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REACH: Risk, Resilience, Ethnicity and AdolesCent Mental Health

Periodic Reporting for period 3 - REACH (REACH: Risk, Resilience, Ethnicity and AdolesCent Mental Health)

Reporting period: 2018-09-01 to 2020-02-29

Aim

The overall aim of this research study, REACH, is to examine the development of mental health problems during adolescence, in particular by ethnic group. REACH is an acronym for our study title, Resilience, Ethnicity, and AdolesCent Mental Health.

Why is REACH important?

We know that most mental health problems in adulthood begin before the age of 18. We also know that the extent and type of mental health problems in adulthood varies by ethnic group. For example, in the UK rates of common mental disorders (such as anxiety) are similar in all ethnic groups. However, rates of severe mental disorders are higher in some minority ethnic groups (e.g. black Caribbean, black African), compared with the majority population. We have known this for a long time. This is a major social and public health issue. What we do not know is why there are these differences and, as a consequence, there have been no public health initiatives specifically designed to address this – this is a public health tragedy. We urgently need research that can help us to understand why these patterns develop, so that we can create strategies to reduce disparities in rates of severe mental disorder by ethnic group. This is what REACH is designed to do, to examine the development of mental health problems through adolescence by ethnic group, and ultimately into adulthood. In particular, our focus is on factors that reduce risk (i.e. on resilience), during adolescence, of mental health problems developing and of them becoming persistent.

How is REACH doing this?

To achieve our aim, we are a conducting a study of adolescent mental health. For this, we will recruit and collect information from a sample of around 3,000 young people aged 11-14 years, from 10-12 schools in south London, UK. There are two parts to this. First, we will use a questionnaire to collect information on mental health and life circumstances and experiences from all 3,000 young people. Second, we will use face to face interviews and some reasoning tasks to collect more detailed information from a sub-sample of around 600 young people on mental health and life experiences and on how social information is processed. We will then follow these young people and collect the same information, one and two years later, to see what has changed. This will allow us to track the development of mental health problems over time and to see what factors increase or decrease risk of the development and persistence of problems.

REACH is an ambitious 5 year study that will lead to strategies to reduce risk of poor mental health outcomes during adolescence, a key developmental stage, in diverse ethnic groups.
We are 54 months into the REACH study. The work performed to date is as follows:

(1) With input and advice from a Young Persons Advisory Group, we have secured full ethical approvals for REACH.

(2) We have successfully engaged and recruited 12 schools.

(3) We have successfully piloted all aspects of the study in 2 schools. In our pilot, we implemented our procedures for recruiting pupils and for completing our in-class questionnaire on tablet computers and, with a sub-sample, face to face interviews and tasks. On the basis of our pilot, we further refined the procedures for the study.

(4) We have completed baseline (Time 1, T1) in-class questionnaires in all 12 of our schools with a total of 4,353 pupils (88% of 4,945 eligible). This exceeds our initial target (around 3,000) substantially. This is because of higher than expected participation rates and larger than expected numbers of eligible pupils per school. In addition, we completed interviews and tasks with 803 pupils from our 12 schools. This exceeds our initial target (around 600).

(5) We have completed at one year (Time 2, T2) follow up in-class questionnaires with 3,749 pupils (86% of 4,353 in our baseline (Time 1) cohorts) from all 12 of our schools. This exceeds our initial target for follow up at T2 (n, 2,484).

(6) We have completed at two years (Time 3, T3) follow up in-class questionnaires with 3,025 pupils (81% of 3,749 so far followed) from 12 of our 12 schools. This again exceeds our initial target for follow up at 2 years (n, 2,208). In addition, 2,693 participants of 3,123 so far approached have agreed to be followed up beyond T3, ensuring the cohorts are protected further waves of data collection.

(7) We have completed face to face interviews and tasks with 803 pupils a T1 and 598 at T2 (74% of 803), exceeding our initial target for T1 (n, 552) and T2 (n, 497).

(8) All T1 and T2 data have been entered and cleaned for analysis. T3 data entry and cleaning is almost complete. Core analyses of data on the prevalence of mental health problems by demographic characteristics, e.g. gender and ethnicity, are complete and 3 papers reporting on these findings are in submission. Further findings have been presented at 5 international conferences and several more papers are in preparation.

We have begun analyses of the information collected and have begun to disseminate the outputs from these.

In sum, all planned work has been completed and all targets have been met or exceeded.

In addition, we have established and implemented an extensive a programme of public engagement (REACHout) to raise awareness of our study and to increase impact. So far, this has included a highly successful study launch event [‘shining a light on adolescent mental health’]; exhibits at the prestigious Royal Society Summer Science Exhibition (2017), New Scientist Live (2018), and Science Museum Lates (2019); three charity events through which we raised over £10,000 for a local youth charity (BigKid Foundation, which works with young people at risk of exclusion); and regular newsletters and a comprehensive website with sections for schools, parents, and young people.

Within local schools, we have delivered, each year, a range of engagement activities, developed in collaboration with schools and young people. Through these activities we have engaged over 10,000 local young people and hundreds of local teachers, so far.

Finally, we have secured funding, as part of a £8m award from the UK Economic and Social Research Council (PI: Craig Morgan) to establish a new research Centre for Society and Mental Health at King’s College London, to continue to follow our cohorts at further time points.
We have established and collected information on mental health and risk and resilience factors in a large, inner-city, ethnically diverse sample of adolescents. As far as we are aware, this is the largest sample of its kind and will enable us to answer important questions of social and public health significance.

We expect, then, our study to provide results in three broad and important areas, as follows:

(1) On how common mental health problems are among adolescents from diverse ethnic groups and how these develop over time.

(2) On what risk and resilience factors increase and decrease risk of the development and persistence of mental health problems over time.

(3) On how (i.e. through what mechanisms) identified risk and resilience factors increase and decrease risk.

As such, our study will progress our knowledge of the extent and development of mental health problems in adolescence beyond the current state of the art. These results will inform the development of policy, mental health services, and interventions for young people to prevent and improve mental health problems.
Presenting initial findings from REACH at the IAYMH conference (September 2017)
REACH launch event at a community venue in south London (September 2016)
REACH team, after completing the 3 Peaks Challenge (August 2016)
Artist representing the themes covered at the REACH launch event (September 2016)
REACH resilience tree, completed at the Royal Society Summer Science Exhibition (July 2017)