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Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis
In the past decade, there have been extensive efforts in the Western world to raise public awareness about mental health problems, with the goal of reducing or preventing these symptoms across the population. Despite these efforts, reported rates of mental health problems have increased in these countries over the same period. In this paper, we present the hypothesis that, paradoxically, awareness efforts are contributing to this reported increase in mental health problems. We term this the prevalence inflation hypothesis. First, we argue that mental health awareness efforts are leading to more accurate reporting of previously under-recognised symptoms, a beneficial outcome. Second, and more problematically, we propose that awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. We propose that this then leads some individuals to experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual's self-concept and behaviour in a way that is ultimately self-fulfilling. For example, interpreting low levels of anxiety as symptomatic of an anxiety disorder might lead to behavioural avoidance, which can further exacerbate anxiety symptoms. We propose that the increase in reported symptoms then drives further awareness efforts: the two processes influence each other in a cyclical, intensifying manner. We end by suggesting ways to test this hypothesis and argue that future awareness efforts need to mitigate the issues we present.
The effect of intolerance of uncertainty on anxiety and depression, and their symptom networks, during the COVID-19 pandemic.
Individuals vary in their ability to tolerate uncertainty. High intolerance of uncertainty (the tendency to react negatively to uncertain situations) is a known risk factor for mental health problems. In the current study we examined the degree to which intolerance of uncertainty predicted depression and anxiety symptoms and their interrelations across the first year of the COVID-19 pandemic. We examined these associations across three time points (May 2020 - April 2021) in an international sample of adults (N = 2087, Mean age = 41.13) from three countries (UK, USA, Australia) with varying degrees of COVID-19 risk. We found that individuals with high and moderate levels of intolerance of uncertainty reported reductions in depression and anxiety symptoms over time. However, symptom levels remained significantly elevated compared to individuals with low intolerance of uncertainty. Individuals with low intolerance of uncertainty had low and stable levels of depression and anxiety across the course of the study. Network analyses further revealed that the relationships between depression and anxiety symptoms became stronger over time among individuals with high intolerance of uncertainty and identified that feeling afraid showed the strongest association with intolerance of uncertainty. Our findings are consistent with previous work identifying intolerance of uncertainty as an important risk factor for mental health problems, especially in times marked by actual health, economic and social uncertainty. The results highlight the need to explore ways to foster resilience among individuals who struggle to tolerate uncertainty, as ongoing and future geopolitical, climate and health threats will likely lead to continued exposure to significant uncertainty.
Navigating the Social Environment in Adolescence: The Role of Social Brain Development
Successful navigation of the social environment is dependent on a number of social cognitive processes, including mentalizing and resistance to peer influence. These processes continue to develop during adolescence, a time of significant social change, and are underpinned by regions of the social brain that continue to mature structurally and functionally into adulthood. In this review, we describe how mentalizing, peer influence, and emotion regulation capacities develop to aid the navigation of the social environment during adolescence. Heightened susceptibility to peer influence and hypersensitivity to social rejection in adolescence increase the likelihood of both risky and prosocial behavior in the presence of peers. Developmental differences in mentalizing and emotion regulation, and the corticosubcortical circuits that underpin these processes, might put adolescents at risk for developing mental health problems. We suggest how interventions aimed at improving prosocial behavior and emotion regulation abilities hold promise in reducing the risk of poor mental health as adolescents navigate the changes in their social environment.
A synthesis of evidence for policy from behavioural science during COVID-19.
Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.
Amplified Concern for Social Risk in Adolescence: Development and Validation of a New Measure.
In adolescence, there is a heightened propensity to take health risks such as smoking, drinking or driving too fast. Another facet of risk taking, social risk, has largely been neglected. A social risk can be defined as any decision or action that could lead to an individual being excluded by their peers, such as appearing different to one's friends. In the current study, we developed and validated a measure of concern for health and social risk for use in individuals of 11 years and over (N = 1399). Concerns for both health and social risk declined with age, challenging the commonly held stereotype that adolescents are less worried about engaging in risk behaviours, compared with adults. The rate of decline was steeper for social versus health risk behaviours, suggesting that adolescence is a period of heightened concern for social risk. We validated our measure against measures of rejection sensitivity, depression and risk-taking behaviour. Greater concern for social risk was associated with increased sensitivity to rejection and greater depressed mood, and this association was stronger for adolescents compared with adults. We conclude that social risks should be incorporated into future models of risk-taking behaviour, especially when they are pitted against health risks.
Evaluating the effectiveness of a universal eHealth school-based prevention programme for depression and anxiety, and the moderating role of friendship network characteristics.
BACKGROUND: Lifetime trajectories of mental ill-health are often established during adolescence. Effective interventions to prevent the emergence of mental health problems are needed. In the current study we assessed the efficacy of the cognitive behavioural therapy (CBT)-informed Climate Schools universal eHealth preventive mental health programme, relative to a control. We also explored whether the intervention had differential effects on students with varying degrees of social connectedness. METHOD: We evaluated the efficacy of the Climate Schools mental health programme (19 participating schools; average age at baseline was 13.6) v. a control group (18 participating schools; average age at baseline was 13.5) which formed part of a large cluster randomised controlled trial in Australian schools. Measures of internalising problems, depression and anxiety were collected at baseline, immediately following the intervention and at 6-, 12- and 18-months post intervention. Immediately following the intervention, 2539 students provided data on at least one outcome of interest (2065 students at 18 months post intervention). RESULTS: Compared to controls, we found evidence that the standalone mental health intervention improved knowledge of mental health, however there was no evidence that the intervention improved other mental health outcomes, relative to a control. Student's social connectedness did not influence intervention outcomes. CONCLUSION: These results are consistent with recent findings that universal school-based, CBT-informed, preventive interventions for mental health have limited efficacy in improving symptoms of anxiety and depression when delivered alone. We highlight the potential for combined intervention approaches, and more targeted interventions, to better improve mental health outcomes.
Measuring online and offline social rejection sensitivity in the digital age.
Social rejection sensitivity has been proposed as a central risk factor for depression. Yet, its assessment has typically been limited to offline contexts. Many of today's social interactions, however, take place online. Here, we developed a measure to assess social rejection sensitivity in both online and offline environments. Across four separate samples including a total of 2381 individuals (12-89 years), the Online and Offline Social Sensitivity Scale was shown to offer a reliable measure of social rejection sensitivity. The study provides evidence that rejection sensitivity across online and offline social environments shows a moderate to strong association with depressive symptoms and maladaptive ruminative brooding. We also found age-related differences in social rejection sensitivity in online and offline contexts with rejection sensitivity decreasing from early adolescence to older age. The scale has the potential to advance future research on the role of social rejection sensitivity in mental health in a digital age. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Peer Influence in Adolescence: Public-Health Implications for COVID-19.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in the widespread implementation of social distancing measures. Adhering to social distancing may be particularly challenging for adolescents, for whom interaction with peers is especially important. We argue that young people's capacity to encourage each other to observe social distancing rules should be harnessed.
The relationship between perceived income inequality, adverse mental health and interpersonal difficulties in UK adolescents.
BACKGROUND: Adolescence is a period of life when young people increasingly define themselves through peer comparison and are vulnerable to developing mental health problems. In the current study, we investigated whether the subjective experience of economic disadvantage among friends is associated with social difficulties and poorer mental health in early adolescence. METHODS: We used latent change score modelling (LCSM) on data from the UK Millennium Cohort Study, collected at ages 11 and 14 (N = 12,995). Each LCSM modelled the mean of an outcome related to mental health and interpersonal difficulties at age 11 (including self-esteem, well-being, emotional difficulties, peer problems, bullying, victimisation and externalising difficulties), the change of the outcome from ages 11 to 14 and its predictors, including perceived income inequality among friends (i.e. perceiving oneself as belonging to a poorer family than the families of one's friends). RESULTS: Perceived income inequality predicted adverse mental health and a range of interpersonal difficulties during adolescence, even when controlling for objective family income. Follow-up analyses highlighted that, at 11 years, young people who perceived themselves as belonging to poorer families than their friends reported worse well-being, self-esteem, internalising problems, externalising problems and victimisation at the same age (relative to those who perceived themselves as richer than or equal to their friends, or who did not know). Longitudinal analyses suggested that victimisation decreased from ages 11 to 14 to a greater extent for adolescents who perceived themselves as poorer than other adolescents. CONCLUSIONS: The salience of economic inequalities in proximal social environments (e.g. among friends) in early adolescence could further amplify the negative effects of economic disadvantage on mental health and behavioural difficulties during this period.
Development of a gamified cognitive training app “Social Brain Train” to enhance adolescent mental health: a participatory design study protocol
Background: Adolescence is a sensitive period for the onset of mental health disorders. Effective, easy-to-disseminate, scalable prevention and early interventions are urgently needed. Affective control has been proposed as a potential target mechanism. Training affective control has been shown to reduce mental health symptoms and improve emotion regulation. However, uptake and adherence to such training by adolescents has been low. Thus, the current study aims to receive end user (i.e., adolescents) feedback on a prototype of a novel app-based gamified affective control training program, the Social Brain Train. Methods: The proposed study aims to recruit participants aged 13-16 years old (N = 20) to provide user feedback on the Social Brain Train app. The first group of participants (n = 5) will complete an online questionnaire assessing demographics, symptoms of depression and anxiety, social rejection sensitivity and attitudes toward the malleability of cognition and mental health. They will complete two tasks assessing cognitive capacity and interpretation bias. Participants will be then be invited to an online group workshop, where they will be introduced to the app. They will train on the app for three days, and following app usage, participants will complete the aforementioned measures again, as well as provide ratings on app content, and complete a semi-structured interview to obtain in-depth user feedback, which will be used to inform modifications to the app. Following these modifications, a second group of participants (n = 15) will follow the same procedure, except they will train on the app for 14 days. Feedback from both groups of participants will be used to inform the final design. Conclusions: By including young people in the design of the Social Brain Train app, the proposed study will help us to develop a novel mental health intervention that young people find engaging, acceptable, and easy-to-use
Expectations of Social Consequences Impact Anticipated Involvement in Health-Risk Behavior During Adolescence.
This study examined how individual differences in expectations of social consequences relate to individuals' expected involvement in health-risk behaviors (HRBs). A total of 122 adolescents (aged 11-17) reported their expected involvement in a number of risk behaviors and whether or not they expect to be liked more or less by engaging in the behavior: the expected social benefit. Higher perceived social benefit was associated with higher anticipated involvement in said behavior. This relationship was stronger for adolescents who reported a higher degree of peer victimization, supporting the hypothesis that experiencing victimization increases the social value of peer interactions. Findings suggest that adolescents incorporate expectations of social consequences when making decisions regarding their involvement in HRBs.