Periodic Reporting for period 4 - REACH (REACH: Risk, Resilience, Ethnicity and AdolesCent Mental Health)
Reporting period: 2020-03-01 to 2021-02-28
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.
(1) With input and advice from a Young Persons Advisory Group, we secured full ethical approvals for REACH.
(2) We successfully engaged and recruited 12 schools.
(3) We 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 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 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 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 agreed to be followed up beyond T3, ensuring the cohorts are protected further waves of data collection.
(7) We 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, T2, and T3 data have been entered and cleaned for analysis. Core analyses of data on the prevalence of mental health problems by demographic characteristics, e.g. gender and ethnicity, and on risk factors for conduct problems, are complete. Several papers reporting these findings have been published (e.g. Knowles et al, 2021; Blakey et al, 2021) or are under review in academic journals. For example, other core analyses, including latent trajectory modelling, have been completed and are in submission with academic journals (3 papers) or are in preparation (4 papers). Further findings have been presented at 5 international conferences.
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.
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 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.