BackgroundAppropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this.ObjectivesThe main objective of this study was to evaluate an online decision aid for youth depression.DesignAn uncontrolled cohort study with pre‐decision, immediately post‐decision and follow‐up measurements.Setting and ParticipantsYoung people (n=66) aged 12‐25 years with mild, mild‐moderate or moderate‐severe depression were recruited from two enhanced primary care services.InterventionOnline decision aid with evidence communication, preference elicitation and decision support components.Main outcome measuresThe main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow‐up.ResultsAfter using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3‐22.9 points lower) on the Decisional Conflict Scale (range 0‐100)) and felt involved and satisfied with their decision. At follow‐up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3‐4.0 points lower) on the Patient Health Questionnaire nine‐item scale (range 0‐27)) and were adherent to 88% (95% CI: 82%‐94%) of treatment courses.Discussion and ConclusionsA decision aid for youth depression can help ensure evidence‐based, client‐centred care, promoting collaboration in this often difficult to engage population.

Purpose This paper aims to report findings from the first year of the Vanguard Laundry evaluation study, which explores the impacts of a work integration social enterprise (WISE) on health. Design/methodology/approach Drawing on social determinants of health (SDH) conceptual framework, a mixed-methods longitudinal case study is used to evaluate the health impacts of a WISE employing people with lived experience of mental illness. In stage one of this study, 31 participants including staff and managers completed semi-structured interviews, validated health and well-being measures and a questionnaire based on the organisation’s theory of change. Quantitative data were analysed descriptively, and qualitative data are analysed thematically. Findings Data provided further evidence of the conceptualised WISE pathways for impact on SDH through employment, social integration, increased income, improved social position and living conditions. While social enterprise (SE) beneficiary staff had lower well-being scores than other staff members and management, the majority reported improved health, increased social supports and enhanced well-being through improved material conditions and increased sense of purpose, confidence and social connection. Research limitations/implications Stage one of this study relied on self-reported data. Future stages will incorporate income support and health data extracted from government agencies with participant consent. Originality/value This paper responds to calls for longitudinal studies that include a range of participants and use health outcome measures to further explore how a WISE impacts health through acting on SDH.

Background Previous research on employee well-being for those who have experienced social and economic disadvantage and those with previous or existing mental health conditions has focused mainly on programmatic interventions. The purpose of this research was to examine how organisational structures and processes (such as policies and culture) influence well-being of employees from these types of backgrounds. Methods A case study ethnographic approach which included in-depth qualitative analysis of 93 semi-structured interviews of employees, staff, and managers, together with participant observation of four social enterprises employing young people. Results The data revealed that young people were provided a combination of training, varied work tasks, psychosocial support, and encouragement to cultivate relationships among peers and management staff. This was enabled through the following elements: structure and space; funding, finance and industry orientation; organisational culture; policy and process; and fostering local service networks.. The findings further illustrate how organisational structures at these workplaces promoted an inclusive workplace environment in which participants self-reported a decrease in anxiety and depression, increased self-esteem, increased self-confidence and increased physical activity. Conclusions Replicating these types of organisational structures, processes, and culture requires consideration of complex systems perspectives on implementation fidelity which has implications for policy, practice and future research.

Summary Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as ‘complex interventions’ that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.