The influence of Executive Function on Mental Health in vulnerable adolescents: a multi-site low and middle income country approach

执行功能（EF）调节情绪，思想和行为，EF的困难与高收入国家（HIC）的心理健康问题密切相关。EF包括一系列认知技能，如工作记忆、认知灵活性、选择性注意和抑制，这些技能构成了推理、计划日常活动和解决问题等高级认知功能的基石。因此，EF在情感，行为，认知和社会功能以及人际关系中至关重要。EF差在许多重要领域具有广泛的影响;特别是，它与抑郁症，焦虑症和注意力缺陷多动障碍等心理健康障碍的发病率增加有关。有两个时期，EF的发展是迅速的：儿童和青少年。这些都是关键的时间点，干预和预防EF的损害。EF差可能是由于生物医学因素，如营养不良或暴露于艾滋病毒和疟疾或暴露于贫困，特别是当这发生在EF快速发展的时期。这些危险因素会影响个体在执行功能任务上的表现以及执行功能的神经基质。严重的社会经济困境和多种风险因素的存在将对青少年实现其潜力产生重大影响，并将影响他们通过就业、社会功能、身心健康对社会的贡献。牛津大学多个部门的研究人员多年来一直专注于EF，心理健康和冒险行为之间的关系，例如（无保护的性行为，酒精或药物使用）。这一领域的研究正在与多个中低收入国家的调查人员合作进行：肯尼亚的Abubakar和Newton;南非的Kahn、Scerif、Demeyere和Stein;埃塞俄比亚和秘鲁的Favara、Sanchez和Pankhurst。该提案将为英国和LMIC研究EF和心理健康的研究人员创建一个平台，协调目前在各研究中心使用的EF工具，并将使新EF措施的试点能够比较EF及其与各研究中心心理健康数据的关联。许多研究表明，儿童和青少年的EF可以通过直接刺激（例如EF特定的培训任务）或通过改善他们的心理社会环境来改善，但并非所有这些干预措施在低收入国家都是经济上可行或文化上可接受的。干预前的一个必要步骤是确保我们有准确的工具，可以可靠地测量不同环境和文化的EF，并评估相关干预措施的文化可接受性。作为这一建议的一部分，我们将改进我们的测量工具，并调查在EF发展的关键时期之一，即青春期，适当的干预措施，以提高EF。改善青少年的EF将确保他们能够利用学校教育，并允许知情的关系和职业选择，以及减少高风险性行为和药物使用行为的风险，并促进身心健康。

Executive function (EF) regulates emotions, thoughts and behaviours, and difficulties in EF have been strongly implicated in mental health problems in high income countries (HICs). EF includes a set of cognitive skills such as working memory, cognitive flexibility, selective attention and inhibition which form the building blocks for higher order cognitive functions such as reasoning, planning every day activities and problem solving. EF is therefore critical in emotional, behavioural, cognitive, and social functioning and interpersonal relationships. Poor EF has wide ranging implications in a number of important areas; in particular, it is associated with increased rates of mental health disorders such as depression, anxiety and attention deficit hyperactivity disorder. There are two periods during which development of EF is rapid; childhood and adolescence. These are critical time points to intervene and prevent impairments in EF.Poor EF can result from biomedical factors, such as poor nutrition or exposure to HIV and malaria or from exposure to poverty, particularly when this occurs during periods of rapid EF development. These risk factors will affect both individuals' performance on EF tasks as well as the neural substrates of EF. The high level of socioeconomic adversity and the presence of multiple risk factors will have a strong influence on adolescents' achieving their potential and will impact their contributions to society through employment, social functioning, mental and physical health. Investigators across multiple Departments at the University of Oxford have over a number of years concentrated on the relationship between EF, mental health and risk taking behaviours such as (unprotected sex, alcohol or drug use). Research in this area is being carried out in collaboration with investigators in multiple Low and Middle Income Countries (LMIC): by Abubakar and Newton in Kenya; Kahn, Scerif, Demeyere and Stein in South Africa; Favara, Sanchez and Pankhurst in Ethiopia and Peru. This proposal will create a platform for UK and LMIC researchers working on EF and mental health, the harmonisation of EF tools currently used across sites and it will enable the piloting of a new EF measure to allow for the comparison of EF and its association with mental health data across sites. A number of studies have shown that EF can be improved in children and adolescents either through direct stimulation (e.g. EF-specific training tasks) or through enhancing their psychosocial environment, but not all these interventions may be financially viable or culturally acceptable in LMICs. A necessary step before intervening is to ensure we have accurate tools which reliably measure EF across settings and cultures, and that the cultural acceptability of relevant interventions is assessed.As part of this proposal, we will refine our measurement tools and investigate contextually appropriate interventions to improve EF, during one of the critical periods of EF development i.e. adolescence. Improving EF in adolescence will ensure they will be able to take advantage of school education and it will allow for informed relational and occupational choices, as well as reduce the risk of high-risk sexual and substance use behaviours and promote physical and mental health.