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)的精神健康问题密切相关。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、社交功能和人际关系方面至关重要。低EF在许多重要领域有广泛的影响；特别是，它与抑郁症、焦虑症和注意力缺陷多动障碍等精神健康障碍的发生率增加有关。儿童期和青春期是EF快速发展的两个时期。这些是干预和预防生态系统损害的关键时间点。生态系统不良可能是生物医学因素造成的，例如营养不良或暴露于艾滋病毒和疟疾，或暴露于贫困，特别是当这种情况发生在生态系统快速发展时期。这些风险因素既会影响个体在EF任务中的表现，也会影响EF的神经基础。高度的社会经济逆境和多重风险因素的存在将对青少年实现其潜力产生强烈影响，并将影响他们通过就业、社会功能、心理和身体健康对社会的贡献。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(如无保护措施的性行为、酒精或药物使用)之间的关系。这一领域的研究正在与多个中低收入国家的研究人员合作开展：肯尼亚的阿布巴卡尔和牛顿；南非的卡恩、塞里夫、德梅耶尔和斯坦；埃塞俄比亚和秘鲁的法瓦拉、桑切斯和潘克赫斯特。这项提议将为致力于EF和心理健康的英国和LMIC研究人员创建一个平台，协调目前在各个站点使用的EF工具，并将允许试行新的EF措施，以允许比较EF及其与跨站点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经济上都是可行的，在LMIC中也不是所有的干预措施都可以被接受。干预前的一个必要步骤是确保我们拥有准确的工具，能够可靠地跨环境和文化测量EF，并评估相关干预措施的文化可接受性。作为这项建议的一部分，我们将完善我们的测量工具，并研究在EF发展的关键时期之一，即青春期，提高EF的背景适当的干预措施。在青春期提高EF将确保他们能够利用学校教育，这将使他们能够进行知情的关系和职业选择，并减少高风险的性行为和药物使用行为的风险，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.