Anna Mankee-Williams

Background: Young people impacted by adverse childhood experiences (ACEs) are often underrepresented in mental health research. Aims: This paper aims to advance inclusive research on ACEs by 1) describing co-designed recruitment and engagement methods in a national project on ACEs (Attune), 2) characterising a highly marginalised cohort of young people using identity descriptors co­designed with participants, and 3) reporting associations between ACEs, identity characteristics and mental health outcomes. Methods: A trauma-aware approach to engage under-represented young people was co­developed with a national youth advisory group, lived experience researchers, and trusted community partners. Our co-created purposive sampling strategy recruited 74 young people, aged 10-24 years, across England, seeking representation by age, sex, gender identity, sexual orientation, ethnicity, neurodivergence, and geographic location. Participants completed validated self-report measures of ACEs, life events, and mental health. Descriptive, correlational and regression analyses examined cohort characteristics and associations between ACEs, identity characteristics, and mental health measures. Results: The final cohort included participants identifying as non-White British (39.5%), non- binary/other gender (25%), and neurodivergent (30%). Half of participants reported exposure to at least one ACE. Analyses identified patterns consistent with prior literature. In addition, ACEs and barriers related to being neurodivergent were associated with increased depression and anxiety symptom severity. Non-binary gender identity was associated with anxiety. We did not observe associations of ACEs or mental health measures, with sex or ethnicity. Conclusions: Under-represented groups can be reached via co-created engagement methods informed by lived experience. We identified important associations between ACEs, identities, and mental health outcomes.

Globally in 2021, about 1 in 4 children and young people (CYP) below age 25 lived with poor mental health. Various forms of digital health interventions (DHIs) have been introduced in attempts to address unmet mental healthcare needs among young people. DHIs use websites or applications in computers, tablets, or smartphones to deliver mental health interventions, which are either self-directed, or therapist guided. This rapid review synthesises the evidence on the cost-effectiveness of DHIs for supporting mental health in CYP. A literature search was carried out in MEDLINE and PsycINFO using Ovid platform. The search was restricted to peer-reviewed studies published in English between Jan 2018 to May 2025. Eligible studies were identified using the population, intervention, comparator, outcome, and study design (PICOS) framework. Studies were eligible for inclusion if they provided a trial- or model-based full economic evaluation or return on investment of a DHI targeting mental health in CYP up to 25 years of age. Titles and abstracts of 1,265 records were screened. 15 studies met the criteria for inclusion following full-text screening of 28 studies. The focal outcomes in the studies included reduction in symptoms linked to depression, anxiety, and alcohol use. Most studies evaluated computerised cognitive behaviour therapy (CBT) or interventions that included aspects of CBT as the primary intervention. All studies except two reported the DHIs to be cost-effective, at least under certain conditions. Two model-based and three trial-based studies reported that the interventions were dominant (cost saving and more effective) with respect to at least one outcome measure. There is some evidence to suggest DHIs hold the potential to expand and extend mental health support for CYP with minimal therapist involvement. Yet, the evidence is not conclusive due to short follow-up periods, variability in the methodological approaches and reporting of results. High quality evidence on cost-effectiveness of DHIs with comparable methodological approaches is needed to inform implementation decisions.

Adverse childhood experiences (ACEs) can harm mental health across the lifespan and reduce life expectancy. We provide a commentary of evidence on the health impacts, and how creative arts and digital interventions may support prevention and recovery.

Conducting research in care homes is difficult, and research originating from care homes is lacking. This article provides reflective insights into the determinants that affect research engagement among UK care home staff. The Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour has been used to structure and explore our reflections relating to time, funding and skills. Our reflections suggest that wider determinants influence research engagement among care home staff and that a culture of research within care homes remains in its infancy. Our reflections highlight that more needs to be done to enable and empower care home staff to engage in research. Conducting research in care homes is difficult, and research originating from care homes is lacking. This article provides reflective insights into the determinants that affect research engagement among UK care home staff. The Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour has been used to structure and explore our reflections relating to time, funding and skills. Our reflections suggest that wider determinants influence research engagement among care home staff and that a culture of research within care homes remains in its infancy. Our reflections highlight that more needs to be done to enable and empower care home staff to engage in research.

The use of digital technology has become increasingly commonplace within the United Kingdom, with many public services, including healthcare, becoming ‘digital by default’ in response to COVID-19 pandemic and pledged government objectives. Digital healthcare delivery has shown to be a beneficial mode of delivery, yet it is unclear whether the benefits of digital healthcare are experienced evenly throughout society. Individuals from lower income households, individuals residing in areas with poor digital infrastructure, and individuals without adequate digital skills are at risk of being excluded from digital healthcare. It is imperative that the determinants of digital inequality are addressed to ensure that vulnerable members of society can assess healthcare that is increasingly being delivered digitally. To achieve this, stakeholders spanning many sectors should collaborate to understand and address the impact that digital inequality has upon health inequality.

Context: Participatory arts‐based methods such as photovoice, drama and music have increasingly been used to engage young people who are exposed to psychosocial risks. These methods have the potential to empower youth and provide them with an accessible and welcoming environment to express and manage difficult feelings and experiences. These effects are, however, dependent on the way these methods are implemented and how potential ethical concerns are handled.Objective: Using the current literature on arts‐based health research as a foundation, this paper examines ethical issues emerging from participatory arts methods with young people with traumatic experiences.Results: We present a typology covering relevant issues such as power, accessibility, communication, trust and ownership, across the domains of partnership working, project entry, participation and dissemination. Drawing on our extensive clinical and research experiences, existing research and novel in‐practice examples, we offer guidance for ethical dilemmas that might arise at different phases of research.Conclusion: Adequate anticipation and consideration of ethical issues, together with the involvement of young people, will help ensure that arts methods are implemented in research and practice with young people in a fair, meaningful and empowering way.Patient or Public Contribution: The issues reviewed are largely based on the authors' experience conducting participatory research. Each of the projects referenced has its own systems for PPI including, variously, consultations with advisory groups, coproduction, youth ambassadors and mentor schemes. One of the coauthors, Josita Kavitha Thirumalai, is a young person trained in peer support and has provided extensive input across all stages.