Alimila Hayixibayi

Background: Self-directed digital mental health programs can increase access to evidence-based interventions for child anxiety. However, there has been little comprehensive investigation of real-world dissemination, especially using implementation science approaches. Objective: This study aimed to describe and comprehensively assess the implementation of the BRAVE Self-Help program for child and adolescent anxiety in Australia over a 10-year period, including implementation strategies during establishment and sustainability phases and implementation-effectiveness outcomes. Methods: This study was a large, open implementation-effectiveness trial involving Australian child and adolescent participants in the BRAVE Self-Help Program, conducted between January 1, 2015, and December 31, 2024. Implementation strategies were reported descriptively across program establishment and sustainability phases. Implementation and effectiveness outcomes were reported across 10 years, in line with the implementation outcomes framework (IOF) and taxonomy of implementation outcomes for digital interventions. Metrics included adoption, penetration, appropriateness, fidelity, feasibility, acceptability, and effectiveness. Results: Over the 10-year period, the BRAVE Self-Help program had 53,726 users, including 28,700 children (mean age 9.36, SD 1.40 years) and 25,026 adolescents (mean age 14.15, SD 1.62 years). Data revealed a wide variety of user characteristics in terms of age, gender, geographical location, baseline severity, and referral sources (community, health, and education settings). Improvement in anxiety symptoms from first to last interaction with the program was observed for participants in general, particularly among those with elevated anxiety at program registration ( P <.001; Cohen d =0.54). Of all users completing the registration assessment, 38.72% (20,026/51,721) completed 3 or more of the 10 sessions, with consistent moderate to high satisfaction rates across all sessions. Conclusions: This study demonstrated that a self-help digital program for child and adolescent anxiety can be successfully disseminated nationally, and that it is feasible, acceptable, and effective for many young people. During a span of 10 years, the BRAVE Self-Help program for child and adolescent anxiety offered evidence-based support to more than 50,000 families. Notably, although progress through sessions was low for some young people, significant improvements could be made in as few as 3 sessions, and decisions to stop treatment occurred for many reasons, including treatment success.

This study examined the links between adolescents' levels of conflict with family members, schoolteachers and their peers, and sense of school connection with the presence of clinical levels of anxiety among Chinese adolescents. Moreover, this study explored whether gender and school grade moderated these associations. A total of 6,576 adolescents (aged 10-19) participated in a cross-sectional survey in Shenzhen, China. Participants completed a series of questionnaires where they self-reported their anxiety levels, conflict with family members, schoolteachers and peers and sense of school connectedness, and demographics. Using logistic regression analysis to look at the links between conflictual relationships, level of school connectedness and adolescents' anxiety explored. Conflicts with family members such as mothers, fathers, schoolteachers, and their peers were related to higher risk of clinical levels of anxiety, while higher perceived school connection was linked with less clinical levels of anxiety. Gender did not moderate these associations. However, school grade moderated the associations of conflict (i.e. father-child quarrelling, mother's usage of emotional abuse, quarrelling with schoolteachers, teachers' physical abuse, quarrelling and fighting with peers, and peers' emotional abuse) with anxiety among Chinese adolescents, the links being stronger in younger adolescents than older adolescents. Our findings suggest that school grade can be a moderator of the links between levels of conflict and adolescent anxiety. Future longitudinal studies should include school grade as a moderator when identifying the potential predictors for adolescents' anxiety.

BACKGROUND Self-directed digital mental health services can increase access to evidence-based interventions for child anxiety. However, there has been little comprehensive investigation of real-world dissemination especially utilizing implementation science approaches. OBJECTIVE To describe and comprehensively assess implementation of the BRAVE Self-Help program for child and adolescent anxiety in Australia over a 10-year period, including implementation strategies during establishment and sustainability phases and implementation-effectiveness outcomes. METHODS This study was a large, open implementation-effectiveness trial with Australian child and adolescent participants of the BRAVE Self-Help Program, collected between January 1, 2015, and December 31, 2024. Implementation strategies were reported descriptively across program establishment and sustainability phases. Implementation and effectiveness outcomes were reported across 10 years, in line with the Implementation Outcomes Framework (IOF) and taxonomy of implementation outcomes for digital interventions. Metrics include Adoption, Penetration, Appropriateness, Fidelity, Feasibility, Acceptability and Effectiveness. RESULTS Examples of implementation strategies included targeted promotion and education strategies across academic, professional and community settings, a focus on geographical areas with low service accessibility, provision of easy-to-access resources and support for common challenges, targeting education contexts, and continuous data-driven and user-informed improvement. Over the 10-year period, the BRAVE Self-Help program had 53,726 users, including 28,700 children (mean 9.36, SD 1.40 years) and 25,026 adolescents (mean 14.15, SD 1.62 years). Data revealed a wide variety of user characteristics in terms of age, gender, geographical location, baseline severity, and referral sources (community, health and education settings). Improvement in anxiety symptoms from first to last interaction with the program was observed for participants in general, particularly among those with elevated anxiety at program registration (P <.001, Cohen d=0.54). Of all users completing the registration assessment, 38.72% (20,026/51,721) completed 3 or more of the 10 sessions, with consistent moderate to high satisfaction rates across all sessions. CONCLUSIONS This study demonstrated that a self-help digital program for child and adolescent anxiety can be successfully disseminated nationally, and that it is feasible, acceptable and effective for many young people. During a span of 10 years, the BRAVE Self-Help program for child and adolescent anxiety offered evidence-based support to more than 50,000 families. Notably, although progress through sessions was low for some young people, significant improvements can be made in as few as three sessions, and decisions to stop treatment may occur for many reasons, including treatment success.

Previous reviews suggest that child maltreatment results in worse depression symptoms during adolescence and young adulthood. However, less is known about how depression symptoms evolve throughout this critical period. This systematic review evaluates changes in depression following child maltreatment and identifies factors influencing this relationship from adolescence to young adulthood. A search of APA PsycINFO, CINAHL, Embase, and Medline until January 13, 2023, found 87 studies from 31,495 records. Studies were included if they examined child maltreatment’s effect on depression symptoms for individuals aged 0 to 24, assessed child maltreatment or abuse, and neglect subtypes, measured depression diagnosis or symptoms at a subsequent time point, and used quantitative longitudinal or cohort designs. Of the studies meeting criteria, only 13 examined depression symptom changes, with mixed results found. Most studies identified severe and worsening depression symptom trends, as shown in both linear and nonlinear depression symptom studies. Other studies examined distinct patterns of depression symptom severity within a single sample (e.g., high vs. low symptom trends) and observed some improvements over time, suggesting the influence of protective factors. However, across all studies, depression symptoms remained relatively worse than in individuals without child maltreatment histories. One-third of studies explored factors influencing depression symptom change, primarily focusing on intrapersonal and interpersonal factors, though findings were inconsistent. A smaller subset investigated environmental factors, demonstrating that school-related aspects consistently impacted the relationship. Findings highlight the importance of early detection and timely intervention through continuous screening to improve depression outcomes for adolescents with child maltreatment histories.

This PhD explored a range of psychosocial risk factors for adolescent problematic internet use (PIU). A survey was conducted among 6552 adolescents (aged 10-19 years) in Guangdong, China. The findings suggest that adolescents experiencing less warmth, and more conflict from parents, teachers and peers are more likely to experience PIU, with these associations mediated by mental health concerns including conduct problems and school anxiety. Therefore, this PhD highlights that to reduce PIU, improving the quality of family and school relationships can be an important pathway, as well as adolescents’ mental health, with targeted school and family-based prevention and intervention programs.

Background: Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs. Objective: This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU. Methods: A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents’ parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations. Results: Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively). Conclusions: These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents.

BACKGROUND Problematic internet use (PIU) is prevalent amongst Chinese adolescents. There is a need to better understand how parent-adolescent relationship quality is associated with adolescent PIU to guide the development of effective prevention and early intervention programs. OBJECTIVE This study aimed to examine parent-adolescent conflict and parental bonding as potential factors associated with adolescent PIU. METHODS A sample of 6552 students (age 10 to 19 years) from 22 schools in Guangdong, China, was recruited. Participants completed questionnaires measuring conflict (involving verbal conflict, emotional abuse, and physical abuse) and parental bonding with parents, and PIU. RESULTS Multiple regression analyses found that greater mother-adolescent conflict and father-adolescent conflict, and lower levels of parental bonding were associated with higher levels of PIU. The association of mother-adolescent conflict with PIU was stronger in older students than younger students, while the association of father-adolescent conflict with PIU was stronger in male students than female students. Compared to those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU. Compared to those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse and physical abuse from their fathers were subject to significantly higher levels of PIU. CONCLUSIONS These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse and physical abuse and to increase parental bonding to lower the risk of PIU in Chinese adolescents.

The potential for adolescent mental health problems arising from heavy internet use is significant. There is a need to better understand the risk and protective factors related to problematic internet use (PIU) amongst adolescents. This study examined the role of adolescents’ perceptions of school-based relationships as potential contextual antecedents to problematic internet use. Specifically, 6552 adolescent students (55.9% boys, 13.51 ± 2. 93 years) from 22 primary and middle schools in southern China completed questionnaires to measure the degree of adolescent conflict with peers, teachers and other staff, school connectedness, perceived classroom atmosphere and problematic internet use. Self-reported data was collected using a two-level stratified sampling. Multiple regression analyses showed that conflict with peers and teachers was positively associated with higher levels of PIU, while school connectedness and perceived classroom atmosphere were negatively associated with PIU. An interaction effect was found for conflict with peers and grade level, such that the association between conflict with peers and PIU was stronger for secondary students compared to primary school students. The results support the need for school-based interventions for PIU to include a focus on conflict with peers and teachers, and for a focus on the enhancement of school connectedness and classroom atmosphere.

This study examined the associations of interpersonal conflict and school connectedness with depressive symptoms in Chinese adolescents. A cross-sectional study was conducted among 6576 adolescents in Shenzhen, China. Participants completed a battery of questionnaires that assessed adolescents’ depressive symptoms, conflict with parents, teachers, and peers, school connectedness, and demographics. Multiple linear regression analysis was used to explore the association of interpersonal conflict and school connectedness with depressive symptoms in adolescents. Results showed that conflicts with their mother, father, teachers, and peers were associated with higher levels of depressive symptoms in adolescents, while greater school connectedness was related to lower levels of depressive symptoms in adolescents. Gender proved to be a moderator of these relationships in that the associations of quarreling with mothers, mothers’ use of emotional punishments, teachers’ use of emotional punishments, and school connectedness with depressive symptoms were stronger in females than males. Moreover, grade level proved to be another moderator, with the associations of teachers’ use of physical punishment and fighting with peers with depressive symptoms being stronger in primary school students than in secondary school students. Our findings suggest that gender and grade level moderated the association of interpersonal conflict and school connectedness with depressive symptoms in Chinese adolescents.