Paper Session 20: Mental Health

The transition from adolescence to emerging adulthood is a critical period of development which may have a profound and long-lasting impact on an individual’s health. The physical, affective, and cognitive changes which occur in emerging adulthood leave young people susceptible to experiencing negative mental health outcomes. Engaging in healthy behaviours such as being physically active, limiting screen time, not binge drinking, and avoiding tobacco and marijuana may help support positive mental health outcomes among emerging adults; however, there has been limited research on the synergistic role by multiple lifestyle behaviors on mental health during this developmental period. Utilizing data from the ADAPT cohort study (n = 493, 68.3% female, 15-18 years at baseline), this study analyzed the prospective relationship between self-reported levels of moderate-to-vigorous intensity physical activity, recreational screen time, sleep, binge drinking, tobacco smoking and marijuana use in adolescence and emerging adulthood with psychological distress and mental wellbeing assessed during emerging adulthood using latent profile and latent transition analysis. Three profiles were observed during adolescence, including the majority being classified as moderately active abstainers, 17% being classified as high screen users and 9% being classified as active partiers. During emerging adulthood, participants were relatively evenly split across the four profiles which included highly active moderate partiers (23%) moderately active moderate partiers (24%), inactive abstainers (31%), and inactive partiers (22%). Adolescents classified into the profile characterized by the healthiest patterns of lifestyle behaviors at baseline reported fewer symptoms of psychological distress during emerging adulthood compared to adolescents who were partiers, and better mental wellbeing than adolescents who were high screen users. Latent transition analysis showed that participants generally transitioned to a range of less healthy profiles during emerging adulthood. There was no significant difference in indicators of mental health among participants who transitioned from the healthiest profile in adolescents to various less healthy profiles as emerging adults. Collectively, these results highlight the need to support adolescents to engage in a range of healthy lifestyle behaviors to reduce psychological distress and promote mental wellbeing during their transition to emerging adulthood.

Author - Matthew Bourke,
The University of Queensland

Co-Author - Denver Brown, PhD, PhD,
Kansas State University

Co-Author - Matthew Kwan, PhD, PhD,
Brock University

BACKGROUND: Sexual and gender diverse young people (SGDY) experience significant mental health disparities compared to non-SGDY amidst the current political climate. SGDY are often overlooked in clinical research/practice, with limited evidence-based interventions available. This study tested Tuned In!, an affirmative mindfulness-based intervention to provide and foster culturally responsive coping skills and self-advocacy for SGDY. Tuned In! was co-developed with SGDY and utilizes elements of Mindfulness-Based Stress Reduction for Teens and Mindful Self-Compassion for Teens and teaches SGDY contemplative practices within a diverse LGBTQIA+ affirming context, promoting mental health, embodied cognition, and intersubjectivity.

METHODS: A pre/post-test design evaluated mental health outcomes among 56 diverse SGDY in the U.S. Tuned In! consists of eight weekly sessions facilitated by trained clinicians (e.g., psychologists, clinical social workers). Self-report measures (e.g., mindfulness, depression, self-compassion, etc.) were completed (baseline/post-intervention/6-months). Focus groups supported understanding feasibility and acceptability.

RESULTS: Significant improvements in all measures were found from pre/post/6-month follow-up, including decreased anxiety (β = -1.57, SE = 0.388, tt = -4.04, p<0.001), depression (β = -1.71, SE = 0.478, tt = -3.58, p<0.001), psychological distress (β = -6.76, SE = 2.51, tt = -2.69, p = 0.01), and increased sexual self-efficacy (β = 2.33, SE = 0.834, tt = 2.79, p = 0.01), self-compassion (β = 0.20, SE = 0.04, tt = 4.61, p<0.001), and mindfulness (β = 1.74, SE = 0.527, tt = 3.31, p = 0.001). Thematic analysis indicated high satisfaction/acceptability, and themes of interconnectedness, self-advocacy, joy, diversity, and kind connection to one’s body.

CONCLUSIONS: This study explored contemplative approaches to enhance mental health and intersubjective community spaces for SGDY. SGDY developed strategies to navigate the current anti-LGBTQIA+ socio-political context, develop compassionate awareness, improve anxiety, depression, distress, and enhance self-advocacy, joy, and community. High engagement and retention rates indicate feasibility and utility of Tuned In!. Follow-up research will scale up Tuned In! with larger samples and longitudinal design to assess the sustainability of outcomes over time.

Co-Presenter - Gio Iacono, PhD, LMSW, RSW,
University of Connecticut

Co-Presenter - Cindy Pan,
University of Pittsburgh

Background: In 2021, youth suicide became the second leading cause of death for ages 10 to 14. Medical problems are significant risk factors, however, the connection between sensory impairments or somatic problems and suicide remains unclear. While social vulnerabilities have been linked to increased adult suicide attempts, the role of social determinants of health (SDoH) in youth suicides, particularly among those with medical problems, is understudied.

Methods: We conducted latent class analysis on medical problems reported in the ABCD study (version 5.1), including 11,864 children aged 9 and 10 at baseline, followed through year 4 (2016-2022). Logistic regression assessed the association between class membership and suicide attempts, and chi-square analysis examined the relationship between medical problem class membership and SDoH classes. Sub-group analyses were performed using logistic regression and chi-square tests.

Results: Three classes were identified: Class 1: Asthma (n=2,033, 17.1%), Class 2: Somatic and Sensory Problems (n=947, 8%), and Class 3: No Medical Diagnosis (n=8,884, 74.9%). Both Classes 1 and 2 showed a higher likelihood of suicide attempts (ORs 1.38 and 1.90, respectively) compared to Class 3, after controlling for demographics. Class 1 had the highest proportion of children in socioeconomically deprived communities, characterized by pollution, extreme heat, food deserts, and poverty. Class 2 had the highest proportion of children in stigmatizing environments with high levels of racism, sexism, and homophobia. Further analysis of Class 2 showed that hearing and vision problems (ORs 2.99 and 2.04, respectively) were associated with a higher likelihood of suicide attempts compared to Class 3. High fevers, inpatient admissions, and antibiotic use were common in children with hearing problems, while developmental delay, prematurity, and prenatal substance exposure were frequent in those with vision problems.

Conclusion: We identified two youth medical profiles associated with increased suicide risk: asthma and somatic/sensory problems, particularly hearing and vision impairments. Chronic ear infections characterized hearing problems, while vision problems were linked to developmental issues, suggesting roles of infection, inflammation, and neurodevelopment in youth suicide. Neighborhood socioeconomic status and stigma may also contribute to suicide risk, necessitating tailored prevention strategies for at-risk youth.

Co-Author - Yunyu Xiao,
Weill Cornell Medicine

Background: Youth with heterogeneous/comorbid mental health diagnoses (HCMHD) are less likely to meet physical activity (PA) guidelines or have adequate sleep than peers without HCMHD. PA and sleep improve cognitive, behavioral and physical health; interventions to target both and tailored to engage youth with HCMHD are lacking. We tested GamerFit, a theory-based health coaching and exergaming intervention delivered via mHealth app for feasibility, acceptability, accessibility and preliminary efficacy to improve PA, sleep, perceptions of barriers and support, and mental health outcomes in this population. Methods: Teens ages 13-17 with HCMHD were randomized 1:1 to the 12-wk GamerFit intervention arm (GamerFit) or an active comparator arm (Fitbit) using single-blind design. GamerFit participants used the app and a Fitbit to follow a progressive exergaming and gamified step program that included motivational messages, exercise/health tip videos, and weekly telehealth coaching. Fitbit participants were given a Fitbit to track PA/sleep and given a booklet with PA/sleep tips. Intervention feasibility, acceptability, and accessibility were assessed using process data and parental/participant report; PA duration/intensity (actigraphy, self-report), sleep duration/quality (actigraphy, self-report), sleep hygiene, perceptions of social support, self-regulation, positive/negative affect, and global quality of life were measured at wks 0, 12 and 16. Results: 62 participants were randomized (15.0±1.5 avg age, 24% female-identifying, 21% non-white, 74% on medication). GamerFit averaged 88% coaching attendance, 34.8 min exergaming per/wk, and 8033 steps/day. Parental/participant perceptions of intervention acceptability and accessibility were high. Days/wk of PA increased significantly in GamerFit vs. Fitbit (diff 2.0±0.9, p=0.04); min/day of light PA increased but was not statistically significant (diff 15.5±23.7, p=.52). GamerFit significantly improved sleep hygiene, sleep quality, perceptions of barriers to exercise, emotional and informational support, affect, and reduced unhealthy days; Fitbit did not. GamerFit showed clinically meaningful improvements on all self-regulation sub-scales; Fitbit worsened or stayed the same. Conclusions: GamerFit is feasible, acceptable, accessible, and shows promise to improve PA, sleep quality, mental and physical health among teens with HCMHD. An effectiveness RCT should take place in a more racially/ethnically diverse population.

Presenter - April B. Bowling, MA, ScD, MA, ScD,
Merrimack College

Co-Author - Alyssa M. Button, PhD, PhD,
Pennington Biomedical Research Center

Co-Author - Robbie Beyl, PhD,
Pennington Biomedical Research Center

Co-Author - James Slavet, PhD,
Marblehead Family Counseling

Co-Author - Tara Daly, MS,
Merrimack College

Co-Author - Phillip Nauta, MA,
Pennington Biomedical Research Center

Co-Author - Peyton Murray,
Pennington Biomedical Research Center

Co-Author - Amanda E. Staiano, PhD, MPP, MS, FSBM, PhD, MPP, MS, FSBM,
Pennington Biomedical Research Center