To co-create with rangatahi (young people) evidence-based eating and wellbeing guidelines for young people in Aotearoa New Zealand (NZ), informed by mātauranga Māori (traditional Māori knowledge).

Rangatahi collaborated with Māori and non-Māori experts to review existing health guidelines covering sustainable eating, physical activity, screen time, sleep and mental wellbeing and develop their own set of guidelines. Peer feedback on the draft guidelines was used to produce the final guidelines. The process integrated scientific evidence with mātauranga Māori, following tikanga Māori (Māori custom) to ensure a culturally centred process.

Wānanga (learning workshops) were held at a local marae (traditional meeting house), and feedback presentations were held in four secondary schools in Hawke’s Bay, NZ.

Seventeen rangatahi from four schools with high Māori student enrolment participated in the wānanga, and ninety-four students provided peer feedback through surveys.

The rangatahi created ten eating and ten wellbeing guideline messages. These messages were invitational (beginning ‘Let’s try to…’) acknowledging the challenging journey for many rangatahi from current to recommended behaviours. Only one quantification (8–10 h of sleep) was included. Three eating and three physical activity guidelines incorporated the concepts of ‘mauri’ (life force). The guidelines addressed contemporary issues including sustainable eating, ultra-processed foods, social dimensions of eating and physical activity, screen time and cyberbullying. They also emphasised respect, rights and responsibilities, concluding with a motivational whakatauki (proverb) about aspirations.

Innovative, relevant and contemporary eating and wellbeing guidelines have been successfully co-created by rangatahi Māori for all young people across NZ.

Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. It is important that we understand their use of, and access to, mental health services.

To examine quantitative evidence on mental health service utilisation and access among young refugees and asylum seekers.

We searched MEDLINE, PsycINFO, Embase, Global Health and The International Bibliography of the Social Sciences. Searches were supplemented by reference list screening and forward-and-backward citation tracking of included studies. Results were synthesised narratively. Our review was pre-registered on PROSPERO (no. CRD42024540885) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Twenty-two studies were included. We found an overall pattern of underutilisation of services by young refugees in comparison with majority population peers, particularly for out-patient services and psychotropic medication. In contrast, there was evidence of increased emergency service use. Service use was particularly decreased for those from low- and middle-income countries, and increased in unaccompanied minors. Service use for trauma-related disorders and schizophrenia was most common, and less likely for neurodevelopmental disorders. Only one study contained data on access-related factors, which identified language as a potential barrier.

There is a disparity between the mental health needs and service use of young refugees, suggesting a need for greater efforts to increase access and use in this population. Future research should explore barriers and facilitators, and build on primary research examining service use in asylum seekers and unaccompanied minors, because both remain underrepresented within the literature.

Improving Access to Psychological Therapies (IAPT), an NHS England service providing talking therapies, is meeting its target recovery rate of 50%. However, engagement in treatment, as well as recovery rates, may be lower for some groups.

To assess variation in treatment completion and recovery rates by demographic and socioeconomic group and to describe rates of further referrals for patients to IAPT and secondary mental health services.

Using 121 548 administrative records for 2019–2020 and 2022–2023 for the Norfolk and Waveney area, we estimated associations of age, gender, ethnicity and deprivation with the likelihood of treatment completion and recovery using logistic regression modelling. We also described rates of further referrals.

Younger people and those living in deprived areas were less likely to recover or complete treatment, with those aged 16–17 years (n = 735) having the lowest adjusted odds for recovery (adjusted odds ratio = 0.5, 95% CI: 0.5–0.6) compared with those aged 36–70 years, and those aged 18–24 years (n = 23 563) having the lowest rate of completion (adjusted odds ratio = 0.5, 95% CI: 0.5–0.6). Further referrals before April 2022 were recorded for 45.4% of 6513 patients who had completed treatment and 68.8% of 9469 who had not completed treatment, and for 39.4% of 2007 recovered patients in 2019–2020 and 53.1% of 1586 who had not recovered. Non-completers had relatively more further referrals to secondary mental health services compared with completers (43.6% v. 22.8%; P < 0.01).

Younger people and those living in deprived areas have lower recovery and completion rates. Those who have completed treatment and not recovered have higher rates of further referrals.

User engagement is recognised as a critical and pervasive challenge that has limited the potential evidence base being developed for mental health apps.

To understand young people’s motivations for participating in a randomised controlled trial for a mental health app and the role of intrinsic (e.g. improving well-being) and extrinsic (e.g. financial incentives) drivers in engagement.

Emotional Competence for Well-Being (ECoWeB) was a superiority parallel three-arm randomised cohort trial recruiting a cohort of 16–22 year-olds across the UK, Germany, Spain and Belgium, who, depending on risk, were allocated respectively to the PREVENT (n = 1262) versus PROMOTE (n = 2532) trials. We conducted in-depth semi-structured interviews in the UK (n = 18, mean age = 17.7, s.d. = 1.5) and Spain (n = 11, mean age 20.6, s.d. = 1.7) to explore participants’ self-reported motivations and engagement. The trial was registered at ClinicalTrials.gov: NCT04148508.

Across arms, 21% of participants never set up an account to access the app and approximately 50% did not complete the 3-month follow-up assessment. Engagement was not significantly higher in the intervention arm compared to the control arms across metrics. Qualitative findings demonstrated that although extrinsic factors alone may be enough to prompt someone to sign up to research, intrinsic drivers (e.g. finding the app useful) are needed to ensure longer-term engagement.

Incentivising participation in clinical trials needs to be consistent with incentives that might be utilised at the point of dissemination and implementation to ensure that findings are replicated if that intervention is adopted at scale.

Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.

We investigated whether the processes outlined in Clark’s (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.

We recruited three groups of adolescents (12–17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD (‘clinical control’), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms (‘community control’). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.

The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.

We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark’s cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.