George Christopher Patton

• MD MB.BS
• University of Melbourne

Purpose “Positive epidemiology” emphasizes strengths and assets that protect the health of populations. Positive mental health refers to a range of social and emotional capabilities that may support adaptation to challenging circumstances. We examine the role of positive mental health in promoting adolescent health during the crisis phase of the CO...

For many young people who self-harm, families are the main source of social and emotional support. Providing family members with accurate information about self-harm, helping them with the ways to communicate positively and offering support for their own well-being can optimise their capacity to support young people who self-harm.

Young people going through a difficult time can feel helpless, and the smallest of problems can feel challenging or overwhelming. A lack of positive future-directed thinking, hopelessness and impulse control problems can make it harder for young people with self-harm to solve problems. Teaching young people a stepwise approach to manage problems im...

ATMAN is a brief psychological intervention designed for young people who self-harm. It can be used for those who are at-risk of self-harm but have not yet done so, as well as those who have previously harmed themselves and are at a very high risk of harming themselves again. ATMAN supports at-risk young people to develop adaptive ways of coping wi...

The assessments are an important part of ATMAN intervention. The assessments are done at three time points in addition to a brief assessment at the start of each session to monitor suicidal thoughts. Pre-intervention assessment allows the facilitator to know the background of the young person, evaluate their mental state, strengths and likely chall...

Emotion regulation is a process by which we influence the emotions we have, when we have them, and the way we experience and express them. By learning to regulate their emotions, young people create a buffer of time between feeling their emotion and reacting to that emotion. This is particularly important when the situation cannot be changed as you...

ATMAN is a brief psychological intervention aimed at promoting young people’s ability to manage their own problems and emotional distress and get help from others to reduce thoughts of self-harm. The ATMAN manual describes an overall approach as well as the details of the intervention. The manual is to be used for the delivery of intervention by th...

This session can be used when the ATMAN facilitator observes that the young person is using substances (such as alcohol, recreational drugs or sleeping pills) in excessive amounts which may be contributing to the self-harm behaviour. The goals of the session are to educate the young person about the relationship between self-harm and alcohol/substa...

The first session of ATMAN intervention is a chance for the facilitator to understand the self-harm behaviour of the young person and come up with a plan to address individual reasons for self-harm. The facilitator develops a shared understanding of self-harm behaviour with the young person, gives an overview of ATMAN intervention and outlines the...

People who self-harm often feel isolated and unsupported. Sometimes people can withdraw into their own shell when they are experiencing emotional difficulties and can stop interacting or sharing information with those with whom they shared a close relationship. Adequate support from social relationships offers protection in those who self-harm thro...

A crisis is an event that can lead to an unpredictable and potentially dangerous situation for an individual, group, community or whole society. In context of self-harm, the crisis mainly consists of an event or stress leading to the person either hurting themselves or thinking about it, with or without wanting to die. A crisis can occur in respons...

Young people are typically at a stage of life where they are learning to negotiate their needs with others while trying to be accepted in various social settings. It can be helpful for young people to reflect upon how they react in various situations and what others feel about it. This insight may help them to explore other ways to respond to other...

The ATMAN brief psychological intervention is part of the overall management for young people with self-harm. In ATMAN, the open-ended session can be used at the end of the intervention following the earlier sessions to either work on the strategies that the facilitator feels need some more work, to reflect on the progress made during the intervent...

Historically, religion has had a central role in shaping the psychosocial and moral development of young people. While religiosity and spirituality have been linked to positive mental health outcomes in adults, their role during the developmental context of adolescence, and the mechanisms through which such beliefs might operate, is less well under...

Purpose: Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by...

Introduction Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as...

Background There has been much speculation about the role of inequitable gender norms and early marriage in mental health and suicide risks in girls and young women, but no prospective study has yet investigated this relationship. Understanding these links has become particularly important in the context of the COVID-19 pandemic which has led to in...

To better understand how health risk processes are linked to adrenarche, measures of adrenarcheal timing and tempo are needed. Our objective was to describe and classify adrenal trajectories, in terms of timing and tempo, in a population of children transitioning to adolescence with repeated measurements of salivary dehydroepiandrosterone (DHEA), D...

The study examines changes over time in crash risk differences between young Australian drivers born in Asia and those born in Australia. Data from the 2003 baseline survey of the DRIVE cohort of 20 806 young drivers aged 17–24 years were linked to police, hospital and death data up until 2016. The association between country of birth and crash was...

Introduction Opportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare needs and respond in timely and appropriate ways. The development of culturally appropriate mental health assessment tools...

One-third of adolescents are diagnosed with a psychiatric disorder by age 16, with female adolescents twice as likely to experience an internalizing (i.e., depression or anxiety) disorder as their male peers. Individual differences in pubertal factors may partially underlie this disparity, potentially via the role of pubertal hormones in shaping br...

Longitudinal cohorts can provide timely and cost-efficient evidence about the best points of health service and preventive interventions over the life course. Working systematically across cohorts has the potential to further exploit these valuable data assets, such as by improving the precision of estimates, enhancing (or appropriately reducing) c...

Longitudinal cohort studies have the potential to examine causal effects of complex health exposures on longer-term outcomes. Utilizing data from multiple cohorts has the potential to add further benefit, by improving precision of estimates and allowing examination of effect heterogeneity and replicability. However, the interpretation of findings c...

Purpose: The Australian Temperament Project Generation 3 Cohort (ATPG3) was established to examine the extent to which offspring social and emotional development is shaped in the decades prior to conception, in parent and grandparent histories of psychosocial adjustment (e.g., emotional regulation, relationship quality and prosociality) and maladju...

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to yout...

Purpose To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions. Method Studies reporting one or more patient or implementation outcomes of a psychosocial intervention...

Background Self-harm in very young people can be a clinically ominous event. While most studies to date have focused on self-harm during the teenage years, fewer studies have examined children aged 12 years or under. We aimed to estimate the incidence and correlates of recent self-harm in a population-based, non-treatment-seeking sample of primary...

Focus of Presentation Utilising data from multiple cohorts to address causal questions in health research has become increasingly widespread due to a number of advantages. These include improved precision of estimates, in particular to investigate effect heterogeneity as well as rare events and exposures, and the ability to examine the replicabilit...

There is increasing evidence that the life-course origins of health and development begin before conception. We examined associations between timing and frequency of preconception cannabis and tobacco use and next generation preterm birth (PTB), low birth weight (LBW) and small for gestational age. 665 participants in a general population cohort we...

Purpose: Adolescence encompasses a critical developmental phase, which fosters or hinders psychological, physical, and social health. Whole-school interventions take a universal approach in targeting the entire school environment (“school climate”) to improve adolescent outcomes;however, little is known about the mediating role of school climate on...

Puberty triggers a period of structural “re-organization” in the brain, when rising hormone levels act via receptors to influence morphology. However, our understanding of these neuroendocrine processes in humans remains poor. As such, the current longitudinal study characterized development of the human subcortex during puberty, including changes...

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest amongst women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in prev...

Introduction This paper compares consequences of cannabis use initiated after high school with those of cannabis initiation in adolescence, with estimates of the proportion of adverse consequences accounted for by adult‐onset and adolescent‐onset cannabis users. Methods A state‐representative sample in Victoria, Australia (n = 1792) participated i...

The brain undergoes extensive structural changes during adolescence, concurrent to puberty-related physical and hormonal changes. While animal research suggests these biological processes are related to one another, our knowledge of brain development in humans is largely based on age-related processes. Thus, the current study characterized puberty-...

Maternal internalizing symptoms during pregnancy, specifically depression and/or anxiety, are commonly linked to negative affectivity (NA) in infant offspring. These links are commonly attributed to biological effects of the in utero environment on fetal development. However, research suggests that internalizing symptoms before and after pregnancy,...

The brain undergoes extensive structural changes during adolescence, concurrent to puberty-related physical and hormonal changes. While animal research suggests these biological processes are related to one another, our knowledge of brain development in humans is largely based on age-related processes. Thus, the current study characterized puberty-...

Purpose Adolescence encompasses a critical developmental phase, which fosters or hinders psychological, physical, and social health. Whole-school interventions take a universal approach in targeting the entire school environment (“school climate”) to improve adolescent outcomes; however, little is known about the mediating role of school climate on...

Background A cluster-randomized controlled trial in secondary schools in Bihar, India, reported the effectiveness of a multi-component, school health promotion intervention (SEHER) when delivered by lay counsellors (“SEHER Mitra” (SM); meaning “friend” in the local language), but not when delivered by a teacher (“Teacher as SEHER Mitra” (TSM)) comp...

Background There are very few studies that have examined the effectiveness of psychological interventions (PIs) that have been developed and tested in high-income countries to reduce self-harm in low and middle-income countries. Objective To evaluate the perspectives and explanatory styles of youth with self-harm and their caregivers to inform the...

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of...

Background School environments affect health and academic outcomes. With increasing secondary school retention in low-income and middle-income countries, promoting quality school social environments could offer a scalable opportunity to improve adolescent health and wellbeing.

Background Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after t...

Background Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after t...

Background: To investigate whether there are bi-directional associations between anxiety and mood disorders and body mass index (BMI) in a cohort of young adults. Methods: We analysed data from the 2004-2006 (baseline) and 2009-2011 (follow-up) waves of the Childhood Determinants of Adult Health study. Lifetime DSM-IV anxiety and mood disorders...

Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians spec...

ummary Background Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological...

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an inc...

Causal mediation approaches have been primarily developed for the goal of "explanation", that is, to understand the pathways that lead from a cause to its effect. A related goal is to evaluate the impact of interventions on mediators, for example in epidemiological studies seeking to inform policies to improve outcomes for sick or disadvantaged pop...

Emerging adulthood is a neglected phase of the life course in health research. Health problems and risk behaviors at this time of life can have long-term consequences for health. The 2016 Lancet Commission on Adolescent Health and Wellbeing reported that the influence of socioeconomic factors was under-researched among adolescents and young adults....

Objective: This study aimed to examine longitudinally whether adrenarcheal timing (adrenarcheal hormone levels independent of age) and tempo (change in hormone levels over time) were associated with amygdala functional connectivity and how this in turn related to anxiety symptoms in the transition from childhood to adolescence. Method: Participa...

Adolescence is the primary age of onset for common psychiatric disorders and thus presents a singular opportunity for prevention, particularly in school settings. Research efforts have advanced the understanding of diverse and interacting risk and protective factors for anxiety and depression. Such factors span individual, family, school, economic,...

Background It remains unclear how life course socioeconomic position (SEP) variations impact later smoking status. We aimed to investigate the associations using a novel methodology – a structured regression framework and to explore the potential underlying mechanisms. Methods Data were from an Australian national cohort (n = 1489). SEP was measur...

Early timing of puberty (i.e., advanced pubertal maturation relative to same-age peers) has been associated with depressive symptoms during adolescence. To date, research on this relationship has focused on gonadarche, the second phase of puberty, while less is known about the first phase of puberty, adrenarche. Increasing evidence suggests that an...

Anemia is regarded as major public health problem among adolescents in Low and Middle-Income Countries (LMICs) but there is limited primary data in many countries, including Nepal. This study investigated the prevalence and correlates of anemia in a nationally representative sample of adolescents within the 2014 National Adolescent Nutrition Survey...

Background: Alcohol and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to calculate global and regional estimates of the prevalence of alcohol, amphetamine, cannabis, cocaine, and op...

Background: To examine the longitudinal patterns of amphetamine use over twenty years from adolescence to the mid-thirties; and identify adolescent antecedents of future problematic patterns of use. Design: Ten-wave longitudinal study following participants from age 15 to age 35 in Victoria, Australia. Participants (N = 1755; 47% males) first enrol...

2018 WMHDAY CAMPAIGN DOCUMENT

Objective: The transition from childhood to adolescence is a vulnerable period for the development of anxiety symptoms. There is some evidence that hormonal changes occurring during adrenarche, an early pubertal phase, might play a role in this increased vulnerability. Little is known about underlying brain mechanisms. Given the role of the amygda...

BACKGROUND: School environments affect health and academic outcomes. With increasing secondary school retention in low-income and middle-income countries, promoting quality school social environments could offer a scalable opportunity to improve adolescent health and wellbeing. METHODS: We did a cluster-randomised trial to assess the effectiveness...

Objective: Parenting and pubertal timing have consistently been associated with internalizing and externalizing symptoms in childhood and adolescence, and there is some evidence that the interaction between these factors may be important in conferring risk. However, few studies have investigated whether neurobiological factors mediate these relati...

OBJECTIVES: The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. METHODS: Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading...

Background and aims: In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use. Methods: This study evaluated a multicomponent community intervention that included community mobilisation, social ma...

Background and aims: In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use. Methods: This study evaluated a multicomponent community intervention that included community mobilisation, social marke...

Background Frequent bullying predicts adolescent mental health problems, particularly depression. This population‐based study with young Australian primary school children aimed to determine the frequency and mental health correlates of bullying, and whether friendship could be protective. Method Participants were a population‐based sample of 1221...

Adolescent self-harm is an emerging public health challenge. It is associated with later psychiatric and substance use disorders, unemployment and suicide. Family interventions have been effective in a range of adolescent mental health problems and for that reason were reviewed for their effectiveness in the management of adolescent self-harm. The...

Epigenetic modifications regulate all gene activity in response to environmental cues, without alterations to the DNA sequence. These processes are very active in early life, with the epigenome affecting growth trajectories and later cardio-metabolic risks. Recent illustrations of how epigenetic changes in the glucocorticoid system alter risks for...

Importance Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. Objective To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjus...

Background: Schools can play an important role in health promotion by improving students’ health literacy, attitudes, health-related behaviours, social connection and self-efficacy. These interventions can be particularly valuable in low- and middle-income countries with low health literacy and high burden of disease. However, the existing literatu...

Appendix to The global burden of lower respiratory infections: results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 Study This appendix provides methodological detail, supplemental figures, and comprehensive information on input data and data transformation. Contents Analytic flowcharts……………………………………....…………………………………………...

Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods W...

Importance Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. Objective To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjus...

Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs)...

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the impo...

Background: The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016...

Background: Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluat...

Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years l...

Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study...