Preventive psychiatry: a blueprint for improving the mental health of young people

Psychometric properties of the patient health questionnaire-8 and general anxiety disorder-7 in adolescents and young adults from three Latin American cities: Internal structure, invariance, internal consistency and divergent validity

BACKGROUND

Depression and anxiety are the most common mental disorders in the world. Screening tools allow early diagnosis and intervention, preventing disease progression and reducing years lost to disability. Internationally, the most widely used screening instruments for depression and anxiety symptoms are the Patient Health Questionnaire (PHQ-8) and the Generalised Anxiety Disorder (GAD-7). Both have been validated in various countries; however, these studies mostly focused on the adult population and clinical settings.

OBJECTIVE

This study assessed the psychometric properties of the PHQ-8 and GAD-7 in adolescents and young adults in deprived urban areas of three of the largest Latin American cities. We evaluated the internal structure, measurement invariance, internal consistency, and divergent validity through correlations with the Manchester Short Assessment of Quality of Life (MANSA).

METHODS

The study included 1056 adolescents (ages 15-16) and 1306 young adults (ages 20-24) from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru). Confirmatory factor analysis was performed using the Weighted Least Squares Mean and Variance (WLSMV) adjusted estimator with polychoric matrices to assess the internal structure of the model. Measurement invariance was evaluated through multi-group factor analysis. Divergent validity was examined using Spearman's rho by correlating MANSA with the PHQ-8 and GAD-7. Finally, internal consistency was assessed with Cronbach's alpha and McDonald's omega.

RESULTS

Our study found that the PHQ-8 and the GAD-7 exhibited good goodness-of-fit indices for a one-dimensional model. Both scales achieved measurement invariance across different sociodemographic variables, including gender, country, education level, and age group. On the other hand, the PHQ-8 (rs = -0.52) and GAD-7 (rs = -0.46) showed a negative correlation with the MANSA, suggesting divergent validity between the higher scores on depressive and anxious symptoms are associated with lower quality of life. Finally, the PHQ-8 and GAD-7 showed adequate internal consistency in all cases evaluated (ω and α > 0.8).

CONCLUSIONS

Both the PHQ-8 and the GAD-7 showed good goodness-of-fit indices for a unidimensional theoretical model, adequate psychometric properties, and evidence of invariance for gender, age group, education level, and country. These findings highlight the reliability and versatility of these instruments in identifying urban young people with emotional distress in Latin America.

Using effective connectivity-based predictive modeling to predict MDD scale scores from multisite rs-fMRI data

BACKGROUND

Major depressive disorder (MDD) is a severe mental illness, and the Hamilton Depression Rating Scale (HAMD) is commonly used to quantify its severity. Our aim is to develop a predictive model for MDD symptoms using machine learning techniques based on effective connectivity (EC) from resting-state functional magnetic resonance imaging (rs-fMRI).

NEW METHOD

We obtained large-scale rs-fMRI data and HAMD scores from the multi-site REST-meta-MDD dataset. Average time series were extracted using different atlases. Brain EC features were computed using Granger causality analysis based on symbolic path coefficients, and a machine learning model based on EC was constructed to predict HAMD scores. Finally, the most predictive features were identified and visualized.

RESULTS

Experimental results indicate that different brain atlases significantly impact predictive performance, with the Dosenbach atlas performing best. EC-based models outperformed functional connectivity, achieving the best predictive accuracy (r = 0.81, p < 0.001, Root Mean Squared Error=3.55). Among various machine learning methods, support vector regression demonstrated superior performance.

COMPARISON WITH EXISTING METHODS

Current phenotype score prediction primarily relies on FC, which cannot indicate the direction of information flow within brain networks. Our method is based on EC, which contains more comprehensive brain network information and has been validated on large-scale multi-site data.

CONCLUSIONS

Brain network connectivity features effectively predict HAMD scores in MDD patients. The identified EC feature network may serve as a biomarker for predicting symptom severity. Our work may provide clinically significant insights for the early diagnosis of MDD, thereby facilitating the development of personalized diagnostic tools and therapeutic interventions.

Emotional suffering in school-aged children and adolescents with and without developmental language disorder

BACKGROUND

Research on emotional suffering symptoms in individuals with Developmental Language Disorder (DLD) is still limited.

AIMS

To describe the emotional suffering experienced by school-aged children and adolescents with DLD.

METHODS AND PROCEDURES

Psychological symptoms were measured using the Spanish version of the Child Behavior Checklist (CBCL) in a sample of 109 (67 boys) children and adolescents with DLD and 101 (62 boys) TD participants reported by their parents.

OUTCOMES AND RESULTS

Participants with DLD experienced more emotional problems than TD children according to their parents. Those with DLD displayed significantly more symptoms related to anxiety, depression, social withdrawal, aggressive behavior, social, thought, and attention problems and also on the internalizing and externalizing composite indexes. A higher percentage of participants with DLD scored within the clinical range on almost all CBCL dimensions compared to TD participants. The severity of rule-breaking problems, aggressive behavior, and social problems decreased with age. Both boys and girls with DLD showed an internalizing and externalizing profile, but girls with DLD scored significantly higher on thought problems.

CONCLUSIONS AND IMPLICATIONS

Population with DLD experience heightened emotional suffering, with some experiencing severe symptoms. This underscores the need for preventive programs that address not only the language difficulties in DLD, but also their socio-emotional development.

Emerging risk factors for heart failure in younger populations: A growing public health concern

Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.

Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study

BACKGROUND

Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations.

OBJECTIVE

The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based "check-in" tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool.

METHODS

We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data.

RESULTS

Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support.

CONCLUSIONS

The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations.

Wellness Coaching in a Summer Internship Program to Address the Mental Health Pandemic Among College Students, 2022-2023

In this article, we describe and present evaluation data for an innovative initiative and approach that integrate a wellness program into a summer pathway program for underrepresented undergraduate students in public health to address the students' mental health needs. This collaborative partnership and integrated wellness approach provide opportunities for summer programs at academic institutions to creatively address the needs of the students they serve. (Am J Public Health. Published online ahead of print April 17, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308014).

Socioeconomic status impacts Chinese late adolescents' internalizing problems: risk role of psychological insecurity and cognitive fusion

INTRODUCTION

Low socioeconomic status (SES) has been shown to be associated with more internalizing problems, but the mechanism of this relationship has not been investigated in Chinese late adolescents.

METHODS

High school students (N = 780, 54.45% girls) were recruited to complete questionnaires to assess SES, anxiety, depression, and cognitive fusion. We tested the hypotheses that this association would be mediated by the psychological insecurity and moderated by their cognitive fusion.

RESULTS

Regression-based analyses indicated that (1) psychological insecurity fully mediated the relationship between SES and internalizing problems; (2) late adolescents with high vs. low cognitive fusion showed a stronger positive association between psychological insecurity and internalizing problems.

DISCUSSION

The results highlight the important effects of psychological security and family resources on late adolescents' mental health and give implications for interventions aimed to reduce adolescent internalizing problems through acceptance and commitment therapy.

Combining the Risk: The Poly-Environmental Risk Score and Psychotic Symptoms in Adolescents

BACKGROUND AND HYPOTHESIS

Psychotic symptoms are common in adolescents and predictive of psychiatric disorders. Numerous risk factors have been shown to precede psychiatric disorders. However, investigating individual risk factors does not account for the cumulative effect these risk factors may have. Therefore, we combined well-researched environmental risk factors for psychotic disorder in a composite measure: the poly-environmental risk score (PERS).

STUDY DESIGN

Risk factors were assessed in a cohort of 801 adolescents (aged 15) at risk for psychopathology. Binarized risk factors included winter birth, low gestational age, low birth weight, ethnic minority status, urban living environment, cannabis use, victim of bullying, emotional abuse, physical abuse, sexual abuse, high paternal age, parental severe mental illness, parental divorce, and parental death. The PERS was weighted with the log odds derived from recent meta-analyses. At age 18, self-reported psychotic experiences (PE) and clinician-rated psychotic symptoms (PS) were assessed. This updated PERS was compared to previous PERS models, which included fewer risk factors and different weightings.

STUDY RESULTS

The PERS was associated with PE and PS. Specifically, a PERS between 3 and 4, and PERS > 4 corresponded with a 2.2- and 5.2-fold increase in the odds of psychotic symptoms in late adolescence. The updated 14-item PERS performed better compared to previous compositions of the PERS.

CONCLUSIONS

A composite score of childhood and adolescent risk factors measured at age 15 was associated with psychotic symptoms at age 18. Future research should consider the cumulative effect of risk factors when examining the determinants of psychopathology.

Study protocol: an effectiveness, cost-effectiveness, and process evaluation of headspace Denmark

Introduction

Since 2013, headspace Denmark has been offered in specific areas to adolescents and young adults between 12 and 25 years, to promote youth mental health and wellbeing. Headspace provides free counselling and support, primarily delivered by trained volunteers in the headspace centres and provides information and knowledge about youth mental health, and headspace services, through community engagement. Until now, effectiveness evaluation of the Danish headspace centres has not been conducted.

Methods

Present study consists of (1) an effectiveness evaluation designed as a propensity score matched quasi-experimental trial, where the exposed person (n = 1,500), in this case the young person receiving counselling sessions at headspace, will be matched by using propensity scores to six unexposed individuals. (2) A cost-effectiveness evaluation (3) a process evaluation with predominantly qualitative methods to investigate the implementation of key activities of headspace, their mechanisms of change, and interactions with contextual factors.

Discussion

headspace centres have achieved national endorsement and are implemented in 30 municipalities in Denmark. Thus, there is a need to investigate the effectiveness of the services. Results from the evaluation can also contribute to new knowledge targeted at international youth mental health promotion initiatives. However, this evaluation is limited by selection bias since it is not possible to separate the impact of the intervention from the impact of help-seeking behaviour.

Sample ascertainment and clinical outcome measures in the Accelerating Medicines Partnership® Schizophrenia Program

Clinical ascertainment and clinical outcome are key features of any large multisite study. In the ProNET and PRESCIENT research networks, the Accelerating Medicines Partnership® Schizophrenia (AMP®SCZ) Clinical Ascertainment and Outcome Measures Team aimed to establish a harmonized clinical assessment protocol across these two research networks and to define ascertainment criteria and primary and secondary endpoints. In addition to developing the assessment protocol, the goals of this aspect of the AMP SCZ project were: (1) to implement and monitor clinical training, ascertainment of participants, and clinical assessments; (2) to provide expert clinical input to the Psychosis Risk Evaluation, Data Integration and Computational Technologies: Data Processing, Analysis, and Coordination Center (PREDICT-DPACC) for data collection, quality control, and preparation of data for the analysis of the clinical measures; and (3) to provide ongoing support to the collection, analysis, and reporting of clinical data. This paper describes the (1) protocol clinical endpoints and outcomes, (2) rationale for the selection of the clinical measures, (3) extensive training of clinical staff, (4) preparation of clinical measures for a multisite study which includes several sites where English is not the native language; and (5) the assessment of measure stability over time in the AMP SCZ observational study comparing clinical ratings at baseline and at the 2-month follow up. Watch Dr. Jean Addington discuss her work and this article: https://vimeo.com/1040425281 .

Identifying the Changing Landscape of Younger Adult Mortality in the United States from 1999 to 2021

PURPOSE

To evaluate temporal trends and drivers of mortality among younger adults (aged 18-39), from 1999 to 2021.

METHODS

Observational study using nationally representative United States mortality data from 1999 to 2021, acquired via the US Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database. Exposure of interest was cause of death. Primary outcomes were population-level mortality rates and percent increase from 1999 to 2021. Secondary outcomes were cause-specific and subgroup-specific (sex, race, ethnicity) mortality rates and percent increases.

RESULTS

From 1999 to 2021, US younger adults aged 18-39 experienced a 54.1% increase in annual mortality (from 113.4 deaths per 100,000 in 1999 to 174.7 deaths per 100,000 in 2021; Cochran-Armitage p < .0001). Before COVID, from 1999 to 2019, younger adults experienced a 10.8% increase in mortality, compared to a 1.5% increase among the broader US population. The top driver of increased younger adult mortality, from 1999 through 2021, was accidental poisoning and exposure to noxious substances. Mortality trends varied by demographic variables with notable increases among American Indian/Alaskan Native Americans.

DISCUSSION

US younger adults are suffering from rising premature mortality. Resources should be calibrated to better support this generation.

Developmental trajectories of gyrification and sulcal morphometrics in children and adolescents at high familial risk for bipolar disorder or schizophrenia

Offspring of parents with severe mental illness are at increased risk of developing psychopathology. Identifying endophenotypic markers in high-familial-risk individuals can aid in early detection and inform development of prevention strategies. Using generalized additive mixed models, we compared age trajectories of gyrification index (GI) and sulcal morphometric measures (i.e., sulcal depth, length and width) between individuals at familial risk for bipolar disorder or schizophrenia and controls. 300 T1-weighted MRI scans were obtained of 187 individuals (53 % female, age range: 8-23 years) at familial risk for bipolar disorder (n = 80, n families=55) or schizophrenia (n = 53, n families=36) and controls (n = 54, n families=33). 113 individuals underwent two scans. Globally, GI, sulcal depth and sulcal length decreased significantly with age, and sulcal width increased significantly with age in a (near-)linear manner. There were no differences between groups in age trajectories or mean values of gyrification or any of the sulcal measures. These findings suggest that, on average, young individuals at familial risk for bipolar disorder or schizophrenia have preserved developmental patterns of gyrification and sulcal morphometrics during childhood and adolescence.

Prevalence and predictors of healthcare use for psychiatric disorders at 9 years after a first episode of psychosis: a Swedish national cohort study

BACKGROUND

Psychotic disorders are known to exhibit heterogeneity with regards to illness course and prognosis, yet few studies have examined long-term healthcare use.

OBJECTIVE

To determine the prevalence and predictors of healthcare use for psychiatric disorders at 9 years after the first episode of psychosis (FEP).

METHODS

National registers were used to identify all Swedish residents aged 18-35 years with FEP between 2006 and 2013. The 12-month period-prevalence of secondary healthcare use was determined at each year of the 9-year follow-up, categorised according to main diagnosis (psychotic disorder vs other psychiatric disorder vs none vs censored). Multinomial logistic regression models were used to examine associations between baseline characteristics and healthcare use at 9 years and derive predicted probabilities and 95% CIs for the four outcome groups, for each predictor variable.

FINDINGS

Among 7733 individuals with FEP, 31.7% were treated in secondary healthcare for psychotic disorders at the 9-year follow-up, 24.1% were treated for other psychiatric disorders, 35.7% did not use healthcare services for psychiatric disorders and 8.5% were censored due to death/emigration. Having an initial diagnosis of schizophrenia was associated with the highest probability of secondary healthcare use for psychotic disorder at 9 years (0.50, 95% CI (0.46 to 0.54)] followed by inpatient treatment at first diagnosis (0.37, 95% CI (0.35 to 0.38)).

CONCLUSION

Although 56% of individuals with FEP were treated for psychiatric disorders in secondary healthcare 9 years later, a substantial proportion were treated for non-psychotic disorders.

CLINICAL IMPLICATIONS

Individuals with an initial diagnosis of schizophrenia, who received their first diagnosis in inpatient settings, may need more intensive treatment to facilitate remission and recovery.

Modeling associations between physical recreation engagement and correlates of post-secondary student psychosocial well-being: Exploring differences among students living with and without a mental health condition

The purpose of the study was to examine on-campus physical recreation engagement as a student-life activity for supporting post-secondary student psychosocial well-being, physical activity (PA) guideline adherence, and academic achievement among post-secondary students. The study aimed to: (1) test a comprehensive model examining associations between engagement in on-campus physical recreation, psychosocial well-being outcomes (campus climate, social support, loneliness, psychological distress), PA guideline adherence, and academic achievement; and (2) explore model differences in the associations among students living with and without a mental health condition. Cross-sectional data from the national spring 2023 Canadian Campus Well-Being Survey were used. The analytical sample included 9575 students (Mage = 23.17 years; 48 % White; 65 % women; 29 % with a mental health condition). Based on findings from structural equation modeling, physical recreation engagement was directly associated with PA guideline adherence, social support, psychological distress, and loneliness. PA guideline adherence, social support, and campus climate were also directly associated with psychological distress, loneliness, and academic achievement. Physical recreation engagement was indirectly associated with more favourable outcomes in academic achievement, psychological distress, and loneliness through higher levels of social support. Physical recreation was indirectly associated with lower levels of psychological distress and loneliness through PA guideline adherence. Exploratory multi-group invariance analyses supported no model differences in the structural associations among students with a mental health condition. Promising targetable processes for supporting student psychosocial well-being through physical recreation engagement are provided. Theoretical and practical implications for informing whole-campus preventive well-being strategies centered on physical recreation among post-secondary students are discussed.

What is the internal structure of intolerance of uncertainty? A network analysis approach

BACKGROUND

Intolerance of uncertainty (IU) is a well-established risk factor for anxiety disorders, as higher levels of IU increase the likelihood of future maladaptive outcomes. However, the presence of low levels of IU does not imply that maladaptive outcomes will not occur, as other risk factors can still lead to the onset of anxiety symptoms. Currently, it is unknown whether IU also serves as a necessary cause for anxiety symptoms, meaning that its absence would ensure the absence of these symptoms.

METHODS

A sample of 186 adolescents (58.6 % boys) between 14 and 18 years of age (M = 16.58 ± 1.01) was followed for six months, with evaluations every three months. Several self-reports were administered to measure IU and general anxiety problems, derived from the Youth Self Report 11-18, and anxiety-specific symptoms, derived from the Self-Administered Psychiatric Scales for Children and Adolescents. The Necessary Condition Analysis approach was applied to determine the extent to which IU is a necessary condition for anxiety.

FINDINGS

The analyses revealed that IU is a necessary condition for anxiety problems (d =.23 -.24), generalized anxiety disorder symptoms (d =.18 -.19), social anxiety disorder symptoms (d =.19 -.29), and school-related anxiety symptoms (d =.19 -.23) after three and six months. However, IU was not a statistically significant necessary condition for separation anxiety disorder symptoms. At baseline, between 29 % and 70 % of the sample exhibited the necessary levels of IU to potentially experience subclinical anxiety symptoms at subsequent follow-ups.

DISCUSSION

IU is a necessary condition for the potential development of anxiety symptoms during adolescence. Recognizing necessary conditions for anxiety symptoms and mental disorders, in general, could lead to substantial progress, given its impact on enhancing our theoretical understanding and improving prevention strategies and clinical treatments.

Suicidal risk, insomnia symptoms, and interoceptive sensitivity: Network analysis in a university student population

Objective: This cross-sectional study examines the relationships between insomnia symptoms, suicidal risk, and interoceptive sensitivity in university students. Participants: A sample of 288 students from French universities was recruited. Methods: The Sleep Condition Indicator, the Suicide Behaviors Questionnaire-Revised, and the Multidimensional Assessment of Interoceptive Awareness were used to assess insomnia, suicidal risk, and interoception. Network analysis explored the connections between insomnia and suicidal risk, while mediation analysis examined the role of the interoceptive sensitivity dimensions. Results: 46.18% of participants had clinical insomnia, and 37.84% had elevated suicide risk. Nocturnal insomnia symptoms were more strongly associated with suicidal risk than daytime symptoms. Trusting body signals was found to partially mediate this association. Conclusions: These findings suggest that nocturnal insomnia may have a greater impact on suicide risk, with trust influencing this relationship. Addressing both insomnia and trust in interventions could help reduce suicide risk in university students.

A Scoping Review of Prevention Classification in Mental Health: Examining the Application of Caplan's and Gordon's Prevention Frameworks (2018-2024)

Mental health prevention is a global priority owing to the increasing burden of mental disorders exacerbated by global crises such as the COVID-19 pandemic, climate change, economic instability, and armed conflicts. These crises have heightened the need for effective preventive strategies addressing mental health across different life stages and populations. To structure and classify such strategies, Caplan's and Gordon's frameworks have been widely used, with one focusing on disease progression and the other on population risk. Although both frameworks are frequently used in mental health prevention, their application in clinical trials remains unexplored. This review addresses this gap by examining how Caplan's and Gordon's frameworks have been applied in mental health prevention, identifying research gaps, and exploring their potential for their combined application to enhance prevention strategies. A scoping review was conducted following PRISMA-ScR guidelines. Studies were selected based on predefined criteria and the data were synthesized. The search spanned PubMed, Scopus, APA PsycArticles, and PubPsych, covering peer-reviewed clinical trials, including randomized controlled trials, published between 2018 and 2024 in English or German. Eligible studies classified interventions based on Caplan's framework, which focuses on disease stage (primary, secondary, tertiary), or Gordon's framework, which categorizes prevention by population risk (universal, selective, indicated). Studies had to focus on mental health prevention, include populations relevant to mental health and well-being, and report mental health or well-being outcomes. Of the 40 included studies, six applied Caplan's framework, 30 applied Gordon's framework and three used a modified classification based on Gordon's approach. One study applied both frameworks, highlighting that their complementary use is rare. Studies were conducted in 19 countries, with the highest number from Germany (n = 8), the USA (n = 8), and the Netherlands (n = 6), across four continents (Asia, n = 5; Australia, n = 5; Europe, n = 22; North America, n = 8). Gordon's framework was applied more frequently, particularly in universal (n = 15) and indicated prevention (n = 12), while Caplan's framework was used mainly in primary prevention (n = 4). Depression (n = 25), anxiety (n = 21), stress (n = 8), and general mental health (n = 8) were the most frequently assessed outcomes. The studies targeted diverse populations, including children (n = 7), adolescents (n = 8), children and adolescents (n = 1) parents and their children or adolescents (n = 2), university students (n = 6), working adults (n = 7), older adults (n = 1), and adults without specifying (n = 8). This review highlights the underutilized potential of integrating Caplan's and Gordon's frameworks in mental health interventions. Two application examples illustrate how these frameworks can be combined to structure prevention strategies more effectively. Future research should explore combining these frameworks to enhance prevention strategies and address the emerging global health challenges.

Incidence and prevalence of dysthymia among young adults in China, 1990-2021, with forecasts to 2046: an age-period-cohort analysis of the Global Burden of Disease Study 2021

BACKGROUND

Dysthymia, a chronic depressive disorder, poses a significant public health challenge due to its prolonged course and substantial impact on quality of life, particularly among high-risk populations such as young adults. This study aims to investigate trends in dysthymia incidence and prevalence among young adults in China from 1990 to 2021 and to project future patterns through 2026.

METHODS

Using data from the Global Burden of Disease (GBD) 2021 Study, we conducted an Age-Period-Cohort (APC) analysis to assess the relative risks (RRs) of dysthymia incidence and prevalence among Chinese young adults aged 20-44 years from 1990 to 2021. Bayesian and Nordpred APC models were applied to forecast age-standardized incidence rates (ASIR) and prevalence rates (ASPR) for the next 25 years (2022-2046).

RESULTS

Between 1990 and 2019, both ASIR and ASPR of dysthymia exhibited a declining trend. Among females, ASIR decreased from 363.099 (95% uncertainty interval [UI]: 339.146, 387.051) per 100,000 population to 318.100 (95% UI: 296.812, 339.388), while among males, it declined from 232.757 (95% UI: 216.022, 249.492) to 208.467 (95% UI: 193.617, 223.317). Similarly, ASPR decreased from 2,072.562 (95% UI: 1,813.254, 2,331.870) to 1,795.234 (95% UI: 1,582.628, 2,007.841) for females and from 1,278.432 (95% UI: 1,116.869, 1,439.994) to 1,131.620 (95% UI: 994.059, 1,269.180) for males. However, a marked increase was observed from 2020, with 2021 rates approaching 1990 levels for both sexes. APC analysis showed that RRs for dysthymia incidence and prevalence increased with age, particularly beyond 35-39 years. More recent cohorts demonstrated lower RRs compared to earlier cohorts, whereas period effects remained relatively stable. Projections indicate a continuous rise in ASIR and ASPR from 2022 to 2046 for both sexes. Throughout the study period, dysthymia prevalence rates consistently exceeded incidence rates, with females exhibiting higher rates than males.

CONCLUSION

Enhancing early diagnostic capabilities in primary care, advancing standardized treatment strategies, improving mental health literacy through health education and social media, and implementing targeted interventions for high-risk groups-particularly young women and individuals in early adulthood-are essential for alleviating the burden of dysthymia in China and other countries with similar demographic and epidemiological characteristics.

Brain health Begins Before Birth (B4): A "learning" pregnancy and birth cohort study

Mental health disorders affect over 1 billion people worldwide, profoundly impacting individuals, families, and the global economy. Risk for psychopathology begins early in life, with the perinatal period representing a critical window of vulnerability. The Brain health Begins Before Birth (B4) Study at Massachusetts General Hospital (MGH) is a prospective birth cohort designed to identify modifiable risk and resilience factors influencing early brain development and child- and adult-onset psychopathology. This study aims to deeply phenotype prenatal exposures through maternal surveys administered at multiple time points during and after pregnancy; assess early neurodevelopmental outcomes through the first two years of life; and triangulate exposure and outcome data with underlying biological mechanisms. The B4 Study consists of structured, remote surveys covering psychosocial, environmental, and health-related factors throughout pregnancy and the first two years of life, supplemented by medical record review. By integrating risk and resilience factors into a dynamic learning cohort model, the B4 Study aims to advance the field of preventive psychiatry by identifying actionable pathways for early intervention, testing strategies in real-time, and ultimately shaping policies that promote lifelong mental health and wellbeing from the earliest stages of development.

Positive childhood experiences in mental health of young adults across adverse childhood experiences levels: A study from Delhi-NCR, India

BACKGROUND

While the impact of adverse childhood experiences (ACEs) on adult health outcomes has received substantial scientific attention, the role of positive childhood experiences (PCEs) has far less widely been explored, especially in low- and middle-income countries.

OBJECTIVE

The present study aimed to understand the association of exposure to cumulative and individual PCEs with current depression, anxiety, stress, and well-being among young adults in Delhi-NCR, India, independently and across ACE exposure levels.

PARTICIPANTS AND SETTING

This cross-sectional study involved 1553 young adults (aged 18-25) of both sexes (70.3 % females) residing in Delhi-NCR.

METHODS

PCEs and ACEs were measured using the Benevolent Childhood Experiences scale and ACE- International Questionnaire, respectively. Depression, anxiety, stress, and well-being were screened using validated tools.

RESULTS

In the overall analysis, exposure to PCEs was negatively associated with depression, anxiety, and stress and positively associated with well-being, even after accounting for ACEs. Feeling comfortable with oneself emerged as the most important PCE item with respect to studied mental health conditions. The stratified analysis showed that while the PCE score was associated only with depression (negatively) in the no ACE category, it was associated with all the studied outcome variables in higher ACE categories.

CONCLUSIONS

The study found PCEs to be associated with better mental health outcomes across varying ACE levels, with the protective effect being particularly pronounced in high ACE contexts. Promoting PCEs can help improve mental health outcomes and well-being despite adversities.

Effectiveness of mental health chatbots in depression and anxiety for adolescents and young adults: a meta-analysis of randomized controlled trials

BACKGROUND

The mental health chatbot is dedicated to providing assistance to individuals grappling with the complexities of depression and anxiety.

OBJECTIVE

The study aimed to evaluate the effectiveness of the mental health chatbot in alleviating symptoms of depression and anxiety among adolescents and young adults.

METHODS

A systematic review framework was employed with a protocol pre-registered on Prospero (CRD42023418877). Databases were systematically searched, including PubMed, ACM Digital Library, Embase, Cochrane and IEEE. Data synthesis was conducted narratively, and meta-analysis was performed by pooling data from the original studies.

RESULTS

Ten randomized controlled trials focused on an acute population, mainly females and university students. Chatbots designed for daily conversations and mood monitoring, using cognitive behavioral therapy techniques, showed efficacy in treating depression (95% CI = -1.09 to -0.23; p = .003). However, it is essential to highlight that these interventions utilizing chatbots for mental health were not found to be efficacious in managing symptoms of anxiety (95% CI = -0.56 to 0.4; p = .74).

CONCLUSIONS

Evidence supports the effectiveness of mental health chatbots in treating depression, but further exploration and refinement are needed to optimize their efficacy in managing anxiety.

Levels of depression, anxiety, and stress among emerging adults in the Philippines: an exploratory spatial analysis

BACKGROUND

Despite the enactment of the mental health law, mental illness in the Philippines is the third most prevalent form of morbidity; hence, screening is warranted, especially among Filipino emerging adults. This exploratory spatial analysis study aimed to identify spatial clusters of depression, anxiety, and stress among Filipino emerging adults.

METHODS

A convenience sampling online self-administered survey was used to collect data from 18 to 29 Filipinos (n = 2729) in the Philippines. The Depression Anxiety Stress Scales-21 was utilized to ascertain the participant's level of depression, anxiety, and stress. Coordinates were plotted with administrative boundaries and OpenStreetMap layer using the software ArcGIS, and clusters were evaluated using the Mapping Clusters-Hot Spot Analysis and Spatial Autocorrelation (Moran's I).

RESULTS

Results of mapping clusters regarding age group and sex showed that Pangasinan, Nueva Ecija, Tarlac, Pampanga, Bulacan, Rizal, Laguna, Cavite, and the National Capital Region in Luzon Island are considered hotspots for severe and extreme levels of depression, anxiety, and stress. These conditions were most prevalent among early emerging adults and females.

CONCLUSION

Our study provided spatial locations of populations susceptible to mental health disorders, and these preliminary findings have implications for health policy and program expansion for mental health.

Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes

Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed 81 PRISMA-guided studies on the efficacy, feasibility, and applicability of NG-CBT approaches. Other important innovations include web-based interventions, AI-operated chatbots, and teletherapy platforms, each of which serves as a critical challenge in delivering mental health care. Key messages have emerged regarding technological readiness, patient engagement, and the changing role of therapists within the digital context of care. Results: Findings indicate that NG-CBT interventions improve treatment accessibility and engagement while maintaining clinical effectiveness. Personalized digital tools enhance adherence, and teletherapy platforms provide scalable and cost-effective alternatives to traditional therapy. Conclusions: Such developments promise great avenues for decreasing the global burden of depression and enhancing the quality of life through novel, accessible, and high-quality therapeutic approaches.

Rethinking how to deal with demand and supply in CAP: a European training perspective

Mental health care is suffering from a substantial gap between current service provision capacity and demand. For the generation of young doctors in psychiatry training programs today, this means they face substantial and potentially overwhelming challenges in their clinical practice. This situation calls for creative solutions in psychiatry training to prepare them best for these challenges. Perspectives of European trainers in child and adolescent psychiatry (CAP) were collected and analysed following an iterative procedure in three rounds using thematic analysis of focus groups. The three iterative rounds resulted in five proposed strategies for meeting the challenges of current and future demand in CAP specifically addressing implications for CAP training. Examples were provided illustrating how these strategies could be put into daily training practices. Four strategies aimed mainly at increasing capacity: efficiency (making best use of the existing CAP workforce); consultation (task-sharing); innovation (practicing differently); and wellbeing of the CAP workforce. An additional strategy focusing on prevention and early intervention was identified to decrease demand upstream. Rethinking CAP training practices through a European perspective on the balance between capacity and demand yielded strategies for aspects of training that are not yet universally applied. Implementation is partly dependent on the larger service provision system of care while training has leverage for future capacity and quality of care.

The Impact of Place-Based Approaches Addressing Mental Health and Substance Use Among Adolescents: A Systematic Review of the Literature

Objectives

We systematically appraised peer reviewed evidence assessing the impact of "place-based approaches" (PBAs) - those requiring multi-sectoral action within localities to address complex health challenges - on mental health outcomes among adolescents.

Methods

We searched six databases from inception to May 2023. We defined PBAs as at least two sectors (e.g., local government, health) working collaboratively within a locality. Studies reporting mental health and substance-use among young people (aged 10-24) were included. Two authors independently assessed study quality using MMAT. Heterogeneity in PBAs, study design and outcomes prevented meta-analysis; results were narratively synthesised.

Results

Thirty-three publications presented data from 22 PBA evaluations; 6 evaluations assessed mental health or wellbeing, 16 appraised substance use. Higher quality evaluations found no impact on mental health outcomes (n = 4), and some evidence for delayed initiation (n = 4) and reduced point-in-time use (n = 10) of alcohol. Evidence for impact on binge-drinking and drug use was mixed.

Conclusion

Based on very few published studies of mixed quality, PBAs have not improved mental health or wellbeing among adolescents. More evidence exists to suggest PBAs can improve certain alcohol use outcomes in young people.

Preventing psychosis in people at clinical high risk: an updated meta-analysis by the World Psychiatric Association Preventive Psychiatry section

Recently published large-scale randomised controlled trials (RCTs) have questioned the efficacy of preventive interventions in individuals at clinical high risk for psychosis (CHR-P). We conducted a systematic review and meta-analysis to include this new evidence and provide future directions for the field. We followed the PRISMA guidelines and a pre-registered protocol, with a literature search conducted from inception to November 2023. We included RCTs that collected data on psychosis transition (the primary outcome) in CHR-P. Secondary outcomes were symptoms severity and functioning. Investigated time points were 6,12,24,36, and +36 months. We used odd ratios (ORs) and standardised mean differences (SMD) as summary outcomes. Heterogeneity was estimated with the Higgins I2. Twenty-four RCTs, involving 3236 CHR-P individuals, were included. Active interventions were Cognitive Behavioural Therapy (CBT), family-focused therapy, Integrated Psychological Therapy, antipsychotics, omega-3 fatty acids, CBT plus risperidone, minocycline, and other non-pharmacological approaches (cognitive remediation, sleep-targeted therapy, brain stimulation). Results showed no evidence that any of the investigated active interventions had a sustained and robust effect on any of the investigated outcomes in CHR-P, when compared to control interventions, including CBT on transition to psychosis at 12 months (9 RCTs; OR: 0.64; 95% CI: 0.39-1.06; I2: 21%; P = 0.08). These results highlight the need for novel treatment approaches in CHR-P. Future studies should consider the heterogeneity of this clinical population and prioritise stratification strategies and bespoke treatments.

Sensitivity of the clinical high-risk and familial high-risk approaches for psychotic disorders - a systematic review and meta-analysis

BACKGROUND

Psychosis prediction has been a key focus of psychiatry research for over 20 years. The two dominant approaches to identifying psychosis risk have been the clinical high-risk (CHR) and the familial high-risk (FHR) approaches. To date, the real-world sensitivity of these approaches - that is, the proportion of all future psychotic disorders in the population that they identify - has not been systematically reviewed.

METHODS

We systematically reviewed and meta-analysed studies in MEDLINE, Embase, PsychINFO, and Web of Science (from inception until September 2024) that reported data on the sensitivity of CHR and FHR approaches - i.e., individuals with a psychosis diagnosis preceded by a CHR diagnosis or a history of parental psychosis (PROSPERO: CRD42024542268).

RESULTS

We identified four CHR studies and four FHR studies reporting relevant data. The pooled estimate of the sensitivity of the CHR approach was 6.7% (95% CI: 1.5-15.0%) and of the FHR approach was 6.5% (95% CI: 4.4-8.9%). There was a high level of heterogeneity between studies. Most FHR studies had a low risk of bias, but most CHR studies had a high risk of bias.

CONCLUSION

Pooled data suggest that CHR and FHR approaches, each, capture only about 6-7% of future psychotic disorders. These findings demonstrate the need for additional approaches to identify risk for psychosis.

Using a co-design approach to develop a Preventative Online Mental Health Program for Youth (POMHPY): a quality improvement project

BACKGROUND

During the COVID-19 pandemic, youth in Ontario, Canada experienced a steep rise in mental health concerns. Preventative intervention programs can address the psychological impact of the pandemic on youth and build resiliency. Co-design approaches to developing such programs actively involve young people, resulting in solutions tailored to their unique needs. The current paper details the co-design approach to creating a Preventative Online Mental Health Program for Youth (POMHPY)-a virtually delivered program designed for Ontario youth ages 12 to 25 that promotes mental, physical, and social wellbeing.

METHODS

The Participatory Action Research (PAR) framework guided the development of the initiative. Literature reviews were conducted to identify existing evidence-based programs targeting youth. Youth perspectives were primarily gathered via the Youth Advisory Group, comprising a Youth Resilience Coordinator and a Youth Engagement Lead, who contributed to a literature review, surveys, focus groups, and program assets. Community insights were gathered through Community Reference Group (CRG) meetings, which engaged participants from local and provincial organizations, as well as individuals either directly representing or affiliated at arm's length with youth.

RESULTS

A review of the current literature highlighted the importance of regular physical activity, social connectedness, good sleep hygiene, and healthy family relationships to emotional wellbeing. Survey findings informed program session length, duration, delivery, and activities. Focus groups expanded on the survey findings and provided an in-depth understanding of youth preferences for program delivery. CRG meetings captured community insights on program refinements to better meet the needs of youth. As such, the development of POMHPY was a collaborative effort among researchers, youth, and community partners.

CONCLUSIONS

The findings highlight the value of co-design and PAR-informed approaches in developing youth-targeted online wellbeing programs, providing actionable insights for iterative improvements and future pilot testing. The resulting 6-week program, led by youth facilitators, will focus on teaching mental, social, and physical wellness strategies and skills through various evidence-based, interactive activities.

The changing impacts of social determinants on youth mental health in Australia

AIMS

Most lifetime mental health disorders begin by age 25 years, and the prevalence among young people has been increasing over recent years. We sought to understand what impact, if any, social determinants have had on this increase through the analysis of an Australian longitudinal dataset (with data from 2007 to 2021).

METHODS

The analysis focused on five social determinants: loneliness and lack of social support, family relationships, participation in education and employment, receipt of government benefits and relative socio-economic status. We analysed cross-sectional changes in self-reported psychological distress between 2007 and 2021 (using the Kessler-10 item; K10 scores) and examined the effects of these five social determinants on psychological distress using weighted linear regression models.

RESULTS

We identified a significant increase in psychological distress among Australians from 2007 to 2021, with the sharpest rise among those aged 15 to 25 years, who saw more than doubling in the percentage of high and very high K10. This period also saw an increase in the prevalence of social determinants such as loneliness and lack of social support, as well as poor family relationships, particularly in 2021 post COVID-19 pandemic. Regression models suggest loneliness and lack of social support had the most pronounced and increasing impact on psychological distress, followed by poor family relationships.

DISCUSSION

The observed significant and steady increases in psychological distress and related social determinant factors, particularly loneliness and lack of social support among young people, highlight the urgent need for comprehensive actions. Coordinated research and community-based initiatives are needed to deliver intrapersonal, interpersonal and socially-focused interventions with a holistic approach to support psychosocial wellbeing. Policymakers must adopt a comprehensive shift in political commitment and a whole-of-government approach to address these challenges.

Reimagining psychosis prevention: responding to the accessibility issues of At-Risk Mental State (ARMS) services through a selective public health approach

At-Risk Mental State (ARMS) services aim to prevent the onset of first-episode psychosis (FEP) in those with specific clinical or genetic risk markers. In England, ARMS services are currently expanding, but the accessibility of this preventative approach remains questionable, especially for a subgroup of FEP patients and those from specific ethnic minority communities. This commentary outlines the key debates about why a complimentary approach to psychosis prevention is necessary, and gives details for an innovative public health strategy, drawing on existing research and health prevention theory.

Early Detection of Psychosis in Eating Disorders: Unnecessary or a Useful Addition?

AIM

The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans-diagnostically assessed the prevalence and co-occurrence of at-risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr.

METHOD

This cross-sectional and observational-prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16-35 who were referred for various kinds of non-psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities.

RESULTS

Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED-consistent and ED-inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference.

CONCLUSIONS

From a trans-diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co-morbid ED in other kinds of psychopathology is being overlooked.

Clinical utility of the at-risk for psychosis state beyond transition: A multidimensional network analysis

To be relevant to healthcare systems, the clinical high risk for psychosis (CHR-P) concept should denote a specific (i.e., unique) clinical population and provide useful information to guide the choice of intervention. The current study applied network analyses to examine the clinical specificities of CHR-P youths compared to general help-seekers and non-CHR-P youth. 146 CHR-P (mean age = 14.32 years) and 103 non-CHR-P (mean age = 12.58 years) help-seeking youth were recruited from a neuropsychiatric unit and assessed using the Structured Interview for Psychosis-Risk Syndromes, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, Global Functioning: Social, Global Functioning: Role, and Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale. The first network structure comprised the entire help-seeking sample (i.e., help-seekers network), the second only CHR-P patients (i.e., CHR-P network), and the third only non-CHR-P patients (i.e., non-CHR-P network). In the help-seekers network, each variable presented at least one edge. In the CHR-P network, two isolated "archipelagos of symptoms" were identified: (a) a subgraph including functioning, anxiety, depressive, negative, disorganization, and general symptoms; and (b) a subgraph including positive symptoms and the intelligence quotient. In the non-CHR-P network, positive symptoms were negatively connected to functioning, disorganization, and negative symptoms. Positive symptoms were less connected in the CHR-P network, indicating a need for specific interventions alongside those treating comorbid disorders. The findings suggest specific clinical characteristics of CHR-P youth to guide the development of tailored interventions, thereby supporting the clinical utility of the CHR-P concept.

The Indirect Effects of Fathers' Parenting Style and Parent Emotion Regulation on the Relationship Between Father Self-Efficacy and Children's Mental Health Difficulties

Improving parental self-efficacy has been linked with reductions in child mental health difficulties; however, underlying mechanisms remain unclear, especially for fathers. This study investigated whether father self-efficacy influences child mental health difficulties indirectly through parenting style and parent-facilitated regulation of children's negative emotions. A community sample of American fathers (N = 350, M = 39.45 years old) completed self-reports on father self-efficacy, parenting styles, parent-facilitated emotion regulation, and their children's mental health difficulties (aged 4-12). Path analysis was used to test a cross-sectional, parallel-sequential indirect effect model. Father self-efficacy had a significant indirect effect on child mental health difficulties via three significant pathways of permissive parenting, authoritative parenting-acceptance of child's negative emotions, and authoritarian parenting-avoidance of child's negative emotions. Our model explained a moderate amount of variance in child mental health difficulties. The findings support promoting father self-efficacy through parenting interventions and highlight parenting beliefs as important for clinicians providing child mental health care.

Co-development of general psychopathology and high-risk personality traits during adolescence

There is strong evidence for a general psychopathology dimension which captures covariance among all forms of psychopathology, yet its nature and underlying association with personality remain unclear. This study examined the co-development of general psychopathology and four high-risk personality traits: anxiety sensitivity, negative thinking, sensation seeking, and impulsivity. Data from two large Australian school-based randomised controlled trials of substance use prevention programs were analysed (N = 2,083, mean age at baseline = 13.49 years). Adolescents completed self-report measures of psychopathology symptoms and personality at baseline, one-, two-, and three-years post-baseline. Latent curve models with structured residuals, were used to examine the co-development of general psychopathology (extracted from a higher-order model) and personality traits from 13 to 16 years of age, controlling for age, sex, and cohort. Higher than usual levels of anxiety sensitivity and impulsivity were associated with higher than usual levels of general psychopathology at subsequent time points, and higher than usual levels of general psychopathology were associated with higher than usual levels of negative thinking at later time points. Sensation seeking was unrelated to general psychopathology. These findings enhance our understanding of the meaning and validity of general psychopathology, highlighting potential personality-based prevention and intervention targets.

Adolescents' experiences of a whole-school preventive intervention addressing mental health and nonsuicidal self-injury: a qualitative study

BACKGROUND

Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents' experiences of such interventions.

METHODS

A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13-15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

RESULTS

The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents' conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents' experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

CONCLUSIONS

Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents' need for autonomy when planning mental health prevention and intervention.

Five-year follow-up of the iBerry Study: screening in early adolescence to identify those at risk of psychopathology in emerging adulthood

The iBerry Study, a Dutch population-based high-risk cohort (n = 1022) examines the transition from subclinical symptoms to psychiatric disorders in adolescents. Here, we present the first follow-up measurement, approximately 3 years after baseline assessment and 5 years after the screening based on self-reported emotional and behavioral problems (SDQ-Y). We give an update on the data collection, details on the (non)response, and the results on psychopathology outcomes. The first follow-up (2019-2022) had a response rate of 79% (n = 807). Our results at baseline (mean age 15.0 years) have shown the effectiveness of using the SDQ-Y to select a cohort oversampled for the risk of psychopathology. At first follow-up (mean age 18.1 years), the previously administered SDQ-Y remains predictive for selecting adolescents at risk. At follow-up, 47% of the high-risk adolescents showed significant mental health problems based on self- and parent reports and 46% of the high-risk adolescents met the criteria for multiple DSM-5 diagnoses. Compared to low-risk adolescents, high-risk adolescents had a sevenfold higher odds of significant emotional and behavioral problems at follow-up. Comprehensive assessment on psychopathology, substance abuse, psychotic symptoms, suicidality, nonsuicidal self-injury, addiction to social media and/or video gaming, and delinquency, as well as social development, and the utilization of healthcare and social services were conducted. This wave, as well as the ones to follow, track these adolescents into their young adulthood to identify risk factors, elucidate causal mechanisms, and discern pathways leading to both common and severe mental disorders. Results from the iBerry Study will provide leads for preventive interventions.

Universal Prevention Strategies to Prevent Opioid Misuse on a U.S. College Campus

Opioid misuse and risk of death due to overdose are critical public health issues and young adults are at risk. College campus communities are ideal settings for the prevention of opioid misuse among young adults due to high enrollment rates, the diversity and availability of resources within the campus community, and the range of risk and protective factors that can be targeted. This practitioner narrative describes a grant-funded three-year opioid misuse prevention project implemented on a U.S. college campus. In keeping with the focus of the grant, the project involved a range of universal prevention activities implemented across the campus community. Lessons learned regarding factors that facilitated implementation in this community context are discussed and may be useful for others interested in implementing prevention activities to help prevent opioid misuse among young adults in their campus communities. Additionally, a reflection on the project and the efficacy of universal prevention to prevent opioid misuse among college students are offered for consideration.

Addressing burgeoning unmet needs in college mental health

America is experiencing burgeoning mental health needs of their college students. Measuring the impact of mental health challenges for these students and the natural ways they adapt to them might enable smart triage of limited mental health resources. This may, in part, be achieved through a combination of technology-assisted personalized measurement-based care, treatment matching, and peer-support. Helping students self-monitor and organize their personal peer networks can destigmatize and increase accessibility to timely mental health care, especially for students of marginalized identities, who might otherwise be hesitant to receive care or be misdiagnosed. A collaborative effort among students, educators, clinicians, and health technology innovators may provide more tractable solutions for student unmet needs than any single entity or resource alone. Novel resources, tailored through a healthy equity lens that is individualized and culturally-sensitive, may meaningfully meet a student's needs, preferences, and acceptability, and translate to daily use and informed decision-making.

Physical activity interventions for the promotion of mental health outcomes in at-risk children and adolescents: a systematic review

Many young people are exposed to risk factors that increase their risk of mental illness. Physical activity provision is an increasingly popular approach to protect against mental illness in the face of these risk factors. We examined the effectiveness of physical activity interventions for the promotion of mental health outcomes in at-risk children and adolescents. We searched health databases for randomised and non-randomised intervention studies, with no date restriction, and assessed risk of bias using the Cochrane Risk of Bias tools. We present a narrative synthesis of our results accompanied with a summary of available effect sizes. Thirty-seven reports on 36 studies were included, with multi-sport or yoga interventions the most popular intervention approaches (a combined 50% of included studies). Outcomes measured included internalising, self-evaluative, wellbeing, overall symptomatology, resilience, externalising, and trauma outcomes. We found that 63% of between-groups effects favoured the intervention arm, and 83% of within-groups effects favoured an intervention effect. While recognising high risk of bias, our findings provide evidence in support of the effectiveness of physical activity interventions for promoting mental health outcomes in at-risk young people. We encourage further work designed to better understand the intervention characteristics that may lead to positive benefits.

Understanding the transdiagnostic mechanisms underlying emerging psychopathology in adolescence: study protocol of a 1-year prospective epidemiological (EMERGE) study

INTRODUCTION

Adolescent mental health is a global public health challenge as most cases remain undetected and untreated, and consequently, have a high likelihood of persistence or recurrence. It is critical to improve early detection of mental disorders and to target individuals experiencing subclinical symptoms. However, most indicated prevention approaches have been developed for risk syndromes of specific mental disorders. This contradicts the increasing recognition of emerging psychopathology as a complex system characterised by rapid shifts in subclinical symptoms, cutting across diagnostic categories and interacting with each other over time. Therefore, this study aims to examine the dynamic course, pattern and network of subclinical symptoms and transdiagnostic mechanisms over time.

METHOD AND ANALYSIS

The EMERGE-study is a prospective, naturalistic, 1-year follow-up study. A general population sample of 1196 adolescents will be recruited. Inclusion criteria are age between 11 and 17 years, German language skills, main residency in Switzerland and access to internet. Individuals will be excluded if they have a current or lifetime axis I mental disorder. Assessments of subclinical symptoms of several mental disorders and potential transdiagnostic mechanisms will be conducted at baseline and at 3-month, 6-month, 9-month and 12-month follow-up. Structural equation modelling will be used to estimate the homotypic and heterotypic patterns of subclinical symptoms and the associations with transdiagnostic mechanisms. Latent growth mixture modelling and growth mixture survival analysis will be carried out to identify subclasses of individuals with different trajectories of subclinical symptoms that may be predictive of an onset of a mental disorder. Network analysis will be applied to assess the centrality of subclinical symptoms and how networks of emerging psychopathology change over time.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Bern Cantonal Ethics Committee (ID 2020-02108). All findings will be disseminated by publication in peer-reviewed scientific journals and by presentation of the results to conferences and stakeholder organisation events.

Mental health and lifestyle-related behaviors in medical students in a Jordanian University, and variations by clerkship status

BACKGROUND

The rigors of medical education often take a toll on students' mental well-being, resulting in heightened stress, anxiety, depression, somatization, and thoughts of self-harm. This study aimed to determine the prevalence of mental health problems among Jordanian medical students (Yarmouk University), explore the links between mental state and demographic and lifestyle factors, and compare mental health profiles between pre-clinical/pre-clerkship (years 1-3) and clinical/clerkship (years 4-6) students.

METHODS

An online survey was distributed to undergraduate medical students at Yarmouk University. Mental health was measured using validated tools (depression: Patient Health Questionnaire, PHQ-9; eating disorders: SCOFF; Generalized Anxiety Disorder Scale, GAD-7; Somatic Symptoms: Patient Health Questionnaire, PHQ-15; overall stress (single-item measure); ability to handle stress; stressors and coping mechanisms. Data on sociodemographic factors, academic performance, and lifestyle choices, also were collected. Bivariate and multivariable analyses evaluated the associations between academic level and mental health, accounting for sociodemographic and lifestyle factors.

RESULTS

Of the 618 medical students who responded, 48.4% screened positive for depression, 36.7% for anxiety, and 63.6% for high level of stress. Slightly over half experienced somatic symptoms, and 28.6% exhibited signs of eating disorders. Roughly, 26% had suicidal thoughts, as measured by item 9 of the PHQ-9 scale. Low reported rates of healthy behaviors were observed (e.g. balanced diets, 5.7%; vigorous physical activity, 17.0%). Smoking prevalence was 24.6%, notably higher among clinical students. At the multivariable level, stress, insomnia, eating disorders and cigarette smoking were significantly associated with depression, anxiety and somatization. Higher physical activity scores were associated with lower depression risk. Females were significantly more likely than males to fall in more severe somatization categories.

CONCLUSION

This study highlights the need to address the alarming rates of mental health problems among Jordanian medical students. While few significant differences were observed between pre-clinical and clinical students, the high rates of depression, anxiety, stress, and negative health practices in both groups suggest the need for interventions that begin at enrollment as well as during transitions to clinical settings. Prioritizing mental health support and promoting healthier lifestyles among medical students are vital steps toward nurturing resilient, well-rounded future medical professionals.

Unhealthy Lifestyle Contributes to Negative Mental Health and Poor Quality of Life in Young University Students

Background: A negative lifestyle is reported to be related to poor mental health and quality of life (QOL). However, there is little information on this in university students. The objective of the present study was to investigate the association between mental health (i.e., anxiety, depression symptoms and stress), QOL, SWLS and lifestyle parameters (i.e., PA, sleep duration, ST and food habits) among Chilean university students and then to determine the differences in mental health, QOL, SWLS and lifestyle parameters according to gender. Methods: This cross-sectional study included a total of 211 university students (128 females and 83 males) aged 18-28 years. Mental health, QOL and lifestyle were measured through validated questionnaires. Results: Bad food habits (lowest score in the food survey) were linked to anxiety (2.3 [0.22-4.36], p = 0.03), depressive symptoms (3.75 [1.54-5.9], p = 0.001) and stress (2.24 [0.31-4.17], p = 0.023). Furthermore, <6 h of sleep was related to poorer mental health (13.5 [7.6-19.5], p = 0.001), anxiety (4.2 [2.0-6.4], p < 0.001), depressive symptoms (5.5 [3.2-7.9], p < 0.001) and stress (3.8 [1.8-5.9], p < 0.001). In addition, ≥4 h of ST was linked positively to negative mental health (8.3 [2.86-13.7], p = 0.003), depressive symptoms (3.45 [1.47-5.4], p = 0.001) and anxiety (3.2 [1.05-5.4], p = 0.004). Non-physical activity was related to the scores for anxiety (2.6 [0.20-5.0], p = 0.030), depression (2.7 [0.009-5.3], p = 0.049) and stress (2.4 [0.12-4.7], p = 0.039). Conclusions: this study showed that unhealthy lifestyle factors (i.e., insufficient sleep, lack of PA and prolonged ST) were strongly associated with poorer mental health and QOL in university students. These findings highlight the importance of addressing these aspects of lifestyle in intervention and health promotion programs aimed at young university students in order to improve their mental health and overall QOL.

Running in the FAMILY: understanding and predicting the intergenerational transmission of mental illness

Over 50% of children with a parent with severe mental illness will develop mental illness by early adulthood. However, intergenerational transmission of risk for mental illness in one's children is insufficiently considered in clinical practice, nor is it sufficiently utilised into diagnostics and care for children of ill parents. This leads to delays in diagnosing young offspring and missed opportunities for protective actions and resilience strengthening. Prior twin, family, and adoption studies suggest that the aetiology of mental illness is governed by a complex interplay of genetic and environmental factors, potentially mediated by changes in epigenetic programming and brain development. However, how these factors ultimately materialise into mental disorders remains unclear. Here, we present the FAMILY consortium, an interdisciplinary, multimodal (e.g., (epi)genetics, neuroimaging, environment, behaviour), multilevel (e.g., individual-level, family-level), and multisite study funded by a European Union Horizon-Staying-Healthy-2021 grant. FAMILY focuses on understanding and prediction of intergenerational transmission of mental illness, using genetically informed causal inference, multimodal normative prediction, and animal modelling. Moreover, FAMILY applies methods from social sciences to map social and ethical consequences of risk prediction to prepare clinical practice for future implementation. FAMILY aims to deliver: (i) new discoveries clarifying the aetiology of mental illness and the process of resilience, thereby providing new targets for prevention and intervention studies; (ii) a risk prediction model within a normative modelling framework to predict who is at risk for developing mental illness; and (iii) insight into social and ethical issues related to risk prediction to inform clinical guidelines.

Using Electronic Health Records to Facilitate Precision Psychiatry

The use of clinical prediction models to produce individualized risk estimates can facilitate the implementation of precision psychiatry. As a source of data from large, clinically representative patient samples, electronic health records (EHRs) provide a platform to develop and validate clinical prediction models, as well as potentially implement them in routine clinical care. The current review describes promising use cases for the application of precision psychiatry to EHR data and considers their performance in terms of discrimination (ability to separate individuals with and without the outcome) and calibration (extent to which predicted risk estimates correspond to observed outcomes), as well as their potential clinical utility (weighing benefits and costs associated with the model compared to different approaches across different assumptions of the number needed to test). We review 4 externally validated clinical prediction models designed to predict psychosis onset, psychotic relapse, cardiometabolic morbidity, and suicide risk. We then discuss the prospects for clinically implementing these models and the potential added value of integrating data from evidence syntheses, standardized psychometric assessments, and biological data into EHRs. Clinical prediction models can utilize routinely collected EHR data in an innovative way, representing a unique opportunity to inform real-world clinical decision making. Combining data from other sources (e.g., meta-analyses) or enhancing EHR data with information from research studies (clinical and biomarker data) may enhance our abilities to improve the performance of clinical prediction models.

Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.

Sensitivity of the familial high-risk approach for the prediction of future psychosis: a total population study

Children who have a parent with a psychotic disorder present an increased risk of developing psychosis. It is unclear to date, however, what proportion of all psychosis cases in the population are captured by a familial high-risk for psychosis (FHR-P) approach. This is essential information for prevention research and health service planning, as it tells us the total proportion of psychosis cases that this high-risk approach would prevent if an effective intervention were developed. Through a prospective cohort study including all individuals born in Finland between January 1, 1987 and December 31, 1992, we examined the absolute risk and total proportion of psychosis cases captured by FHR-P and by a transdiagnostic familial risk approach (TDFR-P) based on parental inpatient hospitalization for any mental disorder. Outcomes of non-affective psychosis (ICD-10: F20-F29) and schizophrenia (ICD-10: F20) were identified in the index children up to December 31, 2016. Of the index children (N=368,937), 1.5% (N=5,544) met FHR-P criteria and 10.3% (N=38,040) met TDFR-P criteria. By the study endpoint, 1.9% (N=6,966) of the index children had been diagnosed with non-affective psychosis and 0.5% (N=1,846) with schizophrenia. In terms of sensitivity, of all non-affective psychosis cases in the index children, 5.2% (N=355) were captured by FHR-P and 20.6% (N=1,413) by TDFR-P approaches. The absolute risk of non-affective psychosis was 6.4% in those with FHR-P, and 3.7% in those with TDFR-P. There was notable variation in the sensitivity and total proportion of FHR-P and TDFR-P cases captured based on the age at which FHR-P/TDFR-P were determined. The absolute risk for psychosis, however, was relatively time invariant. These metrics are essential to inform intervention strategies for psychosis risk requiring pragmatic decision-making.

Childhood and adolescence outcomes in offspring to parents with bipolar disorder: the impact of lifetime parental comorbidity, parental sex, and bipolar subtype

BACKGROUND

Offspring of parents with bipolar disorder have increased risks of their own psychopathology. However, a large-scale survey of psychiatric, somatic, and adverse social outcomes up to adulthood, which could aid in prioritizing and tailoring prevention, is lacking. It also remains to clarify how risks are modified by other parental factors.

METHODS

Swedish population registers were linked to compare offspring having (N = 24,788) and not having (N = 247,880) a parent with bipolar disorder with respect to psychiatric diagnoses and psychotropic medication, birth-related and somatic conditions, social outcomes, accidents, suicide attempts, and mortality. Individuals were followed until age 18. We estimated the influence of lifetime parental psychiatric comorbidity, bipolar disorder subtype, and sex on outcomes.

RESULTS

Children of parents with bipolar disorder had 2-3 times higher risks of all psychiatric diagnoses, except for bipolar disorder, for which the risk was 11-fold. Significantly increased risks were also found for several somatic conditions, low school grades, criminal behavior, victimization, accidents, and suicidal behavior. Adjusting for lifetime parental psychiatric comorbidity attenuated most associations. Offspring of a parent with bipolar disorder type 2 had statistically significantly higher risks of attention deficit hyperactivity disorder, respiratory tract conditions, and accidents compared with offspring of a parent with bipolar disorder type 1. Offspring of mothers with bipolar disorder had higher risks of several psychiatric diagnoses, respiratory tract conditions, low school grades, and accidents compared with offspring of fathers with bipolar disorder. Having two parents with bipolar disorder entailed the highest risks of psychiatric outcomes in offspring.

CONCLUSIONS

Early intervention and family support are particularly warranted for the offspring of a parent with bipolar disorder in the presence of lifetime parental psychiatric comorbidity, when the parent has bipolar disorder type 2, or when the mother or both parents have bipolar disorder.

The relationship between physical activity and Internet addiction among adolescents in western China: a chain mediating model of anxiety and inhibitory control

This study aims to investigate the mediating effect of anxiety and inhibitory control in the relationship between physical activity and Internet addiction (IA) among adolescents. A total of 951 adolescents from western China completed a self-report survey assessing physical activity, anxiety, inhibitory control, and IA. Descriptive analysis, correlation analysis, and mediation analysis were conducted using SPSS software and the Process plug-in. Controlling for age, gender, and only child status, the findings revealed a negative association between physical activity and anxiety, inhibitory control, and IA. Moreover, anxiety were positively correlated with inhibitory control and IA. Additionally, anxiety exhibited a positive association with inhibitory control. Notably, physical activity directly and negatively predicted IA in adolescents, while also indirectly predicting it through anxiety and inhibitory control. This study contributes to a deeper understanding of the mechanisms that underlie the complex effects of physical activity on IA among adolescents.