This study investigated the feasibility of conducting a randomized controlled trial to evaluate a self-management mobile app for bereaved adolescents. Key areas assessed were recruitment, randomization, data collection, and intervention acceptability. In an internal pilot trial - where a pilot phase is embedded within a main trial to assess its feasibility − 36 adolescents aged 12–19 were randomized to use the app or a website with psychoeducation. All adolescents had experienced the loss of a family member and completed assessments prior to receiving the intervention and eight weeks after access. Results revealed the trial to be feasible, although indicating the need for minor adjustments to recruitment, screening, and inclusion criteria. Adolescents reported high satisfaction with the app, highlighting its helpfulness in understanding grief, improving communication, and seeking support. Overall, the study supports the feasibility of proceeding to a main trial within which app helpfulness and effects can be further explored.

Children whose parents have mental health challenges often experience stigma, which may be further intensified by additional marginalized identities. StigmaBeat is a co-designed online resource developed with rural young people to challenge such stigma and share lived experiences. This qualitative, narrative study explored six participants’ ‘narratives of change’ one year after their involvement in developing the resource. Participants described feeling isolated, and particularly stigmatized in encounters with professionals before the project. Their involvement fostered connection with similarly situated peers and contributed to narrative reconstruction and destigmatization, with participants describing a shift from internalizing blame to becoming collectively armed to resist stigma rooted in structural injustice. They also reported greater self-compassion and a strengthened sense of empowerment to challenge stigma and influence others. Participants noted improvements in family dynamics and social relationships. The findings underscore the value of narrative approaches in professional practice—particularly anti-oppressive social work—in promoting non-stigmatizing understandings of social problems and mental health. The results call for social workers and healthcare professionals to engage in critical reflection on embedded assumptions and power dynamics that risk reproducing stigma. Narrative methods can further illuminate how interventions shape participants’ self-perceptions and everyday lives, offering valuable insights for practice development.

Disabled people, including those with autism, are common among those not in education, employment or training (NEET). This leaves caregiving parents to manage a perceived gap between their adult child’s needs and available welfare resources. This study examines how parents provide care in this context, where caregiving is often invisible and unpaid. The research draws on the frameworks of James (1992) and Horowitz (1985), using 20 narratively structured interviews with parents in this caregiving position, which are analysed using an abductive thematic approach. Findings reveal the overarching theme – Managing care to become unneeded: spinning the wheels – where the parents strive to support their adult children’s well-being and independence but face obstacles linked to unsuitable and non-responsive welfare resources. Many parents described their efforts as ‘spinning wheels’ but making little progress. This was commonly explained by a misfit between the services offered and their adult children’s motivation, which had been shaped by their disabilities and past setbacks, making it difficult to seek formal care independently. The study highlights how love and moral obligation influence power dynamics in care relationships and underscores the need to adapt and elaborate theoretical frameworks to capture the complexities of caregiving.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Background There is increasing awareness of the need to analyse symptoms of mental ill-health among early school leavers. Dropping out of compulsory education limits access to the labour market and education and could be related to deteriorating mental health over the course of a lifetime. The aim of this longitudinal study is to explore how early school leavers not in education, employment or training (NEET) narrate their working life trajectories linked to health, agency and gender relations. Methods Twelve early school leavers in the Swedish Northern Cohort (six women and six men) were interviewed over 40 years about their working life and health. Their life stories were analysed using structural narrative analysis to examine the evolution of their working life paths and to identify commonalities, variations and gendered patterns. Results All the participants started in the same position of “an unhealthy gendered working life in youth due to NEET status”. Subsequently, three distinct working life paths evolved: “a precarious gendered working life with negative health implications”, “a stable gendered working life in health challenging jobs” and “a self-realising gendered working life with improved health”. Agency was negotiated through struggle narratives, survival narratives, coping narratives and redemption narratives. Conclusions Even in a welfare regime like Sweden’s in the early 1980s, early school leavers not in education, employment or training experienced class-related and gendered working and living conditions, which created unequal conditions for health. Despite Sweden’s active labour market policies and their own practices of agency, the participants still ended up NEET and with precarious working life paths. Labour market policies should prioritise reducing unemployment, combating precarious employment, creating job opportunities, providing training and subsidised employment in healthy environments, and offering grants to re-enter further education. Our study highlights the need for further analyses of the contextual and gendered expressions of health among early school leavers throughout their lifetime, and of individual agency in various contexts for overcoming adversities.

Background: Losing a family member during childhood is a potentially traumatic event and increases the risk of mental health difficulties. Adolescents have the right to express their views in research of relevance to them, but few studies have involved bereaved adolescents as collaborators (i.e. Patient and Public Involvement (PPI)). Furthermore, to ensure meaningful and non-tokenistic involvement, bereaved adolescents’ levels of participation and experiences of taking part in research need to be evaluated.

Objectives: The aim was to describe and evaluate a PPI process working with bereaved adolescents to develop a self-management mobile app for adolescents in grief.

Methods: The PPI process consisted of four workshops during which the app’s logo, colours, name, content, and layout were discussed with six parentally bereaved adolescents aged 13–18 years. The adolescents were recruited through a non-profit organisation providing support for adolescents in grief. The PPI process was documented and evaluated using participant observations and an online survey completed by the adolescents, covering the themes of social context, participation, and influence.

Results: The adolescents perceived the social context as comfortable and inclusive, where their knowledge was valued. Their participation was characterised by ownership and motivated by a desire to help others with similar experiences. The adolescents’ ability to participate in PPI activities was assisted by the researchers’ flexibility, although challenging assignments may have made participation harder. Throughout PPI activities, adolescents contributed with relevant input and reported feeling influential. The study reached the intended levels of participation and appeared to adequately fulfil the adolescents’ right to participation.

Conclusions: Engaging adolescents who have undergone a potentially traumatic event, such as the loss of a family member, in research can enhance the overall relevance of the study. Moreover, it can entail a meaningful and positive experience for the participating adolescents, while also fulfilling their fundamental right to participation.

Antecedentes: Perder a un miembro de la familia durante la niñez es un evento potencialmente traumático y aumenta el riesgo de dificultades de salud mental. Los adolescentes tienen derecho a expresar sus puntos de vista en investigaciones relevantes para ellos, pero pocos estudios han involucrado a adolescentes en duelo como colaboradores (es decir, Participación Pública y del Paciente (PPI, por sus siglas en inglés)). Además, para garantizar una participación significativa y no simbólica, es necesario evaluar los niveles de participación y las experiencias de participación en la investigación de los adolescentes en duelo.

Objetivos: El objetivo fue describir y evaluar un proceso de PPI que trabaja con adolescentes en duelo para desarrollar una aplicación móvil de autogestión para adolescentes en duelo.

Métodos: El proceso de PPI consistió en cuatro talleres durante los cuales se discutió el logotipo, los colores, el nombre, el contenido y el diseño de la aplicación con seis adolescentes de entre 13 y 18 años, en duelo por alguno de sus padres. Los adolescentes fueron reclutados a través de una organización sin fines de lucro que brinda apoyo a adolescentes en duelo. El proceso de PPI fue documentado y evaluado mediante observaciones participantes y una encuesta en línea completada por los adolescentes, que cubre los temas de contexto social, participación e influencia.

Resultados: Los adolescentes percibieron el contexto social como cómodo e inclusivo, donde se valoraban sus conocimientos. Su participación se caracterizó por la apropiación y fue motivada por el deseo de ayudar a otros con experiencias similares. La capacidad de los adolescentes para participar en las actividades de PPI se vio favorecida por la flexibilidad de los investigadores, aunque las tareas desafiantes pueden haber dificultado la participación. A lo largo de las actividades de PPI, los adolescentes contribuyeron con aportes relevantes y reportaron sentirse influyentes. El estudio alcanzó los niveles de participación previstos y pareció cumplir adecuadamente el derecho de participación de los adolescentes.

Conclusiones: Involucrar en la investigación a adolescentes que han pasado por un evento potencialmente traumático, como la pérdida de un miembro de la familia, puede mejorar la relevancia general del estudio. Además, puede suponer una experiencia significativa y positiva para los adolescentes participantes, cumpliendo al mismo tiempo con su derecho fundamental a la participación.

Amongst the impacts of growing up with a parent with mental health challenges is the experience of stigma-by-association, in which children and young people experience impacts of stigmatisation due to their parent’s devalued identity. This article seeks to expand our understanding of this issue through an abductive analysis of qualitative data collected through a codesign process with young people. Results indicate that young people’s experiences of stigmatisation can be effectively understood as experiences of epistemic injustice. Participants expressed that their experiences comprised ‘more than’ stigma, and their responses suggest the centrality to their experiences of being diminished and dismissed in respect of their capacity to provide accurate accounts of their experiences of marginalisation and distress. Importantly, this diminishment stems not only from their status as children, and as children of parents with mental health challenges but operates through a range of stigmatised identities and devalued statuses, including their own mental health status, sexual minoritisation, disability and social class. Forms of epistemic injustice thus play out across the social and institutional settings they engage with. The psychological and social impacts of this injustice are explored, and the implications for our understanding of stigma around family mental health discussed. 

Parental suicide in childhood increases the risk of mental ill-health, substance use and premature mortality, particularly through suicide. Postvention supports tailored to the well-being and functioning of suicide-bereaved children and their remaining parents are thus of critical importance to counteract negative development. This explorative cross-sectional study seeks clinically relevant knowledge by investigating posttraumatic stress (PTS), sense of coherence (SOC) and family functioning among children (n=22), adolescents (n=18) and parents (n=40) before their attendance at a family-based grief support program. The results demonstrate critical health outcomes for children and parents, and in particular for adolescents. Clinically relevant symptoms of PTS were found in 36% of children, 65% of adolescents, and 37% of parents. All groups showed lower SOC than the norm. Adolescents reported dysfunctional family functioning for the dimensions Communication and Affective Responsiveness. Psychoeducational and trauma-informed support is recommended where family communication and meaning construction of suicide is given special attention. 

Little is known about the experience and impact of intersectional stigma experienced by rural young people (15–25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project’s methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse.

This article aims to investigate what it means to grow up in an alcoholic family environment. Nineteen children aged 6–11 who participated in a psycho-educational programme in the 1990s for children living with parents who misuse alcohol were interviewed about their experiences in a longitudinal study. A narrative analysis of their life stories demonstrates how, on the one hand, they positioned themselves as ‘vulnerable victims’ exposed to their parent’s alcoholism and to situations of severe neglect, domestic violence and sexual abuse. This position was characterized by a sense of powerlessness and lack of resources for coping with emotional distress and risk, as well as an urgent need for protection and care. On the other hand, the children positioned themselves as ‘competent agents’ who had developed purposeful strategies for managing their life situation, such as trying to reduce their parent’s drinking and undertaking the role of a ‘young carer’. The children primarily tried to normalize themselves in their social circle in a position of ‘silenced and invisible victims’. However, the alcoholism was usually exposed and the children occasionally also found themselves in the position of ‘help-seeking victims’ obliged to disclose the ‘family secret’. Remarkably, this rarely changed their situation very much. Instead, the children were commonly left in the position of ‘visible but unprotected victims’.