers prioritise when considering treatment for anxiety and what are their preferences for type of treatment, and (3) how do consumers think care for anxiety could be improved? Consumers reported generally positive views of their GP when seeking help for anxiety, though they had mixed experiences of the approach taken to treatment. Consumers noted that they prioritise effective treatment above other factors and are less concerned with how quickly their treatment works. A preference for psychological intervention or combined treatment with medication was apparent. Consumers noted that key areas for improving care for anxiety were improving access and funding for psychological treatments, increasing community knowledge about anxiety, and reducing stigma.

Peer Worker-Supported Transition from Hospital to Home-Outcomes for Service Users.

BACKGROUND: Transitioning from psychiatric hospitalisation back to community presents a period of heightened suicide, homelessness, relapse, and rehospitalisation risk. The Australian state of New South Wales established a state-wide Peer Supported Transfer of Care (Peer-STOC) initiative to enhance recovery-focused supports available during this transition period. AIMS: To understand the impacts and outcomes of the Peer-STOC program on service users from three stakeholder perspectives: service users themselves, peer worker service providers, and other mental health workers and clinicians interfacing with the program. METHODS: Qualitative data from 82 questionnaires and 58 individual in-depth interviews were analysed thematically using constant comparative methods and an iterative and inductive process. RESULTS: All stakeholders described positive impacts and outcomes of the program for service users. These included: (a) a better, less traumatic inpatient experience; (b) felt understood, cared about and less alone; (c) easier to leave hospital; (d) easier to get back into life and daily routines; (e) built and re-established community connections; (f) gained new knowledge, strategies, and skills; and (g) felt more hopeful about my recovery. CONCLUSIONS: The Peer-STOC program had a positive impact. It enhanced people's experience in hospital, eased their transition from hospital and assisted with people recovering community-based relationships, activities, and routines.

Psychosocial impacts of home-schooling on parents and caregivers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has been highly disruptive, with the closure of schools causing sudden shifts for students, educators and parents/caregivers to remote learning from home (home-schooling). Limited research has focused on home-schooling during the COVID-19 pandemic, with most research to date being descriptive in nature. The aim of the current study was to comprehensively quantify the psychosocial impacts of home-schooling on parents and other caregivers, and identify factors associated with better outcomes. METHODS: A nationally representative sample of 1,296 Australian adults was recruited at the beginning of Australian COVID-19 restrictions in late-March 2020, and followed up every two weeks. Data for the current study were drawn from waves two and three. Surveys assessed psychosocial outcomes of psychological distress, work and social impairment, and wellbeing, as well as a range of home-schooling factors. RESULTS: Parents and caregivers who were home-schooling during the COVID-19 pandemic experienced significantly higher levels of psychological distress and work/social impairment compared to those who were not home-schooling or had no school-aged children. A current mental health diagnosis or lower levels of perceived support from their child's school negatively affected levels of psychological distress, work and social impairment, and wellbeing in parents and caregivers involved in home-schooling. CONCLUSIONS: The mental health impacts of home-schooling were high and may rise as periods of home-schooling increase in frequency and duration. Recognising and acknowledging the challenges of home-schooling is important, and should be included in psychosocial assessments of wellbeing during periods of school closure. Emotional and instrumental support is needed for those involved in home-schooling, as perceived levels of support is associated with improved outcomes. Proactive planning by schools to support parents may promote better outcomes and improved home-schooling experiences for students.

What could we do differently next time? Australian parents' experiences of the short-term and long-term impacts of home schooling during the COVID-19 pandemic.

BACKGROUND: COVID-19 lockdowns have resulted in school closures worldwide, requiring curriculum to be delivered to children remotely (home schooling). Qualitative evidence is needed to provide important context to the positive and negative impacts of home schooling and inform strategies to support caregivers and children as the pandemic continues. This study aimed to explore the experiences of home schooling caregivers at multiple time-points during the pandemic. METHODS: Data were obtained from a longitudinal survey of a representative Australian sample conducted over 8 waves during 2020 and 2021. Participants who had home schooled at least one child during COVID-19 completed open-ended questions at Wave 4 (May 2020; n = 176), Wave 7 (June 2020; n = 145), and Wave 8 (March 2021; n = 57). Participants were asked to describe what they found positive and challenging about home schooling (Wave 4), what they would do differently if they home schooled their children again (Wave 7), and the longer-term impacts of home schooling on caregivers and children (Wave 8). RESULTS: 91% of participants at Wave 4 reported at least one positive and/or negative aspect of home schooling. At Wave 8, 32% and 29% of participants reported no long-term positive or negative impacts of home schooling respectively. Using a qualitative content analysis approach, six themes were developed from the data, encompassing the impacts of home schooling on parents, and the perceived impacts on children. Impacts on parents included connecting with children, managing the work-life-school balance, and the challenge of home schooling when parents are not teachers. Perceived impacts on children included: quieter and safer learning at home, and the negatives of managing schoolwork load and social isolation. At Wave 7, 56 participants (44%) identified at least one thing they would do differently. CONCLUSIONS: Despite some participants reporting positive experiences associated with home schooling, it remains challenging for many parents and their children. Supports for parents and children engaged in home schooling should provide clear and flexible guidance on how to balance schoolwork with other competing demands, assist parents who lack confidence in supporting their children's remote learning, and address risks associated with social isolation.

A framework for involving coproduction partners in research about young people with type 1 diabetes.

BACKGROUND: Involvement of end-users in research can enhance its quality, relevance, credibility and legitimacy; however, the processes through which these changes occur are unclear. Our aim was to explore a coproduction research team's experiences of their involvement in research about young people with type 1 diabetes mellitus (T1DM). METHODS: Semi-structured interviews conducted with two young people with T1DM, two parents, one diabetes educator, one endocrinologist-scientist and one research-engineer explored experiences of coproduction research and its impact on both the research and the participants. Drawing on grounded theory, we undertook inductive analysis and storyline mapping to develop a theorized framework of mechanisms supporting the process of coproduction in T1DM research with young people. FINDINGS: The framework involving coproduction partners in research about young people with type 1 diabetes centres on the unique expertize that different team members bring to the research and describes conditions that enable expert contributions through the enactment of a variety of expert roles. The framework also describes outcomes-the impact of the expert contributions on both the research and the team members involved. CONCLUSION: The findings of this small exploratory study provide a sound foundation to develop further understanding about structures and processes that are integral for the success of coproduction research teams. The framework may provide a guide for researchers planning to incorporate coproduction, on elements that are important for this model of research to succeed. It may also inform coproduction impact assessment research and be used for hypothesis testing and expansion in future studies.

Cause or symptom? A longitudinal test of bidirectional relationships between emotion regulation strategies and mental health symptoms.

Previous work has generally conceptualized emotion regulation as contributing to mental health outcomes, and not vice versa. The present study challenges this assumption by using a prospective design to investigate the directionality of underlying relationships between emotion regulation and mental health in the context of a major population-level stressor. We surveyed a large nationally representative sample of adults (18-91 years, N = 704) at three 1-month intervals across the acute lockdown phase of the COVID-19 pandemic in Australia, using standardized measures of depression and anxiety symptoms. At each time point, we also measured the use of two emotion regulation strategies-cognitive reappraisal and emotional suppression-previously associated with adaptive and maladaptive mental health outcomes, respectively. We found cognitive reappraisal was unrelated to mental health symptoms. In contrast, greater emotional suppression was robustly associated with higher symptom levels for both depression and anxiety. Longitudinal analyses revealed this association reflected bidirectional relationships. Higher symptoms of depression and anxiety each predicted greater subsequent use of emotional suppression, and greater use of emotional suppression predicted higher subsequent symptoms. This bidirectionality suggests emotional suppression is both symptomatic and predictive of psychological distress. The lack of a relationship for cognitive reappraisal is discussed with respect to the pandemic context and evidence that high stress might reduce people's ability to use this strategy effectively. Given the strong emphasis on reappraisal in clinical practice, there is a critical need to understand for whom, what and when this strategy is helpful. (PsycInfo Database Record (c) 2021 APA, all rights reserved).