Academic Stress Interventions in High Schools: A Systematic Literature Review.

The experience of academic stress is common during high school and can have significant negative consequences for students' educational achievement and wellbeing. High school students frequently report heightened levels of school-related distress, particularly as they approach high-stakes assessments. Programs designed to reduce or prevent academic stress are needed, and their delivery in school settings is ideal to improve treatment access. The current review aimed to examine the effectiveness of high school-based programs in reducing or preventing academic stress. A systematic search returned 31 eligible studies across 13 countries. Programs were categorised according to intervention type, format, and facilitator. Results showed that the methodological quality of most studies was poor, and many used an inactive control group. As predicted by theories of academic stress, the strongest evidence was for programs grounded in cognitive-behavioural therapy (CBT). There was evidence that both universal and targeted approaches can be beneficial. The unique implementation issues for these two formats are discussed. Most programs were delivered by psychologists and were generally effective, but almost all of these were CBT programs. A smaller proportion of programs delivered by teachers were effective. Therefore, future studies should evaluate the implementation success of programs to improve the rate of effective delivery by school staff. Overall, the field will benefit from more randomised controlled trials with comparisons to active control groups, larger sample sizes and longer-term follow-ups.

Acceptability and Feasibility of Stepped-Care for Anxious Adolescents in Community Mental Health Services: A Secondary Analysis.

Initial research suggests stepped-care approaches to therapy for youth anxiety is associated with reduced therapy time with similar therapeutic outcomes to treatment-as-usual in real-world settings. Research on the acceptability and feasibility of stepped-care approaches in routine practice is very limited. In a secondary analysis of a pilot randomised controlled trial that compared stepped-care to treatment-as-usual in adolescent mental health services, we examine acceptability and feasibility from consumer and clinician perspectives. Fifteen adolescents and ten clinicians provided brief quantitative and qualitative feedback. Some benefits were noted and these related to improved access to treatment; however, major barriers were also noted. Concerns related to the lack of consumer and clinician choice and flexibility in delivery of stepped interventions, challenges engaging adolescents with internet interventions and associated guided telephone calls, and workplace issues. Systemic changes to facilitate consumer preferences, clinician flexibility and staffing are needed for stepped-care to be feasible in routine care.

Teachers use of fear appeals: Association with student and teacher mental health.

BACKGROUND: Fear appeals are discourses commonly used by teachers to motivate students especially when academic outcomes are paramount. Fear appeals have been associated with better and worse academic performance by the student recipients, with some evidence that fear appeals are detrimental for students who are anxious and have lower self-efficacy. Little is known about the factors that drive teachers' use of fear appeals beyond a desire to increase motivation to excel. AIMS: This study examined the relationship between the use of fear appeals, psychological distress, and self-efficacy in both teachers and students. SAMPLE: Participants were 377 students (81% female, age range 15 to 18, M = 16.68, SD = 0.49) and 96 teachers (73% female, Mean years teaching = 18.04, SD = 12.39). METHODS: Participants completed surveys mid-way through the first school term of their final year of high school. Student surveys examined student anxiety, depression, stress, self-efficacy, and experience of teacher fear appeals. Teacher surveys examined teacher anxiety, depression, stress, emotional burnout, self-efficacy, years of teaching, and use of fear appeals. RESULTS: Teachers use of fear appeals was associated with student distress which was heightened for students with lower academic self-efficacy. Similarly, teachers' use of fear appeals was associated with higher anxiety and lower self-efficacy in teachers themselves. CONCLUSIONS: Therefore, the use and consequence of fear appeals is strongly linked to both student and teacher self-efficacy and distress. Given the detrimental impacts of fear appeals on academic performance in vulnerable students, more research is needed on the consequences of fear appeals.

Tracking stress, depression, and anxiety across the final year of secondary school: A longitudinal study.

Levels of distress, which include stress, depression, and anxiety, are often heightened during the final year of secondary school and have been linked to major examinations that occur during this time period. However, relatively little is known about how these symptoms change over the course of the year or what moderates symptom severity. Using a longitudinal survey design, we tracked student outcomes and potential moderators (i.e., gender, test anxiety, self-efficacy, connectedness with peers, school and family, perceived use of fear appeals by teachers) associated with stress, depression, and anxiety once per term (i.e., 4 times total) over the final year of high school in seven Australian high schools. We hypothesised that student symptoms would increase over time and that symptom severity would be moderated by individual and environmental factors. Six hundred and thirty-eight unique students (M age = 16.95 years, SD = 0.56, range = 15-18 years, female = 474 [74.29%]) participated in at least one of the four surveys administered during each term of the final year of high school. Linear mixed models indicated that stress (d = 0.2) and anxiety (d = 1.7) increased over time. When all potential moderators of distress were entered into the full model, gender, test anxiety, emotional self-efficacy, and peer connectedness were all significant unique predictors of stress. Similar patterns were found for symptoms of depression and anxiety. Time 3 stress was predicted by unique variance in baseline stress, higher test anxiety, and academic self-efficacy. Overall distress increased over time and was moderated by gender, as well as by test anxiety, self-efficacy, and peer connectedness, which are areas that can then be targeted by interventions designed to maintain distress at optimum levels for wellbeing and academic performance.

Psychological stepped care for anxious adolescents in community mental health services: A pilot effectiveness trial.

Stepped-care (SC) interventions for treating adolescent anxiety have been shown to reduce therapy time and societal costs with similar therapeutic outcomes to best practice when applied in university clinics. This pilot study examined clinical- and cost-effectiveness of SC in two community mental health services. Fifty-three anxious adolescents (aged 12-18 years) were randomly allocated to SC or treatment as usual (TAU). Adolescent- and clinician-rated symptom severity and quality of life collected over time indicated SC used significantly less therapy time, with similar benefits in clinical effectiveness, waiting time and quality adjusted life years. Significant barriers limited engagement with early therapy steps.

Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVES: Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness. METHODS: Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later. RESULTS: Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up. CONCLUSIONS: CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective. CLINICAL IMPLICATIONS: CBT may be effective at reducing loneliness among older adults with depression and anxiety.

Intergenerational Programs May Be Especially Engaging for Aged Care Residents With Cognitive Impairment: Findings From the Avondale Intergenerational Design Challenge.

Intergenerational programs are an authentic way to engage elders in meaningful activity and report benefits to both elders and youth. The Avondale Intergenerational Design Challenge (AVID) randomly assigned small teams of technology students aged 13 to 15 years (total N = 59) to 1 of 24 aged care residents with a range of cognitive impairment. Students met with the resident 4 times over 15 weeks and ultimately crafted a personalized item for them. Students showed no change in self-reported attitudes to elders, empathy, or self-esteem post-AVID or at 3-month follow-up, compared to a 3-month within-subject control period pre-AVID. Compared to usual lifestyle activities, residents showed significant improvements in self-reported positive affect and negative affect after student visits and were observed to be significantly more engaged during visits, especially residents with greater cognitive impairment. The personal and guided nature of intergenerational programs may be especially effective in engaging elders with cognitive impairment in meaningful activity.

Autobiographical Memory and Imagining Future Personal Events: Event Specificity and Symptoms of Depression and Stress Following Exposure to an Analogue Trauma.

The aim of the present study was to investigate whether reduced autobiographical memory and future event specificity were associated with elevated depressive and stress symptoms immediately and 1 week following exposure to a trauma film. A non-clinical sample comprising 101 participants completed all phases of the study, which included the following: baseline tests of autobiographical memory and future event specificity; a diary recording intrusions of the film over a 7-day period; and self-report questionnaires assessing depressive, posttraumatic stress and ruminative symptoms 7 days following the trauma film viewing. Overgeneral autobiographical memory was significantly related to deficits in the specificity with which participants imagined future events. Participants who were more specific when remembering past and imagining future events reported less intrusions related to the trauma film over the 7-day period following the film; however, event specificity was not associated with depressive and stress symptoms 7 days later. These findings suggest that reduced past and future event specificity may play a role in the experience of intrusions following the experience of a stressful event.

Diversion of prescribed opioids by people living with chronic pain: results from an Australian community sample.

INTRODUCTION AND AIMS: There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible diversion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community sample of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others. DESIGN AND METHODS: Participants living with chronic non-cancer pain and prescribed opioids for their pain (n=952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication. RESULTS: Participants had been living with pain for a mean of 14.2 years; most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2-5 opioids; the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person; one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95-0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45-2.17), including tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early. DISCUSSION AND CONCLUSION: Few people with chronic non-cancer pain divert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups divert prescription opioids to the illicit marketplace.

Reduced goal specificity is associated with reduced memory specificity in depressed adults.

Models of autobiographical memory suggest a close association between memories, future imagination and setting specific personal goals. However this association has yet to be tested with depressed individuals. The aim of this study was to examine whether the specificity of remembering past and imagining future personal events is associated with the specificity of approach and avoidance goals in depressed individuals. Two samples comprising adults who met criteria for major depressive disorder (MDD; N=30) and adults who had no prior history or current depression (N=30) completed autobiographical memory and future event tests, and a personal goal task. In the depressed sample, the specificity with which participants remembered the past was significantly associated with the specificity with which they generated future goals. The depressed sample also elicited fewer specific approach and avoidance goals compared to the non-depressed sample. These findings suggest that an overgeneral memory deficit extends to impairments in goal specificity.