Assessment and treatment of anxiety disorders in children and adolescents

Parent Perceptions of an Anxiety Prevention Manual for Young Children

Parents are primary "supporters" for helping their children cope with feelings of anxiety, a significant concern for many young children. The current study examined parents' perceptions of an anxiety management manual. Parents reviewed an anxiety coping manual for elementary school-aged children. This manual explained how anxiety influences the body and emotions, as well as presenting cognitive-behavioral anxiety management strategies. The strategies included breathing, imagery (superhero to fight worries and imagine your favorite place), relaxation, talking to supportive others, and using distraction. Convenience samples of 15 parents completed virtual interviews and 6 completed in-person interviews to determine their perceptions of the manual and of worry for today's children. Qualitative analyses were performed to determine themes in the data. Results indicated that parents would use the manual and key themes, which were (1) learning new strategies for helping their child, (2) discussing children's worries, and (3) sharing why the worry strategies would be useful (e.g., for emotion regulation). Parents felt that today's children are worrying more about serious things like school performance and family stressors. Future research needs to examine parent implementation of the strategies over time to determine if the use of anxiety management strategies is related to lower levels of worry for young children, if the strategies reduce anxiety-related stress, and if prevention minimizes the impact of anxiety on emotional functioning.

The improvement path of depression and anxiety among adult women in Shanxi Province, China: a fuzzy-set qualitative comparative analysis

Background

Depression and anxiety (D&A) are currently recognized as complex and prevalent mental disorders that pose major threats to mental health. Women are more susceptible to D&A than men.

Methods

We collected data from female participants in Shanxi Province between November 2021 and March 2022 through on-site investigations and an online survey. The survey collected information on sociodemographic traits, lifestyle factors, and physical and mental health. The degree of D&A was evaluated using the Center for Epidemiological Studies Depression Scale (CESD-10) and the Generalized Anxiety Disorder Assessment Scale (GAD-7). We assessed the impact of these factors on D&A symptoms among women using regression and fuzzy-set qualitative comparative analysis (fsQCA).

Results

D&A symptoms had many common influencing factors. Regression analysis identified key protective factors against D&A, including better self-rated health (Depression: OR = 0.11, 95% CI = 0.03-0.47; Anxiety: OR = 0.11, 95% CI = 0.02-0.57) and the absence of recent illness (Depression: OR = 0.56, 95% CI = 0.38-0.83; Anxiety: OR = 0.49, 95% CI = 0.35-0.70). Age exhibited marginal protective effects for both conditions (OR = 0.99, 95% CI = 0.98-1.00). In contrast, occupational stress constituted a significant risk factor, substantially increasing the likelihood of depression (OR = 2.66, 95% CI = 1.43-4.96) and anxiety (OR = 2.99, 95% CI = 1.43-4.96). FsQCA analysis did not identify the conditions for ideal mental health (all consistency < 0.9). However, it did identify eight condition configurations predicting mental health (absence of depression symptoms), each achieving consistency ≥0.87. Additionally, two distinct configurations explained resilience to anxiety (consistency ≥0.80). All configurations met fsQCA's consistency requirements, with self-rated health (present in 10/10 pathways), social support (9/10), and marital status (9/10) playing important roles in most configurations.

Conclusion

Women's mental health faces significant challenges, with D&A being closely intertwined. FsQCA did not identify any specific condition for the absence of D&A symptoms. However, it revealed multiple pathways to mental well-being, highlighting the need for personalized, multifactorial interventions rather than a one-size-fits-all approach. Regression and fsQCA complement each other, offering unique strengths, and their combined insights should be widely applied to broader research and practice.

A Google Trends analysis exploring public interest in common psychiatric conditions and non-pharmacological interventions

BACKGROUND AND OBJECTIVES

To use Google Trends for analyzing public interest in common psychiatric illnesses such as Depression, Anxiety, Bipolar Disorder, Post-traumatic Stress Disorder, and Obsessive-Compulsive Disorder, along with their various treatment modalities, in the United States over the past 10 years, in order to provide insights into emerging treatment modalities and their popularity among the population.

METHODOLOGY

A cross-sectional study was conducted from May 7 to June 6, 2024, using Google Trends data, specifically Relative Search Volume (RSV) from 2014 to 2023. Relative Search Volume is a metric provided by Google Trends, it is normalized to a scale of 0-100, where 100 represents the peak popularity of a search item within the selected time frame and location. Various psychological diseases and treatment modalities were searched individually, with all data and statistical analysis performed using Microsoft Excel and R v4.3.2.

RESULTS

The analysis revealed an overall increase in annual search interest for various mental health conditions, with Anxiety peaking in 2023 and Depression reaching its highest Relative Search Volume (RSV) in 2019. While Bipolar Disorder (BPD), Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) also showed an upward trend, their increases were less pronounced. Additionally, search interest in therapeutic interventions, including Cognitive Behavioral Therapy (CBT), Psychotherapy, and Dialectical Behavioral Therapy (DBT), significantly increased from 2019 to 2023 compared to 2014-2018 (p < 0.05). In contrast, Electroconvulsive Therapy (ECT) had higher search frequency in the earlier period. These findings suggest a growing public interest in mental health conditions and evidence-based treatment options in recent years.

CONCLUSIONS

Limitations of this study include the use of Google Trends data, which relies on RSV rather than absolute search counts, which may not fully capture the extent of public interest. Additionally, the data cannot differentiate whether the searches were made by patients or healthcare professionals. However, the study's findings reflect a growing recognition and acceptance of diverse treatment approaches for mental health conditions, and concludes that while Google Trends is useful for analyzing public interest in psychiatric illnesses, further research is needed to ensure the reliability of the results.

Evaluating the efficacy of transcranial direct current stimulation (tDCS) in managing neuropathic pain-induced emotional consequences: Insights from animal models

Neuropathic pain is a global health concern due to its severity and its detrimental impact on patients' quality of life. It is primarily characterized by sensory alterations, most commonly hyperalgesia and allodynia. As the disease progresses, patients with neuropathic pain develop co-occurring emotional disorders, such as anxiety and depression, which further complicate therapeutic management. While pharmacotherapy remains the first-line treatment, limitations in its efficacy and the prevalence of side effects often leave patients with insufficient pain relief. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, has recently emerged as a promising alternative for chronic pain management. This review provides an overview of preclinical studies examining the effects of tDCS in rodent models of neuropathic pain. It specifically highlights the potential of tDCS to modulate the emotional-affective component of pain, with a focus on identifying optimal cortical targets for stimulation to enhance the translational application of tDCS in managing pain-related emotional disorders.

Genetic and Regulatory Mechanisms of Comorbidity of Anxiety, Depression and ADHD: A GWAS Meta-Meta-Analysis Through the Lens of a System Biological and Pharmacogenomic Perspective in 18.5 M Subjects

Background: In the United States, approximately 1 in 5 children experience comorbidities with mental illness, including depression and anxiety, which lead to poor general health outcomes. Adolescents with substance use disorders exhibit high rates of co-occurring mental illness, with over 60% meeting diagnostic criteria for another psychiatric condition in community-based treatment programs. Comorbidities are influenced by both genetic (DNA antecedents) and environmental (epigenetic) factors. Given the significant impact of psychiatric comorbidities on individuals' lives, this study aims to uncover common mechanisms through a Genome-Wide Association Study (GWAS) meta-meta-analysis. Methods: GWAS datasets were obtained for each comorbid phenotype, followed by a GWAS meta-meta-analysis using a significance threshold of p < 5E-8 to validate the rationale behind combining all GWAS phenotypes. The combined and refined dataset was subjected to bioinformatic analyses, including Protein-Protein Interactions and Systems Biology. Pharmacogenomics (PGx) annotations for all potential genes with at least one PGx were tested, and the genes identified were combined with the Genetic Addiction Risk Severity (GARS) test, which included 10 genes and eleven Single Nucleotide Polymorphisms (SNPs). The STRING-MODEL was employed to discover novel networks and Protein-Drug interactions. Results: Autism Spectrum Disorder (ASD) was identified as the top manifestation derived from the known comorbid interaction of anxiety, depression, and attention deficit hyperactivity disorder (ADHD). The STRING-MODEL and Protein-Drug interaction analysis revealed a novel network associated with these psychiatric comorbidities. The findings suggest that these interactions are linked to the need to induce "dopamine homeostasis" as a therapeutic outcome. Conclusions: This study provides a reliable genetic and epigenetic map that could assist healthcare professionals in the therapeutic care of patients presenting with multiple psychiatric manifestations, including anxiety, depression, and ADHD. The results highlight the importance of targeting dopamine homeostasis in managing ASD linked to these comorbidities. These insights may guide future pharmacogenomic interventions to improve clinical outcomes in affected individuals.

A Systematic Review of Parental Involvement in Digital Cognitive Behavioural Therapy Interventions for Child Anxiety

Cognitive behavioural therapy (CBT) is an efficacious intervention for child anxiety that has been translated into accessible digital formats, many of which involve parents in treatment. However, the value of parental involvement in treatment is not clearly understood. This systematic review examined characteristics of parental involvement (i.e., format and content of sessions, level of therapist guidance, and parent session compliance) in digital CBT for child anxiety (mean child age ≤ 12 years) and their relation to child outcomes (primary disorder remission, clinician-, parent-, and child-rated anxiety, and global functioning). Systematic searches in CINAHL, Embase, ERIC, PsychINFO, PubMed, and Scopus up to 14th August 2023, and citation searching, identified 27 articles (as 23 studies) assessing 14 interventions. Two were parent-only programmes for 3-6-year-old children, with the remaining being parent-child programmes targeting older children. Parents were actively involved as coaches/collaborators, assisting their children with anxiety management and exposure, and less often as co-clients working on their own difficulties. Benefits of treatment were observed across interventions, except for one, psychoeducation-based programme. Higher remission rates were more frequently observed in interventions delivered in controlled settings, those with fewer parent-only sessions, or those incorporating more parent- or therapist-led exposure sessions. Most studies were conducted with affluent samples, limiting generalisability, and several received a high risk of bias rating. Future research should examine parent and family related mechanisms of change and modify interventions for improved adherence, such as restricting the number of modules parents are required to complete and teaching key therapeutic strategies such as exposure early in the programme.

Predicting remission following CBT for childhood anxiety disorders: a machine learning approach

BACKGROUND

The identification of predictors of treatment response is crucial for improving treatment outcome for children with anxiety disorders. Machine learning methods provide opportunities to identify combinations of factors that contribute to risk prediction models.

METHODS

A machine learning approach was applied to predict anxiety disorder remission in a large sample of 2114 anxious youth (5-18 years). Potential predictors included demographic, clinical, parental, and treatment variables with data obtained pre-treatment, post-treatment, and at least one follow-up.

RESULTS

All machine learning models performed similarly for remission outcomes, with AUC between 0.67 and 0.69. There was significant alignment between the factors that contributed to the models predicting two target outcomes: remission of all anxiety disorders and the primary anxiety disorder. Children who were older, had multiple anxiety disorders, comorbid depression, comorbid externalising disorders, received group treatment and therapy delivered by a more experienced therapist, and who had a parent with higher anxiety and depression symptoms, were more likely than other children to still meet criteria for anxiety disorders at the completion of therapy. In both models, the absence of a social anxiety disorder and being treated by a therapist with less experience contributed to the model predicting a higher likelihood of remission.

CONCLUSIONS

These findings underscore the utility of prediction models that may indicate which children are more likely to remit or are more at risk of non-remission following CBT for childhood anxiety.

Childhood Anxiety Disorders

Anxiety disorders are common in children and adolescents, with many youths experiencing functional impairment in multiple domains because of these conditions. Biologic and cognitive-behavioral models provide a basis for the development and maintenance of these disorders. Cognitive behavioral therapy (CBT) with exposures and selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors are empirically supported treatments for childhood anxiety disorders. Exposures are a key component of CBT treatment and a case vignette demonstrates how to tailor exposures to the unique fears of the child.

The Organization of Anxiety Symptoms Along the Threat Imminence Continuum

Pathological anxiety is highly prevalent, impairing, and often chronic. Yet, despite considerable research, mechanistic understanding of anxiety and its translation to clinical practice remain limited. Here, we first highlight two foundational complications that contribute to this gap: a reliance on a phenomenology-driven definition of pathological anxiety in neurobiological mechanistic research, and a limited understanding of the chronicity of anxiety symptom expression. We then posit that anxiety symptoms may reflect aberrant expression of otherwise normative defensive responses. Accordingly, we propose that threat imminence, an organizing dimension for normative defensive responses observed across species, may be applied to organize and understand anxiety symptoms along a temporal dimension of expression. Empirical evidence linking distinct anxiety symptoms and the aberrant expression of imminence-dependent defensive responses is reviewed, alongside the neural mechanisms which may underpin these cognitive, physiological, and behavioral responses. Drawing from extensive translational and clinical research, we suggest that understanding anxiety symptoms through this neurobiologically-informed framework may begin to overcome the conceptual complications hindering advancement in mechanistic research and clinical interventions for pathological anxiety.

Learning to be mindful ─ experiences of mindfulness-based stress reduction for young adults with moderate to severe mental disorders

INTRODUCTION

Mental disorders among young adults are a major health challenge. Mindfulness-based stress reduction (MBSR) has in previous research shown positive effects on mental health. However, research evaluating MBSR for young adults with mental disorders is insufficient and qualitative research exploring experiences of the programme is scarce. The aim of this study was to explore experiences of MBSR as a supplementary treatment in psychiatric outpatient care among young adults with moderate to severe mental disorders, from a short- and long-term perspective.

METHOD

Eleven young adults (aged 18-27 years) who had participated in an MBSR programme were interviewed approximately three months or two years later. The analytic method was Grounded Theory.

RESULTS

The analysis resulted in a theoretical model including one core category and five categories. The model illustrated a learning process, explaining the participants' short- and long-term experiences of learning to pay attention to the body, regulate emotions, a change of attitude towards oneself, and still using skills two years after the programme.

DISCUSSION

The MBSR programme was experienced as a learning process which improved the longstanding ability to cope with emotional stress in daily life. Tailoring MBSR to individual needs may further enhance its effectiveness.

CONCLUSION

The experienced short- and long-term health-promotion benefits of an MBSR programme among young adults with mental disorders support its implementation in psychiatric and primary health care. Future research should investigate how to optimise implementation and tailor to individual needs.

Parental Overprotection and Locus of Control as the Mechanisms Explaining the Relationship Between Parent and Child Anxiety: A Multiple Mediation Model

The study probes the role played by parenting control practices and parental locus of control in the relationship between parent and child anxiety. The study particularly aims at probing these matters in light of the parental gender-specific role, striving to improve our understanding of the differential etiological contribution of mothers' and fathers' anxiety and parental practices to child's anxiety. The study consisted of 316 parents (159 mothers and 157 fathers) who reported their own and their child's anxiety using valid instruments. The general path model used in the study exhibited an adequate fit to the data, generally confirming our theory regarding the direct and indirect associations between parent-child anxiety. Using SEM multiple group analysis for parental gender, a strong-direct unique association was found between parent and child anxiety. For mothers, this association was partially mediated by maternal overprotection. Finally, maternal external locus of control was positively associated with child anxiety, after accounting for the effects of all other maternal variables. The study's findings and limitations are profoundly discussed in light of parental gender differences.

Efficacy of a Cognitive‑Behavioral Anxiety Management Program Integrated Within a Reading Intervention

This study examined the efficacy of a 2-year anxiety management intervention integrated with a reading intervention for struggling readers in upper-elementary grades on anxiety outcomes. The study randomly assigned 128 struggling readers to one of three conditions: (a) reading intervention with anxiety management intervention (RANX), (b) reading intervention with math fact practice, an attention control, (RMATH), and (c) business-as-usual comparison (BaU). Findings demonstrated promising results for students in the RANX condition, particularly compared with the BaU condition. However, findings were not always statistically significant suggesting the need for additional adequately powered trials. Secondary analyses among students beginning with average anxiety showed significant reductions in physical symptoms of anxiety at year 1 posttest favoring RANX over RMATH and BAU, as well as between RANX and BAU on reading anxiety at year 2 posttest. Among students beginning with elevated anxiety, significant reductions in social anxiety were found at year 2 posttest favoring RANX over RMATH and BaU. The findings underscore the promise of integrating anxiety management and reading interventions.

Effectiveness of a cognitive behavioural therapy (CBT)-based intervention for reducing anxiety among adolescents in the Colombo District, Sri Lanka: cluster randomized controlled trial

Anxiety disorders are found to be the most prevalent psychological problems among children and adolescents. Cognitive behaviour therapy (CBT) was found to be effective at reducing anxiety. The purpose of this study was to assess the effectiveness of a universal school-based intervention for reducing anxiety among Grade 9 schoolchildren. A randomized controlled cluster trial was conducted by randomly assigning 36 schools in the Colombo district in Sri Lanka into study and control arms, each comprising 18 schools with 360 students. The levels of anxiety, self-esteem and depression status were assessed using the validated Screen for Child Anxiety Related Disorders (SCARED) tool and the Rosenberg self-esteem scale, respectively, and the Depression, Anxiety and Stress Scale 21 (DASS-21) at baseline, after intervention, and after 3 months. A CBT-based universal intervention package was administered weekly by a trained teacher for eight weeks with a one-month self-practice period to a randomly selected Grade 9 class in each school in the study arm. The control arm received routine care. Anxiety and self-esteem scores and depression status were compared between the two arms after the intervention and at 3 months of follow-up using the generalized estimation equation (GEE), controlling for confounding and clustering. The nonresponse and loss to follow-up rates were < 1%. When comparing the study arm with the control arm using GEE, anxiety levels were significantly lower [β = (-0.096), 95% CI = (-0.005) - (-0.186), p = 0.038] at follow-up but not postintervention [β = (-0.024), 95% CI = 0.006 - (-0.055), p = 0.115]. There were no significant differences in depression status after intervention (OR = 0.257, 95% CI =0.052-1.286; p = 0.098) or follow-up (OR = 0.422, 95% CI 0.177-1.008; p = 0.052), and self-esteem significantly increased after intervention (β = 0.811, 95% CI = 0.314-1.309; p = 0.001) but not at follow-up [β=0.435, 95% CI=(-0.276)-1.145, p=0.231]. This study revealed that the universal package based on CBT is effective at reducing anxiety and improving self-esteem among adolescents. The trial registration number and date were SLCTR/2018/018 and 19th of June 2018 respectively.

Impact of a mindfulness-based intervention on well-being and mental health of elementary school children: results from a randomized cluster trial

Prevention programs, such as mindfulness-based interventions (MBIs), are often implemented in schools to prevent psychological disorders from emerging in children and to support their mental health. This study used a randomized cluster design to evaluate the impact of a MBI, called Mission Méditation, on the well-being and the mental health of elementary school children's. 13 classrooms of an elementary school were randomly allocated to the experimental condition (7 classrooms, n = 127 students) or the waitlist control condition (6 classrooms, n = 104 students). Participants in the experimental condition received a 10-week MBI. Regression analyses revealed significant differences between conditions for inattention. Participants in the MBI condition reported no change in pre- to post-intervention, whereas participants in the control condition reported pre- to post-intervention increases. Results also showed significant differences in perceived competence. Participants in the MBI condition reported a non-significant decrease in perceive competence, whereas participants in the control condition reported significantly higher perceive competence scores from pre- to post-intervention. Results do not indicate that the MBI had a significant impact on participant's well-being and mental health. This suggests that MBIs may not have an added value when compared to other preventive interventions geared towards well-being and mental health promotion in school settings.

Pediatric anxiety disorders: Basic concepts for primary care

Anxiety disorders in children and adolescents often present in primary care, and many clinicians will need to guide families on treatment. The purpose of this article is to give a brief overview of assessment and treatment principles for clinicians in primary care. Anxiety and its expression are heavily influenced by children's developmental progression and capabilities. Anxiety disorders have multiple underlying etiologies including temperament, environmental exposure to stressors, and childhood trauma. All anxiety disorders are strengthened by an operant process known as escape conditioning. The most effective treatments for child and adolescent anxiety begin with behavioral-based interventions including exposure with response prevention (ERP) and cognitive behavioral therapy (CBT). Medication can be effective in combination with CBT and ERP, or as a standalone treatment when behavioral interventions are not available. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors have been evaluated by randomized clinical trials for the treatment of childhood anxiety, but most are not approved by the Food and Drug Administration. When anxiety is severe and functional impairment is high, referral for psychiatric care and multimodal treatment reduces the likelihood of poor outcomes.

Exploring the Association of Age with Depressive Symptomatology in Childhood and Adolescence: A Network Study

OBJECTIVE

This study aimed to explore the association of age with individual depression and anxiety symptoms and their connectivity (i.e., number/strength of connections with other symptoms) in girls and boys.

METHOD

Our study comprised cross-sectional data from 31,960 Dutch girls and 32,162 Dutch boys aged 8 to 18 and considered 11 depression symptoms and 14 anxiety symptoms measured by the Revised Child Anxiety and Depression Scale. Network estimations were used to examine whether age was associated with individual symptoms and, in a separate step, with the connectivity of depression symptoms with other depression symptoms and with the connectivity of depression symptoms with anxiety symptoms.

RESULTS

Age was, in general, positively associated with depression symptoms in girls, but not in boys, and with the connectivity of depression symptoms with other depression symptoms in both sexes. These findings were the most profound for energy-related symptoms in girls. Age was, in general, negatively associated with anxiety symptoms and not or negatively associated with the connectivity of depression symptoms with anxiety symptoms in girls and boys, respectively. Substantial differences across symptoms were found.

CONCLUSIONS

This study shows that it is important to focus on individual symptoms, for age is mainly associated with energy-related depression symptoms and their connectivity in girls. Future etiologic studies may examine the role of energy-related depression symptoms in the development of depressive symptomatology in girls as these symptoms seem potential targets for the prevention of depression in the female population.

Mental disorders in former street-working boys

The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004-2005 and again in 2021, when the participants' mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.

Association between gut microbiota and anxiety disorders: a bidirectional two-sample mendelian randomization study

BACKGROUND

There are many articles reporting that the component of intestinal microbiota implies a link to anxiety disorders (AD), and the brain-gut axis is also a hot topic in current research. However, the specific relevance between gut microbiota and AD is uncertain. We aimed to investigate causal relationship between gut microbiota and AD by using bidirectional Mendelian randomization (MR).

METHODS

Genetic instrumental variable (IV) for the gut microbiota were obtained from a genome-wide association study (GWAS) involving 18,340 participants. Summary data for AD were derived from the GWAS and included 158,565 cases and 300,995 controls. We applied the inverse variance weighted (IVW) method as the main analysis. Cochran's Q values was computed to evaluate the heterogeneity among IVs. Sensitivity analyses including intercept of MR-Egger method and MR-PRESSO analysis were used to test the horizontal pleiotropy.

RESULT

We discovered 9 potential connections between bacterial traits on genus level and AD. Utilizing the IVW method, we identified 5 bacterial genera that exhibited a direct correlation with the risk of AD: genus Eubacteriumbrachygroup, genus Coprococcus3, genus Enterorhabdus, genus Oxalobacter, genus Ruminiclostridium6. Additionally, we found 4 bacterial genera that exhibited a negative association with AD: genus Blautia, genus Butyricicoccus, genus Erysipelotrichaceae-UCG003 and genus Parasutterella. The associations were confirmed by the sensitivity analyses.

CONCLUSION

Our study found a causal relation between parts of the gut microbiota and AD. Further randomized controlled trials are crucial to elucidate the positive effects of probiotics on AD and their particular protection systems.

Traffic-related pollution and symptoms of depression and anxiety among Chinese adults: A population-based study

BACKGROUND

Limited understanding exists regarding the associations of traffic-related pollution with depression and anxiety symptoms in individuals residing within low- and middle-income countries.

METHODS

Data for this study were extracted from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey, implemented between June 20 and August 31, 2023. We determined residential proximity to major roadways through self-reports and evaluated depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), along with anxiety symptoms assessed through the Generalized Anxiety Disorder-7 (GAD-7). We examined the associations between residential proximity to major roadways and depression and anxiety symptoms using logistic regressions and generalized linear models, while controlling for potential confounding variables.

RESULTS

This study comprised a total of 22,723 participants. The adjusted odds ratios (OR) for depression symptoms were 1.34 (95 % confidence interval (CI) 1.20, 1.51), 1.29 (95 % CI 1.17, 1.43), 1.34 (95 % CI 1.20, 1.49), and 1.32 (95 % CI 1.17, 1.49) among individuals residing within <50 m, 50-100 m, 101-200 m, and 201-300 m, respectively, in comparison to those residing >300 m from a major roadway. Individuals residing <50 m, 50-100 m, 101-200 m, and 201-300 m from a major roadway exhibited adjusted OR for anxiety symptoms of 1.49 (95 % CI 1.30, 1.69), 1.21 (95 % CI 1.07, 1.37), 1.38 (95 % CI 1.21, 1.56), and 1.38 (95 % CI 1.20, 1.59), respectively, in contrast to those residing >300 m.

CONCLUSIONS

This study provides valuable insights into the associations between environmental factors and mental health. The findings underscore the importance of integrating environmental considerations into comprehensive mental health frameworks, especially for individuals residing near high-traffic areas.

Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning

Background: The association between stressful life events (SLEs) and adolescent anxiety symptoms has been extensively studied, but the specific impacts of different SLEs domains remain inconclusive. Moreover, limited research has examined the role of family functioning in these associations.Objective: This study aimed to investigate the associations between various recent SLEs and adolescent anxiety symptoms and explore the role of family functioning.Methods: Data were obtained from the second phase of the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research in Guangzhou, China. A total of 10,985 students (51.9% boys; mean [SD] age, 15.3 [1.5] years) from forty middle schools participated in the study in 2022 and completed a self-report questionnaire assessing anxiety symptoms, SLEs, and family functioning using the Generalized Anxiety Disorder-7 (GAD-7), Adolescent Self-rating Life Events Checklist (ASLEC; including five subscales: interpersonal stress, academic stress, punishment-related stress, loss-related stress, and adaptation-related stress), and the adapted Chinese version of the Family Assessment Device (FAD), respectively. Linear mixed-effects models were performed and the moderation role of family functioning was also examined.Results: The fully adjusted model revealed that a 1-SD increase in the overall ASLEC score was associated with higher levels of anxiety symptoms (β = 2.23, 95%CI: 2.15-2.32). Among various SLEs domains, the academic domain shows the most significant association (β = 2.25, 95%CI: 2.17-2.33). Family functioning exerted an independent protective influence on anxiety symptoms, with each 1-SD increase in FAD scores negatively associated with anxiety symptoms (β = -2.11, 95%CI: - 2.29 to - 1.93) in the adjusted model. Moreover, family functioning significantly buffered the impacts of overall SLEs and each domain, except for adaptation-related SLEs, on anxiety symptoms.Conclusion: Higher recent SLEs levels were associated with increased anxiety symptoms among adolescents, with academic SLEs showing the greatest association. Positive family functioning had both direct and buffering influences on anxiety symptoms.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population

INTRODUCTION

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms.

METHODS

Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-related symptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms.

RESULTS

Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity.

CONCLUSIONS

Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Adolescents' electronic devices use during the COVID-19 pandemic and its relationship to anxiety and depression levels: a cross-sectional study

BACKGROUND

The aim of this study is to assess the prevalence of anxiety and depression symptoms among adolescent students in the West Bank region of Palestine, with a particular focus on the impact of electronic device usage on their mental well-being.

METHODS

This cross-sectional study included a representative sample of 1,140 adolescents enrolled in governmental secondary schools. We targeted schools located in Nablus, Ramallah, and Hebron districts, which, respectively, represent the northern, central, and southern regions of the West Bank. We collected data on their sociodemographic characteristics, patterns of electronic device usage, scores from the Beck Depression Inventory-II, and the 7-item Generalized Anxiety Disorder scale, all gathered through a self-administered online questionnaire. To explore the independent relationship between anxiety, depression, and various factors, we calculated odds ratios and their corresponding 95% CI using a binary logistic regression model.

RESULTS

The study revealed a prevalence of moderate to severe anxiety at 35.4% [95% CI: 32.7-38.3%] and moderate to severe depression at 23.9% [95% CI: 21.4-26.4%]. Notably, anxiety scores were significantly higher among females [OR = 3.8, 95% CI: 2.5-5.9], individuals with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.1-3.0]. Similarly, significantly elevated depressive scores were observed among females [OR = 2.0, 95% CI: 1.3-3.1], those with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.3-2.8]. Conversely, students who used electronic devices for shorter durations were less likely to experience depression [OR = 0.49, 95% CI: 0.32-0.76] or anxiety [OR = 0.47, 95% CI: 0.32-0.69].

CONCLUSION

Considering the alarming rates of anxiety and depression in adolescents, along with their connection to the time spent using electronic devices, we strongly recommend the creation of initiatives and support networks to alleviate this issue's impact. Encouraging healthier lifestyles, such as reducing screen time and increasing physical activity, could potentially enhance the mental well-being of adolescents.

Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

BACKGROUND

Behavioral cough suppression therapy (BCST) with a speech-language pathologist is a common treatment for chronic nonspecific cough (a.k.a., tic cough) in children. Yet, the outcomes and duration of pediatric BCST have eluded formal investigation. This study examined whether BCST improves cough in children with nonspecific cough and factors that predict the course of treatment. Additionally, the cough characteristics and comorbidities associated with the condition were examined.

METHODS

A retrospective, observational cohort design was utilized. Cough characteristics, medical history, and BCST treatment details and outcomes for 151 children were extracted from the electronic medical record of a large outpatient pediatric otolaryngology clinic.

RESULTS

Cough was dry and onset unaccompanied by illness in most cases. Roughly half of patients reported gradual onset and cough proceeded by tickle. On average, patients experienced symptoms for 19 months (SD = 20.09) before diagnosis. Rates of comorbid General Anxiety Disorder were elevated compared to pediatric norms. Additionally, high rates of asthma (22.1%), reflux (62.3%), and disordered sleep breathing (19.2%) were observed. Common findings on laryngoscopy included interarytenoid edema and erythema. Vocal fold changes were observed in 22.9% of children. BCST reduced cough in 92.5% of patients following an average of 1.7 sessions. Comorbid behavioral health diagnoses (p = 0.013) or induced laryngeal obstruction symptoms (p = 0.025) were significant predictors of increased therapy sessions. Cough proceeded by tickle significantly predicted fewer sessions in therapy (p = 0.011).

INTERPRETATION

Although randomized clinical trials are needed, these data suggest that BCST is a low-risk, effective treatment for children with nonspecific cough.

Association of tumor location with anxiety and depression in childhood brain cancer survivors: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the association between the location (supratentorial or infratentorial) of brain tumors and the development of depression and anxiety in childhood cancer survivors. Understanding the risk factors for the development of depression and anxiety disordersin these patients is crucial for early diagnosis and successful treatment.

METHODS

The meta-analysis included articles that listed patients diagnosed with an intracranial tumor before the age of 18 years, provided the location of the tumor, had exact data on the prevalence of anxiety and depression, or measured these disorders using different assessment tools. The search was conducted in five different databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library). Risk of bias was assessed using QUIPS-2. Outcome measures used were prevalences and standardized means.

RESULTS

The analysis included 42 eligible articles with a total number of 1071 patients. Relevant articles were cohort studies, cross-sectional studies, and case series. Based on the available data infratentorial brain tumor survivors had significantly higher scores on various assessment tools measuring anxiety (MRAW (raw mean scores): 36.24 [CI (confidence interval): 28.81-43.67]; versus MRAW: 23.21 (CI 0.91-45.51); p = 0.02, and depression (MRAW: 27.57 (CI 14.35-40.78) versus MRAW: 13.84 (CI 11.43-16.26); p < 0.01.

CONCLUSION

Childhood infratentorial cancer survivors have more impairments in terms of depression and anxiety; these children and adults should be monitored more frequently and may require closer follow-up on their mental health. The main limitation of our study originates from the lack of data on follow-up times used by different studies.

Developmental Epidemiology of Pediatric Anxiety Disorders

This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.

Treatment for Anxiety Disorders in the Pediatric Primary Care Setting

Anxiety disorders are among the most diagnosed mental health problems in children and adolescents. Without intervention, anxiety disorders in youth are chronic, debilitating, and amplify risk of negative sequelae. Youth with anxiety present to primary care frequently and often families choose to first discuss mental health concerns with their pediatricians. Both behavioral and pharmacologic interventions can be effectively implemented in primary care, and research demonstrates the effectiveness of both approaches.

Treatment Implications of Sleep-Related Problems in Pediatric Anxiety Disorders: A Narrative Review of the Literature

Pediatric anxiety disorders and sleep-related problems (SRPs) are highly prevalent and are associated with serious health or psychopathological consequences. This narrative review aims to provide an overview of the current evidence of the associations between anxiety disorders and SRPs, to examine how this relationship may affect treatment, and to evaluate future directions for the field. Despite their strong bi-directional relationship, SRPs are often neglected in pediatric anxiety literature. There is little consensus on the conceptualization and related measurements of SRPs, which has led to methodological limitations and difficulties. Furthermore, available research suggests that anxiety treatment alone may be inadequate as clinically impairing SRPs were still present post-treatment, which may, in turn, diminish effects of therapy. Understanding the implications of the relationship between anxiety and SRPs on treatment outcomes may be helpful in recognizing opportunities for high impact and enduring interventions.

Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder

Objective: Avoidant/restrictive food intake disorder (ARFID) is associated with increased risk for anxiety, which may adversely affect prognosis. The appetite-stimulating hormone, ghrelin, increases in response to stress, and exogenous ghrelin decreases anxiety-like behaviors in animal models. The aim of this study was to evaluate the relationship between ghrelin levels and measures of anxiety in youth with ARFID. We hypothesized that lower ghrelin levels would be associated with increased anxiety symptoms.

Methods: We studied a cross-sectional sample of 80 subjects with full and subthreshold ARFID diagnosed by DSM-5 criteria, aged 10-23 years (female, n = 39; male, n = 41). Subjects were enrolled in a study of the neurobiology of avoidant/restrictive eating conducted from August 2016 to January 2021. We assessed fasting ghrelin levels and anxiety symptoms (State-Trait Anxiety Inventory [STAI] and STAI for Children [STAI-C] measuring general trait anxiety; Beck Anxiety Inventory [BAI] and BAI for youth [BAI-Y] assessing cognitive, emotional, and somatic symptoms of anxiety; and Liebowitz Social Anxiety Scale [LSAS] assessing symptoms of social anxiety).

Results: Consistent with our hypothesis, ghrelin levels were inversely associated with anxiety symptoms as assessed by STAI/STAI-C T scores (r = -0.28, P = .012), BAI/BAI-Y T scores (r = -0.28, P = .010), and LSAS scores (r = -0.3, P = .027), all with medium effect sizes. Findings held in the full threshold ARFID group when adjusting for body mass index z scores (STAI/STAI-C T scores, β = -0.27, P = .024; BAI/BAI-Y T scores, β = -0.26, P = .034; LSAS, β = -0.34, P = .024).

Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID.

Quantitative electroencephalographic biomarker of pharmacological treatment response in patients with anxiety disorder: a retrospective study

This study aimed to investigate the effectiveness of a quantitative electroencephalography (qEEG) biomarker in predicting the response to pharmacological treatment in patients with anxiety disorder. A total of 86 patients were diagnosed with anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, and subsequently treated with antidepressants. After 8-12 weeks, the participants were divided into treatment-resistant (TRS) and treatment-response (TRP) groups based on their Clinical Global Impressions-Severity (CGI-S) scores. We obtained the absolute-EEG measurements for 19-channels and analyzed qEEG findings according to the frequency range: delta, theta, alpha, and beta. The beta-wave was subdivided into low-beta, beta, and high-beta waves. The theta-beta ratio (TBR) was calculated, and an analysis of covariance was performed. Of the 86 patients with anxiety disorder, 56 patients (65%) were classified in the TRS group. The TRS and TRP groups did not differ in terms of age, sex, or medication-dosage. However, the baseline CGI-S was higher in the TRP group. After calibration by covariates, the TRP group showed higher beta-waves in T3 and T4, and a lower TBR, especially in T3 and T4, than the TRS group. These results indicate that patients with a lower TBR and higher beta and high-beta waves in T3 and T4 are more likely to respond to medication.

Research Review: The neuroscience of emerging adulthood - reward, ambiguity, and social support as building blocks of mental health

BACKGROUND

The interval between adolescence and adulthood, 'emerging adulthood' (EA), lays the foundation for lifelong health and well-being. To date, there exist little empirical data - particularly in the neurobiological domain - to establish markers of risk and resilience during the transition to adulthood. This gap in the literature is concerning given the numerous forms of psychiatric illness that emerge or worsen during this period.

METHODS

In this review, we focus on two strands of research with distinct importance for EA: reward sensitivity, and tolerance of ambiguity. We begin by placing these domains in a framework that considers the unique developmental goals of EA and then synthesize emerging neurobiological research on how these domains develop during EA. We then consider their role in common mental health problems that occur during this interval as well as how social support may moderate outcomes. Finally, we offer recommendations for advancing research to understand developmental process and outcomes in EA.

FINDINGS AND CONCLUSIONS

Few longitudinal studies specifically address emerging adult development and the milestones that characterize this interval. Data on neurobiological development are similarly sparse. Understanding neurobiological development during this window and its links to key adjustment outcomes is crucial for optimizing outcomes.

Pediatric anxiety: An update for primary care NPs

ABSTRACT

New guidelines for identifying anxiety in pediatric patients constitute important changes in screening for primary care providers, including primary care NPs. This article seeks to guide NPs in both following the screening guidelines and providing strategic care for patients and their families.

Editorial Perspective: Are treatments for childhood mental disorders helpful in the long run? An overview of systematic reviews

Mental disorders may have severe consequences for individuals across their entire lifespan, especially when they start in childhood. Effective treatments (both psychosocial and pharmacological) exist for the short-term treatment of common mental disorders in young people. These could, at least theoretically, prevent future problems, including recurrence of the disorder, development of comorbidity, or problems in functioning. However, little is known about the actual effects of these treatments in the long run. In the current editorial perspective, we consider the available evidence for the long-term (i.e., ≥2 years) effectiveness and safety of treatments for attention deficit hyperactivity disorder, behavior disorders, and anxiety and depressive disorders for children between 6 and 12 years old. After providing an overview of the literature, we reflect on two key issues, namely, methodological difficulties in establishing long-term treatment effects, and the risk-benefit ratio of treatments for common childhood mental disorders. In addition, we discuss future research possibilities, clinical implications, and other approaches, specifically whole-of-society-actions that could potentially reduce the burden of common childhood mental disorders.

Human fear neurobiology reimagined: Can brain-derived biotypes predict fear-based disorders after trauma?

Human studies of fear neurobiology have established neural circuits that are activated to threatening stimuli, whether it be during Pavlovian fear conditioning or in response to naturally occurring threats. This circuitry involves the central and basolateral amygdala, as well as the bed nucleus of the stria terminalis, insula, hippocampus, and regulatory regions such as the anterior cingulate cortex and ventromedial prefrontal cortex. While research has found that fear-based disorders, such as anxiety and post-traumatic stress disorder, as associated with dysfunction in these circuits, there is substantial individual heterogeneity in the clinical presentation of symptoms. Recent work has used data-driven methods to derive brain biotypes that capitalize on the activity of the fear circuit and its interaction with other regions of the brain. These biotypes have great utility in both describing individual variation in psychopathology and in identifying individuals at greater risk for fear-based disorders after an environmental stressor, such as a traumatic event. The review discusses recent examples of how fear neurobiology studies can be leveraged to derive biotypes that may ultimately lead to improved treatment.

Comparative analysis of pediatric anxiety measures in clinical sample: evaluation of the PROMIS pediatric anxiety short forms

OBJECTIVE

Examine the psychometric properties, validity in relation to a legacy measure, and diagnostic accuracy of the PROMIS Anxiety Short Form 2.0 (PROMIS A-SF) Caregiver and Youth Reports in a clinical sample.

METHODS

Participants were 301 youth and caregivers referred to a behavioral health clinic by their pediatrician. Participants and their caregivers completed PROMIS A-SF (youth and caregiver proxy), SCARED (youth and caregiver proxy), and a semi-structured interview. Descriptive, correlational, test-retest reliability, and receiver operating characteristic (ROC) analyses were conducted for both measures.

RESULTS

PROMIS A-SF measures were highly correlated with SCARED total scores and the panic subscale. PROMIS A-SF measures had AUCs ranging from .49-.79 for the detection of any of three primary subtypes of anxiety: Generalized Anxiety, Separation Anxiety, and Social Anxiety.

IMPLICATIONS

Dimensional anxiety subtypes, such as Social Anxiety may not be well detected on the PROMIS youth measure. Use of the PROMIS A-SF as a part of Evidence Based Assessment process is discussed.

Early exposure to flame retardants is prospectively associated with anxiety symptoms in adolescents: A prospective birth cohort study

BACKGROUND

Anxiety disorders emerge during childhood and adolescence and are frequently preceded by subsyndromal anxiety symptoms. Environmental toxicants, including gestational polybrominated diphenyl ether (PBDE) exposure, are associated with neuropsychiatric sequelae; however, the role of PBDEs as risk factors for anxiety in adolescence is unclear.

METHODS

Using data from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort enrolled from 2003 to 2006, we investigated the relationship between gestational serum PBDE concentrations and anxiety symptoms in adolescents (N = 236). We measured five PBDE congeners (PBDE-28, -47, -99, -100, and -153) at 16 ± 3 weeks of gestation and calculated their sum (∑PBDE). We assessed self-reported anxiety symptoms using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and depressive symptoms using the Children's Depression Inventory (CDI-2) at age 12 years. We estimated the associations of maternal PBDE concentrations with child anxiety and depressive symptoms using multivariable linear regression and modified Poisson regression. Covariates included child sex, maternal race, maternal age at delivery, maternal marital status, maternal education, and household income at the 12-year study visit as well as maternal depressive and anxiety symptoms. Sensitivity analyses were performed to control for maternal lead and mercury at delivery.

RESULTS

After adjusting for predetermined covariates, each doubling in maternal PBDE concentrations was associated with increased SCARED scores (e.g., for ∑PBDE, SCARED total score, β = 1.6 95% confidence interval [CI]: 0.3-2.9, p = .019) and a nonsignificant increase in depressive symptoms (e.g., for CDI total score, β = .8, 95% CI: -0.2-1.8, p = .11).

CONCLUSIONS

Gestational serum PBDE concentrations just before mid-pregnancy and during a period of active cortical and limbic neurogenesis, synaptogenesis and myelogenesis may be a risk factor for developing anxiety symptoms in early adolescence.

Age, Sex and Relationship Strengths: Internalizing Symptom Differences in Children and Youth Within a Clinical Sample

BACKGROUND

Internalizing problems such as depression, anxiety and anhedonia are particularly problematic due to their covert nature. Due to their deleterious effects on psychological well-being, social connection and education, it is important to understand the development of internalizing problems and their unique contributors.

OBJECTIVES

Examine whether internalizing symptoms vary by (i) age, and (ii) sex, and whether (iii) relationship strengths are associated with sex and internalizing symptoms.

METHOD

Using a polynomial model with Tweedie distribution with log link, this study examined relationships for 18,701 clinically referred children and adolescents between 4 and 18 years of age assessed using the interRAI Child and Youth Mental Health assessment.

RESULTS

Internalizing symptoms reported by children and adolescents varied by age and sex. Sex differences in internalizing symptoms became prominent after about six years of age with female adolescents reporting higher levels when compared to male peers. An increase in relationship strengths corresponded with a decrease in internalizing symptoms for both sexes. However, the pattern depended on sex. In our sample, females required a greater number of relationship strengths to observe a decrease in internalizing symptoms.

CONCLUSIONS

The current study illustrates a difference in internalizing symptoms between females and males with respect to age and relationship strengths. The results may have implications for prevention and intervention strategies geared towards internalizing symptoms for children and adolescents.

Health-Related Fitness as a Predictor of Anxiety Levels Among School Adolescents: An observational cross-sectional study

Background

There is an inverse association between cardiorespiratory fitness and general anxiety levels in adolescents. Obesity also is associated with a higher risk of anxiety in this population. However, little is known about the association between other health-related fitness elements with anxiety symptoms in this population. The authors explored the relationship between health-related fitness and anxiety symptoms in a large sample of Brazilian youth.

Methods

This was an observational cross-sectional study with a sample comprised of 257 school adolescents, who were 136 girls (52.9%) and 121 boys (47.1%). The health-related fitness elements were evaluated by FitnessGram® test and anxiety levels by Multidimensional Anxiety Scale for Children - 39. Hierarchical regression analyses were used to determine the association between health-related fitness elements and anxiety symptoms in both sexes.

Results

In male adolescents, only the cardiorespiratory fitness was significantly associated with anxiety symptoms (F_{(1, 119)} = 6.472; P = 0.012; R² = 0.052; adjusted R² = 0.044). In turn, the anxiety symptoms showed an inverse small relationship with cardiorespiratory fitness (r = - 0.227; P < 0.01). However, in female adolescents, no association was found between health-related fitness elements and anxiety symptoms.

Conclusion

The level of cardiorespiratory fitness may represent a marker of anxiety in male adolescents.

Mangione CM, Barry MJ, Nicholson WK, Cabana M, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Silverstein M, Stevermer J, Wong JB. Screening for Anxiety in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

IMPORTANCE

Anxiety disorder, a common mental health condition in the US, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. The 2018-2019 National Survey of Children's Health found that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression.

OBJECTIVE

The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in children and adolescents. This is a new recommendation.

POPULATION

Children and adolescents 18 years or younger who do not have a diagnosed anxiety disorder or are not showing recognized signs or symptoms of anxiety.

EVIDENCE ASSESSMENT

The USPSTF concludes with moderate certainty that screening for anxiety in children and adolescents aged 8 to 18 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety in children 7 years or younger.

RECOMMENDATION

The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger. (I statement).

Anksiyete Bozukluğu Tanılı Ergenlerin Belirtileri Açısından Ergen-Ebeveyn Uyumu

Aim: Considering the role of the parent in the children and adolescent's access to treatment, it is important that the symptoms are adequately noticed by the parents. In this study, it was aimed to examine the adolescent-parent agreement in terms of symptoms of adolescents with anxiety disorder. Material and Method: 100 adolescents who applied to the child and adolescent psychiatry outpatient clinic and were diagnosed with anxiety disorder according to the DSM-5 diagnostic criteria were included in the study. In the study, the sociodemographic form and the Revised Child Anxiety and Depression Scale (RCADS) adolescent and parent form were used for data collection. Results: When the parent and adolescent forms of RCADS were compared, the adolescent scores were significantly higher than the parents in all subscales and scale total scores, except for the separation anxiety subscale. The ICC (95% CI) value between the parent and adolescent forms of RCADS ranged from 0.06 to 0.74. Conclusion: In our study, it was found that adolescents scored their symptoms higher than their parents, and the correlation between parent-child reporting was low-moderate. Age, gender, comorbidity, and parental psychopathology were among the factors affecting adolescent-parent agreement.

Management of anxiety disorders among children and adolescents in UK primary care: A cohort study

BACKGROUND

Anxiety disorders are common in childhood and adolescence but evidence-based guidance on their management is limited in the UK. In the absence of guidelines, we examined what treatment young people with anxiety disorders receive in primary care in the year following diagnosis.

METHOD

We delineated a cohort of individuals diagnosed with anxiety disorders aged 10-18 using the Clinical Practice Research Datalink (CPRD). We estimated the annual prevalence of antidepressant and anxiolytic prescribing and referrals to mental health services in the year following diagnosis between 2003 and 2019 via Poisson models, adjusted for age, gender, and practice-level deprivation.

RESULTS

34,490 out of 52,358 (66 %) individuals were not prescribed or referred in the year following diagnosis. Those registered to practices in the most deprived compared to the least deprived areas were less likely to be referred (PR 0.80, 95%CI 0.76-0.84) and prescribed antidepressants (PR 0.77, 95%CI 0.72-0.82). Referrals increased 2003-2008 (22-28 %) and then declined until 2019 (28-21 %). Antidepressant prescribing decreased substantially between 2003 and 2005 (18-11 %) and then increased slightly between 2006 and 2019 (11-13 %). Anxiolytic prescribing declined between 2003 and 2019 (10-2 %).

LIMITATIONS

Prescriptions in the CPRD are not coupled with information about indication. Some prescriptions may therefore have been incorrectly attributed to the treatment of anxiety disorders.

CONCLUSION

The continued use of antidepressants necessitates the development of evidence-based guidance. The lower likelihood of being prescribed medication and/or referred among young people in more deprived practice populations, where incidence of anxiety disorder and other mental illnesses is higher, must also be investigated and rectified.

Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders

OBJECTIVE

The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data.

METHODS

De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes.

RESULTS

Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0-7.6), social housing use (aHR: 1.7; CI 1.4-2.1), income assistance (aHR: 1.8; CI 1.6-2.1), criminal accusation (aHR: 2.2; CI 2.0-2.5), criminal victimization (aHR:2.5; CI 2.2-2.7), and not completing high school (aOR: 3.1; CI: 2.5-3.9).

CONCLUSION

Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.

Positive valence systems in youth anxiety development: A scoping review

Research on pathophysiological mechanisms supporting anxiety development in youth has traditionally focused on the role of threat systems. However, emerging research suggests that the positive valence system (PVS) may also play a strong and unique role in the development and maintenance of anxiety during childhood and adolescence. To better understand the connection between the PVS and anxiety, this scoping review describes current research spanning multiple units of analysis (i.e., self-report, behavior, neural circuits) linking child and adolescent anxiety and risk for anxiety to various PVS constructs (i.e., positive affect, reward responsiveness, reward learning and decision-making). After screening, 78 peer-reviewed articles and dissertations published between 1998 and May 2021 were included in a qualitative review. Though some consistencies in the literature were found, such as high neural reactivity to incentive anticipation in youth at temperamental risk for social anxiety and blunted positive affect in youth with social anxiety disorder, the literature is largely inconsistent. Inconsistencies could be related to the small number of similar studies, small and homogenous study samples, and variability in methodologies employed in this research. It cannot be confirmed whether findings linking PVS constructs to anxiety are unique to anxiety symptoms or better accounted for by co-occurring depressive symptoms. This review concludes with recommendations for robust future research in this area.

Toxic Metal -Mediated Neurodegradation: A Focus on Glutathione and GST Gene Variants

Increasing pieces of evidence have supported those chemicals from industrial, agricultural wastes and organoleptic activities play important role in the development of neurological disorders. The frequency of neurological disorders is increased to a much extent in recent years with the advancements in science and technology. Google Scholar, PubMed, and Scopus databases were selected to search the relevant information by using keywords including "Heavy metals", "Neurotoxicity", "Glutathione", "Glutathione AND Neurodegenerative disorders" etc. Heavy metals are particularly recognized as a major resource of toxicities during the stage of early pregnancy where a fetus gets exposed to them from maternal activities and circulation. As infants have a weak immune system and cannot respond to the specific challenge as faced by the body during mercury, zinc, iron, and cadmium exposure. Daily diet and drinking habits in addition to industrial activities also form a major field of study under investigation. This study aims to investigate the role of these metals in the accumulation of pollutants in the brain, liver, and kidneys hence leading to serious consequences. Moreover, their prevalence in teenagers that are under the age of ten years is being observed that leads them to learn, writing, and intellectual abilities. Males are more affected due to their hormonal differences. The role of the GST gene in the development of cognitive conditions and its phenotypes has been discussed thoroughly in this review. The mutations of GST lead to the accumulation of peroxides and superoxides which exacerbate oxidative damage to cells. Binding of toxic metals to GSH genes and the role of glutathione transferase genes is was demonstrated in this review.

ADHD and ODD Dimensions: Time Varying Prediction of Internalizing Problems from Childhood to Adolescence

OBJECTIVE

Although childhood ADHD is a risk factor for internalizing problems, it consists of separable inattention and hyperactivity dimensions that differentially predict outcomes. Oppositional defiant disorder also consists of separable dimensions (i.e., irritable, oppositional), co-occurs with ADHD, and predicts internalizing outcomes. To discern independent associations with internalizing problems, dimensions must be considered simultaneously.

METHODS

Controlling for age, sex, and race, we tested inattention, hyperactivity, irritability, and oppositionality as time-varying predictors of 6 to 7-year prospective change in parent- and teacher-rated internalizing problems in 230 ethnically- diverse (50% Caucasian) 5 to 10 year old youth (M = 7.4 years, 68% male) with (n = 120) and without ADHD (n = 110).

RESULTS

Escalating inattention and irritability, but not hyperactivity and oppositionality, uniquely predicted internalizing problems.

CONCLUSION

These findings suggest that inattention and irritability are unique risk factors for later internalizing problems. These dimensions may catalyze internalizing problems across development and constitute important intervention targets.

Emotion Regulation in Adolescents: Evidence of the Validity and Factor Structure of the Cognitive Emotion Regulation Questionnaire (CERQ)

The Cognitive Emotion Regulation Questionnaire (CERQ) is an assessment tool to evaluate cognitive emotion regulation strategies. The main objective of this study is to provide new empirical evidence about the validity and reliability of the CERQ via a sample of 271 Spanish adolescents (136 female, 135 male) aged from 15 to 18 years (M = 15.7, SD = 0.76). The analytical process was carried out in two phases. A confirmatory factor analysis was performed on the polychoric correlation matrix between items. Four possible alternative models were contrasted: two models with nine factors and two models with two second-order factors and nine first-order factors, with 36 and 27 items, respectively. The model with nine correlated factors and 27 items obtained the best indices of overall fit. Subsequently, the reliability of the measurements was estimated on this model. The results reaffirm the validity of the 27-item version of the CERQ over the original 36-item structure. The findings also confirm that the CERQ is a reliable instrument for the evaluation of emotion regulation strategies in adolescents.