Simon Denny

ObjectiveTo evaluate changes in mental health symptoms, wellbeing, recovery, and emotion regulation among young people receiving care in a recovery-oriented inpatient unit and day programme.MethodsThis is a prospective observational longitudinal cohort study of young adults aged 16-25 years assessed at baseline, 3 months, and 6 months. Measures included the Depression Anxiety Stress Scales-21 item version, Difficulties in Emotion Regulation Scale, Interpersonal Emotion Regulation Questionnaire, Recovery Assessment Scale-20 item version, and WHO-5 Wellbeing Index. Lifestyle and psychosocial factors were assessed.ResultsSeventy participants were enrolled; 71.4% were female and 52.9% aged 17-19 years. Significant reductions in depressive symptoms were observed, with DASS-21 Depression scores decreasing from 26.3 at baseline to 20.5 at 6 months (p = .04). Emotion regulation difficulties improved significantly, with DERS-16 scores decreasing from 58.9 to 53.5 (p = .02). Recovery scores and wellbeing showed positive but non-significant trends. Positive changes were observed in outdoor activity, physical activity, diet quality, and perceived social support.ConclusionsThis study provides preliminary evidence that a tailored, recovery-oriented inpatient and day programme model is associated with reduced depressive symptoms and improved emotion regulation among young adults with mental health concerns. These findings support further evaluation of youth-specific, recovery-oriented mental health services.

New Zealand research on inequities in children's developmental health outcomes is sparse. We aimed to describe the prevalence, clustering, and socio‐environmental associations of developmental health in preschool‐aged children. A latent profile analysis was performed using data from child participants of Growing Up in New Zealand at age 4.5‐years to identify profiles of developmental health status. Seven measures were included in the latent profile analysis, representing four domains of developmental health: ‘physical’, ‘motor’, ‘socioemotional and behavioural’, and ‘communication and learning’. Multinominal logistic regression was used to investigate socio‐environmental associations of latent profile membership. Six latent profiles were identified ( N = 6109), including three healthy/flourishing profiles: ‘healthy’ (52.6% of the sample), ‘early social skills flourishing’ (14.5%), and ‘early learning skills flourishing’ (4.0%); and three suboptimal profiles: ‘early learning skills difficulties’ (19.5%), ‘physical health difficulties’ (5.6%), and ‘developmental difficulties cluster’ (3.7%). Children experiencing socioeconomic disadvantage, of Māori or Pacific ethnicity, and with unmet healthcare needs had increased odds of being classified to suboptimal developmental health profiles. In this large, diverse cohort, one‐in‐four children were classified as having suboptimal developmental health. Addressing inequities in developmental health is crucial to improving health over the life course.

Aim: The current study describes food‐purchasing behaviours of healthcare staff, determines whether purchasing food at work is associated with overall indicators of healthy eating, and explores opportunities for improving the hospital food environment.Methods: A secondary analysis of a health and wellbeing survey of healthcare workers (n = 501) in Queensland, Australia. Multiple regression models describe the associations between food purchases and indicators of healthy eating, while controlling for age, gender and work role.Results: More than 60% of staff purchased food/drinks at work in the past week, and this was inversely associated with indicators of healthy eating. For example, among those purchasing food/drinks at work on most days, only 18% reported their overall diet as excellent or very good, compared to 50% of those who do not purchase food/drink at work (odds ratio [OR] = 0.24; 95% confidence interval [CI] = [0.12,0.48] in adjusted models). Staff feedback prioritised strategies to make healthy meals more accessible and affordable.Conclusion: Improvements to the retail food environment in hospitals could have a positive impact on the overall nutritional wellbeing of staff.

Objective: To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared.Design: Data were from a nationally representative health survey.Setting: Secondary schools in New Zealand, 2012.Participants: A total of 7769 students, 9 % were SGM individuals.Results: Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96).Conclusions: SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.

Objective: Our aim is to examine the unbiased association between use of school‐based health services (SBHS) and student health outcomes.Data Sources: Data are from a nationally representative health and well‐being survey of 8500 New Zealand high school students from 91 high schools.Study Design: Student data were linked to the level of SBHS available to them: no SBHS, regular clinics from visiting health professionals, a health professional onsite, or a health team onsite.Data Collection/Extraction Methods: Causal analyses are used to compare utilization of SBHS and their association with student‐reported health outcomes, including foregone health care, depressive symptoms, emotional and behavioral difficulties, suicide risk, substance use, and unsafe sexual behaviors.Principal Findings: Results from the multinomial propensity score–weighted regressions show that the use of SBHS was associated with poorer health outcomes, suggesting that selection bias was present due to unmeasured confounders. Instrumental variable analyses found that that students using team‐based SBHS had a 4.7 percent (95% CI 0.5‐8.9) probability of high levels of depressive symptoms compared to 14.2 percent (95% CI 11.5‐16.8) among students not using team SBHS. For suicide attempt, students using team‐based SBHS had a 2.0 percent (95% CI −0.3‐4.2) probability of a suicide attempt in the previous 12 months compared to 5.6 percent (95% CI 2.6‐8.5) among students not using team SBHS.Conclusions: These analyses suggest that team‐based SBHS are associated with better mental health among students who attend them.

Objective: School-based health services (SBHS) have been shown to improve access to mental health services but the evidence of their effectiveness on students’ mental health is lacking. Our objective was to examine associations between variation in the provision of SBHS and students’ mental health. Methods: A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted in March–November 2012. Students’ mental health is related to data on school health services obtained from clinic leaders and clinicians from 90 participating high schools. Results: After adjustment for socio-demographic differences in students between schools, increasing levels of services were associated with progressively lower levels of student-reported depressive symptoms (p = 0.002), emotional and behavioural difficulties (p = 0.004) and suicidality (p = 0.008). Services with greater levels of nursing hours (p = 0.02) and those that performed routine, comprehensive psychosocial assessments (p = 0.01) were both associated with lower levels of student-reported depressive symptoms. Greater levels of nursing hours and doctor hours were associated with lower self-reported suicidality among students. Conclusions: Although a causal association between school-based health services and students’ mental health cannot be demonstrated, these findings support the benefit of such services and the need for a cluster randomized trial.

Purpose: To examine whether there is an association between students self-reported suicide attempts and non-suicidal self-injury and exposure to suicidal behaviour among friends, family members or within school communities. Methods: A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted from March through November 2012. Students’ self-reported suicide attempts and repeated non-suicidal self-injury was examined in relation to student reports of self-harming behaviour among friends and family as well as data from school administrators of completed suicides within the school community. Results: Almost 1 in 20 (4.5%) students reported a suicide attempt in the last 12 months and 7.9% reported repeated non-suicidal self-injury in the last 12 months. The risk of both suicide attempts and repeated non-suicidal self-injury was highest among females, students from homes with economic deprivation and among students reporting an episode of low mood in the previous 12 months. Students exposed to suicide attempts or completed suicide among friends and/or family members were at increased risk of reporting attempted suicide and repeated non-suicidal self-injury in the last year. There was no association between completed suicide in school community and students self-reported suicide attempts or repeated non-suicidal self-injury. Conclusions: Low mood and exposure to suicide attempts of friends and family members are associated with suicide attempts and repeated non-suicidal self-injury in New Zealand high school students. This research highlights importance of supporting adolescents with low mood and exposed to suicide of friends and family.

This study explores the association between neighbourhood opportunities for Positive Youth Development (PYD) and adolescent depressive symptoms, well‐being and suicide risk. A 2‐stage random sample of 8500 students(years 9–13) from 91 high schools from throughout New Zealand was collected in 2012. Analyses were restricted to neighbourhoods with more than 10 students resulting in a final sample of 5191 adolescents within 266 neighbourhoods. Multilevel models linked data from neighbourhoods to individual student data to explore the association between neighbourhood opportunities for PYD and student depressive symptoms, well‐being and suicide risk. Neighbourhoods with a high proportion of students involved in activities that help others, attend church groups, or participate in sports teams were associated with significantly increased well‐being among students living in these neighbourhoods. No neighbourhood‐level measures were found to significantly alter rates of depressive symptoms or suicide risk. Findings suggest that providing neighbourhood opportunities for PYD may enhance adolescent well‐being.