[The epidemiology of mental disorders in youth : A narrative review including Austrian data]

Neurocognitive and emotional long-term effects of COVID-19 infections in children and adolescents: results from a clinical survey in Bavaria, Germany

BACKGROUND

While children and adolescents typically experience mild symptoms during the acute phase of the COVID-19 infection, some may develop severe post-infectious symptoms. In our study Post-COVID Kids Bavaria we integrated somatic and psychiatric aspects of the post-COVID syndrome to provide a holistic description of symptoms, provide early treatment, and detect possible risk factors associated with post-infectious neurocognitive and emotional impairments.

METHODS

We conducted an observational study involving 85 pediatric patients aged 12-17 years (M = 12.48, 61.2% female) who had confirmed COVID-19 infections and were experiencing persistent symptoms for at least 4 weeks. Our neuropsychological assessment comprised infection-specific patient interviews, psychopathological examinations, emotional well-being and behavioral difficulty questionnaires, and (computerized) tests assessing concentration, attention, and memory skills. Additionally, patients underwent neurologic, pneumologic, gastrointestinal, and cardiologic assessments.

RESULTS

Overall, the majority of patients reported experiencing elevated levels of fatigue (82.4%), loss of motivation (72.9%), concentration and attention deficits (71.8%), a worsened mood (53%), and a higher level of anxiety (31.8%). The most common diagnosis was the post-COVID adjustment disorder (ICD-10 F43.2, U09.9!; 38.8%) followed by the post-COVID attention deficit disorder (ICD-10 F98.80, U09.9!; 23.5%). Neuropsychiatric evaluation primarily identified deficits in sustained attention. There was a significant association between somatic and psychiatric post-COVID diagnoses. Patients with allergies exhibited a higher risk of developing a post-COVID adjustment disorder. For the post-COVID attention deficit disorder, age, sex, obesity, pre-existing psychiatric diagnosis, and the virus variant were relevant factors.

CONCLUSIONS

Our findings indicate a diverse array of neuropsychiatric symptoms associated with the post-COVID syndrome, emphasizing the interconnectedness between somatic and neuropsychiatric diagnoses. To optimize treatment, comprehensive strategies involving both somatic and psychiatric professionals are crucial for addressing the syndrome's complexity and managing symptoms effectively.

STUDY REGISTRATION

The study Post-COVID Kids Bavaria was registered with the German Clinical Trials Register (DRKS), funded by the Bavarian State Ministry of Health, Care and Prevention and approved by the Ethics Committee of the University of Regensburg on the 29th of November, 2021 (Reference: 21-2691-101).

Predictors of mental health during young people's transition from out-of-home care in Austria

BACKGROUND

Care leavers are often disadvantaged in terms of their mental health compared to the general population. The factors influencing care leavers' mental health in the third decade of their lives have so far not been studied systematically.

OBJECTIVE

Based on a resource model, external contextual factors before, during and after out-of-home care are examined with regard to their positive or negative effects on mental health.

PARTICIPANTS AND SETTING

The sample consists of 121 care leavers, born between 1987 and 1997 and aged between 20 and 29 at the time of the paper-and-pencil survey. The participants had been in out-of-home care for at least two years and left care at the age of 16 or later.

METHODS

Multiple hierarchical regression analysis with pairwise deletion and bootstrapping was used to identify predictors of mental health. The final model explains 27 % of the variance in the dependent variable "mental health" and is significant.

RESULTS

Emotional abuse by parents (β = -0.187; p = 0.027) before out-of-home care is negatively associated, but a longer length of stay (β = 0.202; p = 0.023) and support from friends (β = 0.227; p = 0.015) during out-of-home care, as well as an independent economic status (β = 0.326; p < 0.001) and a romantic relationship (β = 0.160; p = 0.044) after the transition show positive correlations with mental health.

CONCLUSIONS

The results point to the need for support in building social relationships and sufficient psychosocial support during and after out-of-home care.

[Transitional psychiatric needs and identity development of adolescents in Tyrol]

BACKGROUND

Due to the structural separation of child and adolescent psychiatric treatment and adult psychiatric treatment, a switch between these two systems upon the age of 18 is necessary. Considering the importance of an organized transition, patients from an age of 17 were asked about their transition needs and aspects of their identity development. Thus future improvements in the treatment structures in this sensitive phase should derive.

METHODS

With the help of the Transition Readiness and Appropriateness Measure (TRAM), the transition-specific needs of 17 to 24-year-old patients (N = 42) at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Hall in Tirol were surveyed. In addition, the connection between identity development and transition was examined using the Assessment of Identity Development in Adolescence (AIDA).

RESULTS

Almost 80% of the patients stated that they needed further care. 'Patient-related factors' and 'family support' were described as barriers to the willingness to transition. A significant connection was found between identity development and the willingness or need for transition (r = 0.431, p < 0.01), although this was more pronounced in relation to the need for transition (r = 0.821 p < 0.01). In addition, those affected stated that they were frequently and severely burdened by stress, 45% reported self-injurious behavior, 48% suicidal thoughts or behavior in the last six months. In terms of psychopathology, anxiety and depression were among the most common symptoms. In terms of functional impairment, the 'relationships' area was the most affected.

CONCLUSIONS

The study provides initial insights into the transition-specific characteristics and needs of patients in transition age. The integration of standardized measuring instruments in institutional care systems, which individually record the transition-related needs, the willingness and need of young people in transition age, can facilitate targeted and needs-based treatment or transition. Interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry as well as a continuous transfer of the therapeutic relationships in the transition process should also be guaranteed.

Improving mental health by improving the mental health literacy? Study protocol for a randomised controlled evaluation of an e-mental health application as a preventive intervention for adolescents and young adults

Background

From the age of 14, many adolescents enter a vulnerable developmental phase, with a sharp increase in mental illness at 16. The COVID19 pandemic has further exacerbated this issue. Hence, universal and easily accessible prevention in the young is needed. E-mental health interventions are on the rise due to numerous benefits such as potential low-costs, low-threshold and high scalability. However, effectiveness and acceptance of mobile health (mHealth) preventive interventions remain unresearched.

Method

In a two-armed, randomised controlled study design adolescents and young adults from 14 years old will be recruited. Following an initial baseline assessment, they will be randomised to a) the intervention group (IG, n = 75), which will receive a mHealth intervention (the application 'Mental Health Guide', co-developed by lived experience experts) or b) the waiting list control group (CG, n = 75). Both groups will be followed up after 3 and 6 months following post assessment. We hypothesize an increase in mental health literacy in the IG compared to the CG for post and follow-up assessment (primary outcome: Mental Health Literacy Scale). In addition, we expect an improvement in mental health and psychological well-being, improved emotion regulation, reduced psychological distress, as well as good quality ratings in usability and acceptance in the use of the 'Mental Health Guide' We performed multiple simulations of possible outcome scenarios, incorporating an array of factors, to generate realistic datasets and obtain accurate estimates of statistical power.

Conclusion

As a first-of-its-kind in this field, this study investigates whether a mHealth intervention based on mental health literacy may improve the mental health literacy and further aspects of psychological functioning of young people in a vulnerable phase. Furthermore, the results promise to provide important knowledge of how universal prevention may be implemented with low costs for diverse populations.

Trial registration

This trial was registered in the DRKS register (DRKS-ID: DRKS00031810) on 23 June 2023.

Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions.

OBJECTIVE

This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms.

METHODS

A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores.

RESULTS

We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI -0.68 to -0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19-related symptoms were found.

CONCLUSIONS

The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required.

[Mental health of sexual and gender minority youth in Austria: scoping review and research agenda based on international evidence]

A robust body of international evidence documents that lesbian, gay, bisexual, transgender, and other youth with diverse sexual orientations and/or gender identities (i.e., sexual and gender minority youth) face unique mental health vulnerabilities but are also equipped with unique resources. However, it is unclear to what extent these findings are applicable to sexual and gender minority youth in Austria, because the sociolegal and developmental contexts differ across countries. According to PRISMA guidelines, we conducted a systematic scoping review (1) to identify published studies on the mental health of sexual and gender minority youth in Austria, and, based on this, (2) to derive research recommendations supplemented by international evidence. We searched five scientific databases (PsycInfo, PSYNDEX, PubMed, Scopus, Web of Science; March 2022) and additionally contacted researchers and community leaders to find pertinent studies. Only two published empirical studies on the mental health of sexual and gender minority youth in Austria could be located, reflecting the sparse state of research in Austria. Against this background, we outline a detailed research agenda following a socio-ecological approach. Including sexual orientation and non-binary gender identities in population-based studies to assess onset, prevalence, and trajectory of mental health burdens, as well as conducting targeted, resource-based, and developmentally sensitive research on all levels seem paramount to reduce health disparities and societal stigma and to support sexual and gender minority youth in their development.

[Epidemiology of mental well-being in childhood and adolescence. Results from three epidemiological studies before and during the COVID-19 pandemic]

BACKGROUND

Continuous nationwide health monitoring is important to track the well-being of children and adolescents and to map developmental trajectories. Based on the results of three selected epidemiological studies, developments in child well-being over the past 20 years are presented.

METHODS

Data are based on (1) the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (BELLA study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; (2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, N = 1600-1700), which is based on the BELLA Study; and (3) the International Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). Well-being was assessed in 7‑ to 17-year-olds using indicators of health-related quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC)).

RESULTS

Overall, children and adolescents show consistently high health-related quality of life and high overall life satisfaction pre-pandemic (2002-2018), which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years later, improvements are evident but have not yet reached baseline levels. Psychological problems, as well as symptoms of anxiety and depression, increased by up to 12 percentage points at the beginning of the pandemic and are still higher two years after the onset of the pandemic compared to pre-pandemic studies.

CONCLUSION

The epidemiology of child well-being provides a necessary data basis to assess the support needs of children and adolescents and to use this as a basis for developing measures of health promotion, prevention, and intervention.

[A three-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic]

BACKGROUND AND RESEARCH QUESTION

The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing a series of articles in a special issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape.

METHOD

First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other.

RESULTS AND CONCLUSIONS

On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, a significant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.

Family cohesion, shame-proneness, expressive suppression, and adolescent mental health-A path model approach

Objective

The family remains one of the most important relationship systems into early adulthood and provides an important foundation for lifelong mental health. Dysfunctional family cohesion can promote adjustment problems in adolescents and might also affect adolescents' self-concept and strategies for coping with emotional distress. To test these relationships and the underlying mechanisms, we proposed a dual mediation model describing the associations between family cohesion and internalizing and externalizing problems, mediated by shame-proneness and expressive suppression.

Methods

A sample of 526 German-speaking adolescents aged 14 to 18 years from Austria, Germany, and Switzerland participated in an online self-report survey encompassing questionnaires on family cohesion, shame-proneness, expressive suppression, and psychological problems. We tested a path model to examine the indirect pathways of the associations between family cohesion and internalizing and externalizing problems via shame-proneness and expressive suppression, while controlling for age, gender, and guilt-proneness.

Results

We found a significant dual mediation of the associations between family cohesion and internalizing and externalizing problems by shame-proneness and expressive suppression. The indirect pathways were all significant, except for the indirect pathway from family cohesion to externalizing problems via shame-proneness.

Discussion

Our results provide a model for the mechanisms by which disrupted family cohesion can be related to psychological problems in adolescents. Expressive suppression emerged as crucial when considering the consequences of shame-proneness in adolescents, as it was only indirectly related to externalizing problems via expressive suppression.

Peer Facilitators as Core Co-developers of an Online Peer Encouragement Network (OPEN2chat) for Austrian Adolescents

Adolescence is a crucial developmental time, and it is essential to ensure stable mental health during the transition to adulthood. Peer-to-peer networks seem to be a promising tool to support adolescents during that time. While co-development often concentrates on the end-user, this paper focuses on the peer facilitators of an online peer encouragement network (OPEN2chat), where adolescents can chat with peer facilitators about their problems. We conducted 3 group discussions with 18 peer facilitators after a testing phase to improve the process of these interactions. Thematic analysis was used to analyse the data after transcription. The four main themes were the responsibility of the peer facilitators toward their peers, especially their role of giving advice; the interaction process itself; time management; and technology aspects of the application. Including these stakeholders in the development process empowered the young people, helped eliminate problems with the application, and made the researchers more sensitive toward potential issues and emotions that peer facilitators encounter that may have been missed without a co-development process. Eliminating these problems might also help establish a better environment and support system for the actual end-users.

Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective

BACKGROUND

In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance.

METHODS

We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria.

RESULTS

We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework.

CONCLUSIONS

Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.

[Effectiveness and Safety of Home Treatment in Child and Adolescent Mental Health Care: A Systematic Literature Review]

OBJECTIVE

In child and adolescent psychiatry, home treatment is becoming increasingly important due to limited inpatient care capacities and changing treatment philosophies. This paper examines its effectiveness and safety.

METHODS

We did a systematic literature search and summarized the home treatment model characteristics as well as the evidence on its benefits and harms narratively.

RESULTS

In the six identified studies, improvements in symptoms were found in both, home and institutionalized treatment. In the long-term, home treatment seems to be slightly superior and involves fewer hospital days. However, a best-practice model cannot be derived from the data available.

CONCLUSION

Home treatment can be considered as an alternative to inpatient treatment, but requires coordination with other mental health care elements and further evaluation.

[Patterns of psychopathology and psychosocial background of patients at first presentation at the child and adolescent psychiatric outpatient department of the University Clinic Salzburg]

BACKGROUND

This study examines the prevalence of psychiatric disorders and psychosocial background of outpatients at an Austrian child and adolescent psychiatry department.

METHODS

One hundred eighty-three patients were examined using the Mini International Neuropsychiatric Interview for Children and Adolescents and the Multidimensional Clinical Screening Inventory. Pearson's chi-square tests were used to explore the prevalence of psychiatric disorders between gender and age-groups and their relationship with the psychosocial background of patients.

RESULTS

Most patients (86.9%) had at least one psychiatric disorder. Almost three quarters (72.4%) of these patients made use of extramural facilities. Boys and girls did not differ in age or presence of a disorder. Internalising disorders were more common among older patients. Externalising disorders were more common among boys and younger patients. 65.2% of patients suffered from at least one co-morbid disorder. Boys and those with at least one externalising disorder showed more problems at school. Girls were victims of sexual assault more often, but boys experienced more extra-familial physical abuse. Girls and those with internalising disorders showed more self-harming and suicidal behaviour. A combination of internalising and externalising disorders correlated with increased drug consumption. Boys spent more time using a computer.

CONCLUSIONS

The results show that particular psychopathologies often appear in connection with certain psychosocial burdens. Especially boys show increased vulnerability in relation to school problems. The willingness of patients to make use of extramural points of contact should guide future policies to consider therapeutic options encompassing parents, schools and welfare institutions for children prone to the development of psychiatric symptoms due to psychosocial risk.

The Mental Health in Austrian Teenagers (MHAT) Study: design, methodology, description of study population

Profound epidemiological data on the prevalence of mental health disorders and respective risk and protective factors is a prerequisite for adequate prevention, intervention and service planning. Children and adolescents are regarded as high priority groups for prevention in this field because of the high chronicity and individual burden of mental health disorders. The Mental Health in Austrian Teenagers (MHAT)-Study is the first epidemiological study based on a large representative sample of adolescents (N > 3700) in Austria in order to obtain the prevalence of a wide range of behavioral problems and psychiatric disorders. Adolescents are recruited from multiple settings (schools, course providers for early school leavers and psychiatric clinics) in order to enhance the representativity of the sample. A “gold-standard” two-stage design (screening questionnaire and diagnostic interviews) is used to obtain psychiatric diagnoses that are based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders which was published by the American Psychiatric Association in 2013. This paper aims at presenting the study design and methodology of the MHAT study, describing the study population as well as discussing relevant strengths and limitations.