Emily Klineberg

Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London

This paper investigates the extent to which social support can have a buffering effect against the potentially adverse consequences of bullying on school achievement and mental health. It uses a representative multiethnic sample of adolescents attending East London secondary schools in three boroughs. Bullied adolescents were less likely to achieve the appropriate academic achievement benchmark for their age group and bullied boys (but not girls) were more likely to exhibit depressive symptoms compared to those not bullied. High levels of social support from family were important in promoting good mental health. There was evidence that high levels of support from friends and moderate (but not high) family support was able to protect bullied adolescents from poor academic achievement. Support from friends and family was not sufficient to protect adolescents against mental health difficulties that they might face as a result of being bullied. More active intervention from schools is recommended.

Longitudinal Risk Factors for Persistent Fatigue in Adolescents

OBJECTIVE To examine whether sedentary behavior, obesity, smoking, and depression are risk factors for persistent fatigue in adolescents. DESIGN Longitudinal population-based survey. SETTING Twenty-eight randomly selected schools in east London, England, in 2001 and 2003. PARTICIPANTS A total of 1880 adolescents (49% male; 81% nonwhite British) aged 11 to 12 years and 13 to 14 years in 2000. INTERVENTION Confidential questionnaires completed in class. MAIN OUTCOME MEASURES Persistent fatigue (extreme tiredness twice weekly or more often in the previous month at both surveys), sedentary behavior, physical activity, depressive symptoms, body mass index, and smoking. RESULTS Severe fatigue was reported in 11% of participants aged 11 to 14 years and 17% of participants aged 13 to 16 years. Eighty-four participants (4%) reported persistent fatigue. Across both surveys, only 3 pupils reported chronic fatigue syndrome. In multivariate logistic regression, risk of persistent fatigue was independently associated with being sedentary for more than 4 hours per day (odds ratio = 1.6; 95% confidence interval, 1.1-2.3; P = .01), being physically active (odds ratio = 1.5; 95% confidence interval, 1.1-2.3; P = .004), and depressive symptoms (odds ratio = 2.0; 95% confidence interval, 1.5-2.7; P < .001) in the first survey, after adjustment for age, sex, and socioeconomic status. Obesity and smoking were not associated with fatigue. CONCLUSIONS Persistent fatigue is common. Being highly sedentary or highly active independently increased the risk of persistent fatigue, suggesting that divergence in either direction from healthy levels of activity increases the risk for persistent fatigue. Mental health is important in the etiology of persistent fatigue. To help define effective preventive strategies, further work is needed on the mechanisms by which these factors contribute to fatigue.

Symptom recognition and help seeking for depression in young adults: a vignette study

PurposeMany young people with psychological problems do not seek help. Recognition of problems and knowledge of appropriate sources of help may increase the likelihood of help seeking. This study aimed to explore whether young adults recognised depressive symptoms in a vignette, and how they thought a young person might respond to these symptoms.MethodsA postal survey was sent to 3,004 young people aged 16–24 in SW England. The survey included a two-part vignette; the first part depicted mild depressive symptoms, and the second part depicted severe depressive symptoms. Open-ended questions exploring symptom recognition and illness behaviour were answered by 1,125 respondents.ResultsSevere depressive symptoms were recognised by 61.4% of respondents. Young men, particularly those from deprived backgrounds were less likely than women to recognise a mental health problem. Men were also less likely to suggest seeing a doctor than women. 64.7% of the respondents who recognised a mental health problem suggested seeing a doctor, however, only 16.4% thought a severely depressed person actually would see a doctor.ConclusionsWhilst the majority of young people recognised symptoms of severe depression, the gap between perceived options for help and proposed help seeking behaviour is clinically relevant. The sociodemographic groups at greatest risk of suicide are the least likely to recognise depression, highlighting a need to develop interventions targeting men, particularly those from deprived backgrounds.

The health diagnoses of homeless adolescents: a systematic review of the literature.

BACKGROUND Homelessness during adolescence impacts negatively upon young peoples physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. METHODS We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. RESULTS Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. CONCLUSION Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.

Determinants of successful clinical networks: the conceptual framework and study protocol.

BackgroundClinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovations non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks.Methods/DesignThe objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each networks initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks.DiscussionThis is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks.

Acculturation and health status among African-Caribbean, Bangladeshi and White British adolescents--validation and findings from the RELACHS study.

ObjectiveThis paper reports the validation process for research questions that measure cultural identity in a survey of adolescents from a multi-ethnic urban area.MethodFour questions that tapped preferred cultural origins of friends and clothing were used to classify subjects into categories for cultural identity described by Berry (1980). We assessed face, content and construct validity of these questions by: i) investigating the meaning of cultural identity from an African-Caribbean, Bangladeshi, and White British perspective in three focus groups; ii) asking participants to comment on the questions and their suitability for studies of cultural identity; and iii) using data from the Research with East London Adolescents: Community Health Survey (RELACHS) study of adolescents to test hypotheses about associations of acculturation with health outcomes (physical and mental) in order to assess whether these trends are consistent with previous research, and are in accord with trends predicted by the Berry model.ResultsQuestions about the cultural origins of friends and clothing showed good face and content validity. However, only the questions on friendship choices showed some associations in the predicted directions, with some associations that were unexpected. The most significant findings were that, in comparison with marginalised pupils, for African-Caribbean pupils assimilation was associated with more tiredness (OR=40.7, 3.8–432.8,p<0.001) and traditionalism with less obesity (OR=0.1, 0.02–0.5, p<0.001). For Bangladeshi pupils integration was associated with a lower risk of depression (OR=0.4, 0.2–0.8, p<0.001).ConclusionQuestions on friendship choices can be used to assess cultural identity, but associations with health and health risk behaviours are different for each ethnic group.

Cultural identity, clothing and common mental disorder: a prospective school-based study of white British and Bangladeshi adolescents

Objective: Cultural integration is the healthiest outcome for young people living in multicultural societies. This paper investigates the influence of different cultural identities on the risk of common mental disorders among Bangladeshi and white British pupils. Design: The cultural identity of 11–14-year-old school pupils was assessed by their preferences for friends and clothes of their own or other cultural groups; using this information pupils were classified into traditional, integrated, assimilated or marginalised groups. We undertook prospective analyses of cultural identity and its impacts on the later mental health of young people. Setting: East London. Participants: In 2001, white British (573) and Bangladeshi (682) school pupils from a representative sample of schools completed a self-report questionnaire that assessed their cultural, social and health characteristics. In 2003, 383 white British and 517 Bangladeshi pupils were resurveyed and completed measures of mental health. Main outcome measure: Strengths and difficulties questionnaire. Results: Bangladeshi pupils preferring clothes from their own cultural group (traditional clothing) were less likely to have later mental health problems when compared with Bangladeshi pupils showing an equal preference for clothing from their own and other cultures (integrated clothing; odds ratio (OR) 0.3, 95% CI 0.1 to 0.9). In gender-specific analyses, this finding was sustained only among Bangladeshi girls (OR 0.1, 95% CI 0.1 to 0.7). Integrated clothing choices were least risky only for white British adolescents. Friendship choices showed no prospective associations with later mental health problems. Conclusions: Cultural identity, expressed by clothing preferences, influences mental health; the effects differ by gender and ethnic group.

Adolescent chronic fatigue syndrome and somatoform disorders: A prospective clinical study

To examine and compare the presenting characteristics and the change in the physical and psychosocial functioning of adolescents with chronic fatigue syndrome (CFS) or somatoform disorders who have received an adaptable multidisciplinary intervention over a 12‐month period.

What are the reasons for clinical network success? A qualitative study

BackgroundClinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success.MethodTen participants were interviewed using face-to-face, audio-recorded semi-structured interviews about critical factors for networks’ successes over the study period 2006–2008. Respondents were purposively selected from two stakeholder groups: i) chairs of networks during the study period of 2006–2008 from high- moderate- and low-impact networks (as previously determined by an independent review panel) and ii) experts in the clinical field of the network who had a connection to the network but who were not network members. Participants were blind to the performance of the network they were interviewed about. Transcribed data were coded and analysed to generate themes relating to the study aims.ResultsThemes relating to influential factors critical to network success were: network model principles; leadership; formal organisational structures and processes; nature of network projects; external relationships; profile and credibility of the network.ConclusionsThis study provides clinical networks with guidance on essential factors for maximising optimal network outcomes and that may assist networks to move from being a ’low-impact’ to ‘high-impact’ network. Important ingredients for successful clinical networks were visionary and strategic leadership with strong links to external stakeholders; and having formal infrastructure and processes to enable the development and management of work plans aligned with health priorities.

Addressing adolescent substance use in a paediatric health‐care setting

The aim of this study is to review the operation of a specialist adolescent drug and alcohol consultation liaison service in a tertiary paediatric hospital.