The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: Findings from the Global Burden of Disease Study 2019

A feasibility study of an add-on psychomotor body-image protocol during CBT-E in female patients with an eating disorder

BACKGROUND AND OBJECTIVES

Disturbed body image is a potential precursor and maintaining factor when it comes to eating disorders. One of the dominant treatment approaches for eating disorders, enhanced cognitive-behaviour therapy (CBT-E), includes the cognitive-affective body image dimension as a core treatment target. Adding a component that focuses on the lived body dimension, could improve body image. In the current study, the feasibility of a psychomotor body image treatment as an add-on to CBT-E was examined.

METHODS

In this pilot study, 115 primarily female patients with different eating disorders in outpatient CBT-E treatment participated. They were asked to complete questionnaires examining body image before and after the psychomotor body image treatment.

RESULTS

Results showed good satisfaction with the treatment, and a significant improvement in body attitude and body satisfaction after the psychomotor body image treatment, with large effect sizes and clinical relevance. Results also showed that, overall, pre-treatment levels and changes over the course of treatment in body attitude and body satisfaction did not differ between patients within anorexia nervosa, bulimia nervosa or binge eating disorder diagnostic subgroups.

LIMITATIONS

Limitations were lack of a control group, and the fact that the body image treatment was complementary to CBT-E. This means that it is unclear whether other factors contributed to the change in body image as shown in the current study.

CONCLUSIONS

These results indicate that an experiential psychomotor approach in addition to a more cognitive-behavioral approach is feasible, and warrants future research.

Cannabis legalization: a call for the integration of main health and crime indicator domains towards comprehensive policy impact assessments

Several jurisdictions have implemented legalization policies for non-medical cannabis, mainly towards improving public health and reducing illegal cannabis markets and crime. As some legalization initiatives are approaching maturity, conducting policy impact assessments has become timely. Emerging data, however, suggest rather mixed pictures for key outcomes and indicators. While many key health-related indicators show increases in adverse outcomes, improvements are shown for main crime-related outcomes associated with legalization. However, legalization policies are evaluated predominantly by utilizing separate approaches for the health outcomes and crime-related indicators, while comprehensive policy assessments require meaningful integration of all related indicators. We provide suggestions for an integrated approach to assessing cannabis legalization policies concerning health and crime-related outcomes. This approach is also valuable for policymakers and other stakeholders to create an empirical basis for relative valuations and choices regarding cannabis legalization's main policy outcomes.

Age- and sex-specific analysis of the impact of bipolar disorder in Iran and its provinces: Prevalence, incidence, and disability-adjusted life years: Global burden of disease 2021

OBJECTIVES

This study sought to deliver a prevalence, incidence, and Disability-Adjusted Life Years (DALYs) of bipolar disorder in Iran, covering both national and subnational scales. The results were broken down by age group and sex, alongside an analysis of trends in bipolar disorder from 1990 to 2021. The estimates gathered were further compared to global averages to offer deeper insights into the prevalence and impact of bipolar disorder in Iran.

METHODS

This study analyzed data from the Global Burden of Disease 2021 framework to assess various health metrics. Key indicators such as prevalence, incidence, and Disability-Adjusted Life Years (DALYs) were examined using all-age count estimates and age-standardized rates per 100,000 individuals. The analysis spanned the years 1990 to 2021, with results categorized by sex, age group, and geographic location. Furthermore, percentage changes over this period were calculated. To enhance the reliability of the findings, all reported estimates included a 95 % uncertainty interval.

RESULTS

In 1990, the age-standardized prevalence rate of bipolar disorder in Iran was 770.09 per 100,000 individuals [95 % UI: 657 to 902], and by 2021, it slightly increased to 780 per 100,000 [95 % UI: 667 to 915]. The percentage change over the period from 1990 to 2021 was 0.01 %. In 2021, the total number of bipolar disorder cases in Iran was reported at 724,891, with a 95 % uncertainty interval ranging from 614,626 to 848,263. Among these cases, 376,813 were observed in females and 348,077 in males. Notably, individuals aged 10 to 24 accounted for 127,388 of the overall cases, making this age group the most affected. The age-standardized incidence rate (per 100,000) of bipolar disorder was estimated to be 52 [95 % UI: 44 to 61] in 1990 and 53 [95 % UI: 45 to 62] in 2021, reflecting a minimal change of 0.01 % over this period. Similarly, the age-standardized disability-adjusted life years (DALYs) rate (per 100,000) for bipolar disorder was recorded at 164 [95 % UI: 107 to 240] in 1990 and 166 [95 % UI: 109 to 241] in 2021, with an equivalent negligible change of 0.01 % from 1990 to 2021.

DISCUSSION

In Iran, the burden of bipolar disorder has been found to exceed global averages, and due to demographic changes, young population, regional stressors this burden has grown significantly over the past three decades. Therefore, it remains crucial to focus increasing access to mental health care by increasing mental health care infrastructure in the country, especially in densely populated areas.

Psychosocial factors driving common substances used among Ghanaian senior high school students

OBJECTIVE

Substance use among adolescents poses a significant public health challenge, particularly in low- and middle-income countries like Ghana. This study investigates the prevalence of substance use and its psychosocial correlates among in-school adolescents in Ghana, with the goal of identifying key risk and protective factors to inform culturally appropriate prevention and intervention strategies.

RESULTS

The findings revealed distinct patterns of substance use linked to social and familial influences. Male students, those living with relatives, and those with peers who drank alcohol had a higher likelihood of alcohol use. Students who engaged in part-time work or had family members who smoked were more likely to use cigarettes. Older adolescents and those with friends who used shisha showed increased shisha consumption. Notably, limited social media exposure and living with parents or siblings were associated with reduced marijuana use. Furthermore, students who reported substance use exhibited signs of potential substance use disorder. The study underscores the strong influence of peer and family substance use behaviours on adolescent substance uptake. These findings highlight the need for targeted, context-specific interventions that address psychosocial risk factors while reinforcing protective family and social dynamics to promote adolescent well-being in Ghana and similar settings.

Major depressive disorder in children and adolescents is associated with reduced hair cortisol and anandamide (AEA): cross-sectional and longitudinal evidence from a large randomized clinical trial

Pediatric major depressive disorder (MDD) represents a leading cause of disability worldwide in children and adolescents, while its underlying pathophysiology remains largely elusive. The endocannabinoid system (ECS) and the hypothalamus-pituitary-adrenal (HPA) axis are considered intertwined regulatory systems crucially implicated in the pathophysiology of depressive disorders. This study explores the cross-sectional and longitudinal association between the ECS, specifically anandamide (AEA), and the HPA axis with its main effector cortisol and MDD status and severity in children and adolescents. Utilizing data from the omega-3-pMDD trial, a phase III Randomized Clinical Trial assessing the efficacy and safety of omega-3 fatty acid supplementation in pediatric MDD, we examined hair AEA and cortisol concentrations in 110 children and adolescents aged 8-17 years, with MDD. Associations between MDD, symptom severity and hair AEA and cortisol concentrations were explored across four measurement time points (baseline, week 6, 24 and 36). Additionally, 127 healthy children and adolescents were examined once to enable cross-sectional comparisons between MDD cases and healthy controls. Baseline comparisons for the 237 children and adolescents showed lower cortisol and AEA levels in hair of children and adolescents with MDD compared to healthy controls. Longitudinal multi-level analysis over all time-points further corroborated negative longitudinal associations between hair cortisol and depressive symptoms in children and adolescents with MDD. Taken together, reduced baseline AEA and cortisol levels emerge as robust biomarker in depressed youth, while the negative longitudinal association between hair cortisol and depression symptoms might provide useful for therapy monitoring purposes. These results hold implications for early detection, diagnosis, and therapeutic response prediction in pediatric MDD.

Everybody @ease - reaching Out To Vulnerable Subgroups of Young People with Mental Health Problems in the Netherlands: an Adaptation of the Standard @ease Working Method

Young people with mental health problems do not always receive appropriate care. This study aims to increase understanding of the barriers and facilitators that young people face in their pathways towards care, by making use of targeted outreach activities by @ease, a youth-friendly walk -in center in the Netherlands. A questionnaire enquiring demographic characteristics, symptom levels and levels of functioning was administered to young people as part of a pilot-outreach program at @ease. Semi-structured interviews were conducted with participants to explore their attitudes towards and experiences with mental health care and how these influenced their help-seeking. Sixty-six participants were included in the pilot-outreach @ease program. Main themes concerning participant help-seeking were 'beliefs about self and others', 'accessibility of care', 'social network' and 'previous experiences with mental health care'. Participants also gave suggestions for care improvement. The outreach pilot successfully reached young people previously underrepresented through the regular @ease program. A key finding is that participants' previous experiences with mental health care played an important role in shaping their attitudes towards future help-seeking for mental health problems, influencing them both positively and negatively.

Memory function in patients with opioid dependence treated with buprenorphine and methadone in comparison with healthy persons

Methadone and buprenorphine are commonly used for drug abuse treatment but may impair cognitive function. This study assessed memory performance in patients receiving these treatments compared to healthy controls. A cross-sectional study was conducted on 93 buprenorphine- and 120 methadone-treated patients, compared with 120 healthy controls. The Wechsler Memory Scale was used, and scores were compared among the study groups using Kruskal-Wallis with Tukey's post-hoc test. Maintenance therapy duration was compared between case groups using an independent t-test or Mann-Whitney U test. Healthy controls were superior to both treatment groups in mental control. The methadone group surpassed controls in personal and general information (P < 0.05), while buprenorphine-treated patients scored lower in associate learning. Patients receiving methadone for > 2 years had a higher mean score of awareness of place and time than those on long-term buprenorphine (P = 0.034). Longer buprenorphine treatment correlated with improved total memory scores (P = 0.03). The mental test showed no significant adverse effect for either medication on most mental aspects, except for mental control, which was worse than the control group in both medications. In some aspects, treated patients even outperformed controls. Buprenorphine preserves memory function better than methadone over time.

Influence of Lifestyle Habits on Psychological Well-Being of University Students: A Quantitative Cross-Sectional Study

Background: This study explored the influence of three key lifestyle habits-physical activity (PA), adherence to the Mediterranean diet (MD), and sleep duration-on psychological well-being indicators (resilience, psychological distress, and self-esteem) in university students. Methods: A total of 928 students (67.3% females; total sample mean age = 21.01 ± 1.95) from the Faculty of Education at the University of Granada participated. Validated self-report instruments were used to assess all variables: the International Physical Activity Questionnaire (IPAQ-SF), the KIDMED index, the Connor-Davidson Resilience Scale (CD-RISC), the Depression Anxiety Stress Scales (DASS-21), and the Rosenberg Self-Esteem Scale. Results: Results showed that male students reported higher levels of PA, better MD adherence, longer sleep duration, and more favorable psychological outcomes. Stepwise regression analyses indicated that MD adherence was the strongest and most consistent predictor of resilience, self-esteem, and psychological distress. Sleep duration emerged as a key factor, particularly in predicting resilience among men. Although no direct association was found between PA and psychological distress, mediation analysis revealed a significant indirect effect through sleep duration. Conclusions: These findings underscore the relevance of promoting healthy lifestyle habits in an integrated and sex-sensitive manner to enhance mental health (MH) in university students. In particular, targeting future teachers may be essential, given their potential role as promoters of well-being in school settings.

Global burden and trends of self-harm from 1990 to 2021, with predictions to 2050

Background

Self-harm has become a major public health problem globally. Data on the burden of self-harm in this study were taken from the GBD 2021. This study aimed to quantify historical trends (1990-2021) in the global burden of self-harm across genders, age groups, and regions, and project future changes (2022-2050) through Bayesian forecasting models.

Methods

Based on the seven GBD super-regions, the burden of self-harm was analyzed by region, age, and gender from 1990 to 2021. Hierarchical statistical approach was used to predict trends in global and regional changes in the burden of self-harm, 2022-2050.

Result

In 2021, the global DALYs and death counts from self-harm were 33.5 million (95% UI: 31.3-35.8) and 746.4 thousand (95% UI: 691.8-799.8). The region with the highest number of DALYs and deaths is South Asia and the highest age-standardized rates of DALYs and mortality were in central Europe, eastern Europe, and central Asia. Globally, the burden of self-harm was higher for males than for females. DALYs rates were highest among adolescents and young adults (20-29 years), whereas mortality rates showed a predominantly age-progressive pattern with the highest burden observed in middle-aged and older populations, albeit with a modest decline in the oldest age groups. Forecasting models showed a sustained decline in the global burden of self-harm from 2022-2050.

Conclusion

The results highlight the need for policymakers to allocate resources to high-burden regions (e.g., South Asia and Eastern Europe), to implement gender- and age-specific prevention programs, and to strengthen cross-sectoral collaboration to address the underlying social determinants of self-harm. The findings call for strengthened mental health services and targeted interventions to effectively respond to and reduce the devastating impact of self-harm on individuals and the global community.

Global burden and trend of substance use disorders, self-harm, and interpersonal violence from 1990 to 2021, with projection to 2040

BACKGROUND

Alcohol use disorders (AUD), drug use disorders (DUD), interpersonal violence, and self-harm are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with this. This study aims to estimate the disease burden, trends, projections, and disparities of AUD, DUD, interpersonal violence, and self-harm among all ages and sexes from 1990 to 2021.

METHODS

This study is a secondary analysis utilizing data from the Global Burden of Disease (GBD) 2021 in 204 countries and territories. The incidence, deaths, and disability-adjusted life years (DALYs), projection, and the inequality were estimated for AUD, DUD, interpersonal violence, and self-harm among all age and sex.

RESULTS

In 2021, there were 55.78 (46.56-64.31) million new cases of AUD, 13.61 (11.63-15.67) million new cases of DUD, 29.40 (26.17-32.65) million new cases of interpersonal violence, 5.49 (4.6-6.5) million new cases of self-harm globally. By 2040, AUD is forecasted to be 51.98 (29-74.97) million, DUD will be 13.81 (9.23-18.39) million, 36.01 (15.25-56.78) million for interpersonal violence, and 10.55 (3.16-17.94) million for self-harm. In terms of gender and age distribution, males had higher incidence, mortality, and DALYs for AUD, DUD, and interpersonal violence compared to females. Females had higher incidence of self-harm, while males had higher mortality. By age group, individuals aged 15-49 bore the highest burden of DUD, interpersonal violence, and self-harm, while those aged 50-74 had the highest burden of AUD. The burden of these conditions is closely related to the socio-demographic index (SDI). High- and middle-high SDI regions had a heavier burden of AUD, DUD, and self-harm, while low- and middle-low SDI regions had a heavier burden of interpersonal violence. Additionally, from 1990 to 2021, health inequalities for AUD and self-harm decreased, while those for DUD and interpersonal violence increased.

CONCLUSIONS

From 1990 to 2021, the disease burden of AUD, DUD, interpersonal violence, and self-harm exhibited specific patterns across different genders, age groups, and regions. Multilevel interventions should be initiated, with a focus on reducing inequalities through resource allocation and policy support.

Predicting the onset of mental health problems in adolescents

OBJECTIVE

Mental health problems are the major cause of disability among adolescents. Personalized prevention may help to mitigate the development of mental health problems, but no tools are available to identify individuals at risk before they require mental health care.

METHODS

We identified children without mental health problems at baseline but with six different clinically relevant problems at 1- or 2-year follow-up in the Adolescent Brain Cognitive Development (ABCD) study. We used machine learning analysis to predict the development of these mental health problems with the use of demographic, symptom and neuroimaging data in a discovery (N = 3236) and validation (N = 3851) sample. The discovery sample (N = 168-513 per group) consisted of participants with MRI data and were matched with healthy controls on age, sex, IQ, and parental education level. The validation sample (N = 84-231) consisted of participants without MRI data.

RESULTS

Subclinical symptoms at 9-10 years of age could accurately predict the development of six different mental health problems before the age of 12 in the discovery and validation sample (AUCs = 0.71-0.90). The additive value of neuroimaging in the discovery sample was limited. Multiclass prediction of the six groups showed considerable misclassification, but subclinical symptoms could accurately differentiate between the development of externalizing and internalizing problems (AUC = 0.79).

CONCLUSIONS

These results suggest that machine learning models can predict conversion to mental health problems during a critical period in childhood using subclinical symptoms. These models enable the personalization of preventative interventions for children at increased risk, which may reduce the incidence of mental health problems.

Incorporating Patient-Reported Outcome Measures and Patient-Reported Experience Measures in Addiction Treatment Services in Belgium: Naturalistic, Longitudinal, Multicenter Cohort Study

BACKGROUND

Traditionally, treatment outcomes of service users with a substance use disorder (SUD) are measured using objective and provider-reported indicators. In recent years, there has been a shift toward incorporating patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to capture service users' perspectives on treatment outcomes and experiences.

OBJECTIVE

The OMER-BE (Outcome Measurement and Evaluation as a Routine Practice in Alcohol and Other Drug Services in Belgium) study evaluates the acceptability and feasibility of PROMs and PREMs in different SUD treatment services, using the recently developed International Consortium for Health Outcomes Measurement Standard Set for Addictions. This paper presents the design and baseline characteristics of the study, indicators of attrition at 45-day follow-up, and the feasibility of the implementation of PROMs and PREMs in residential and outpatient services.

METHODS

A convenience sample of 189 treatment-seeking individuals with SUD from different inpatient (therapeutic communities and psychiatric centers) and outpatient treatment services was followed for six months. Sociodemographic characteristics; clinical factors; and PROMs including recovery strengths, quality of life, and global health were assessed at baseline and within 3 weeks after starting treatment. Additionally, PROMs and PREMs were measured 45, 90, and 180 days later. Comparisons were made between treatment modalities, and indicators of attrition at the 45-day follow-up were assessed using ANOVA and chi-square tests.

RESULTS

Baseline differences were observed between the three treatment modalities regarding education, SUD treatment history, primary substance, and Attention-Deficit/Hyperactivity Disorder Self-Report scores. Overall, patients in psychiatric treatment centers had a higher education level and less polysubstance use, while outpatients had fewer previous SUD treatments but received relatively more often opioid agonist treatment. Inpatients reported more attention-deficit/hyperactivity disorder symptoms and higher SUD severity than outpatients. Additionally, recovery strength scores were significantly lower in the outpatient group compared to the other groups, particularly in the subdomains of "Substance Use," "Self-care," and "Outlook on Life." At the 45-day follow-up assessment, the attrition rate was 36.6%. Comparisons between participants who completed the 45-day follow-up and those who dropped out revealed that completers were significantly older, had a higher level of education, were more likely to live alone, and were more likely to have a mother born in Belgium. They also had higher average scores on the "Material Resources" domain of the Substance Use Recovery Evaluator, which includes questions about stable housing, a steady income, and effective financial management.

CONCLUSIONS

Evaluating PROMs and PREMs appears to be feasible in a diverse group of treatment-seeking patients with SUD in Belgium. However, challenges remain for structural implementation in practice, especially in outpatient services. Routine monitoring of PROMs and PREMs has the potential to empower patients, service providers, and policy makers by providing a comprehensive understanding of service users' needs and treatment effectiveness.

Psychiatric disorders following the clustering of family disadvantages in previous generations: a multigenerational cohort study

PURPOSE

There is a lack of multigenerational research on the extent to which mental health is informed by transmission of multiple disadvantages across previous generations. This study aims to investigate how family socioeconomic and psychosocial disadvantages cluster and transition over grandparental and parental generations, and how this might be associated with grandchild psychiatric disorders.

METHODS

We utilized a cohort study with data following three generations from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Family disadvantages as exposures were measured across two periods- grandparental adulthood (parental childhood) and parental adulthood (grandchild childhood), and included socioeconomic (i.e., low income, non-employment, overcrowding, and single parenthood) and psychosocial aspects (i.e., single parenthood, teenage motherhood, psychiatric disorders, and criminality of father). Psychiatric disorders in the adult grandchildren as outcome were defined by hospitalizations with a main or contributing diagnosis reflecting mental and behavioral disorders from age 18 until 2019.

RESULTS

Multiple disadvantages within the grandparental and parental generations, respectively, predicted higher probabilities of grandchild psychiatric disorders. Multigenerational transmission is evident in that grandchildren with combinations of grandparental socioeconomic disadvantages and parental psychosocial disadvantages had comparably high probabilities of psychiatric disorders. Importantly, improved socioeconomic and psychosocial circumstances across previous generations predicted comparably low probabilities of grandchild psychiatric disorders.

CONCLUSION

Mental health of future generations is informed by the transmission of multiple disadvantages across previous generations, and the transition from grandparental socioeconomic disadvantages into parental psychosocial disadvantages is particularly important.

Health-Promoting Effects and Everyday Experiences With a Mental Health App Using Ecological Momentary Assessments and AI-Based Ecological Momentary Interventions Among Young People: Qualitative Interview and Focus Group Study

BACKGROUND

Considering the high prevalence of mental health conditions among young people and the technological advancements of artificial intelligence (AI)-based approaches in health services, mobile health (mHealth) apps for mental health are a promising way for low-threshold and large-scale mental health promotion, prevention, and intervention strategies, especially for young people. However, insufficient evidence on health-promoting effects and deficient user-centric designs emphasize the necessity for participatory methods in the interventions' development processes.

OBJECTIVE

This study aimed to explore young people's everyday experiences using an AI-based mHealth app for mental health promotion based on ecological momentary assessments and ecological momentary interventions. Our analysis of qualitative data focused on exploring young people's use patterns in daily life and mental health-promoting effects.

METHODS

We conducted problem-centered interviews and focus groups with a subsample of 27 young people aged 14 to 25 years, who were among the participants of 2 microrandomized trials testing and evaluating an AI-based mHealth app (AI4U training). Our study used a participatory approach, with "co- and peer researchers" from the dialogue population actively engaged in research processes and data analysis. Structural content analysis guided the qualitative analysis.

RESULTS

Participants reported enhanced emotional self-awareness and regulation in daily life through the ecological momentary assessments and ecological momentary interventions. Young people appreciated the AI4U training for managing emotions and stress. They had no trust issues regarding disclosing their mental health via the AI4U training in daily life. Some faced challenges integrating it into their daily routines and highlighted the value of autonomy in use decision-making processes.

CONCLUSIONS

Our findings reveal that young people benefited from enhanced emotional awareness and management through the use of the AI4U training, appreciating its anonymity for facilitating emotional disclosure. The results suggest that enhanced self-directed use may improve daily life integration, although participants noted that they sometimes avoided using the AI4U training during distress despite recognizing its potential benefits. These findings indicate the importance of balancing directed use and autonomy in digital interventions to harmonize compliance with effectiveness in daily life. We highlight the importance of participatory research for tailored digital mental health solutions.

Associations between adolescent psychiatric disorders and adulthood payment problems: a Norwegian register study of complete birth cohorts of 1995-1997

BACKGROUND

Psychiatric disorder diagnoses are linked to long-term socioeconomic 'shadows' into adulthood, but little is known about how these diagnoses are associated with adulthood payment problems in Norway and whether these associations are moderated by parental and area characteristics.

METHODS

We combine Norwegian registry data with payment problem records from the public debt enforcement agency for the 1995-1997 birth cohorts (n=173 750). We ascertain behavioural, neurotic, mood and substance use disorder diagnoses from specialised care at ages 13-17. Payment problems are defined as any records of mandatory deductions in wages or benefits up to age 23. Causal forests are used to explore the potential moderating role of sociodemographic variables.

RESULTS

Some 6% of the sample have payment problems, but the share is higher among men and among people with low childhood socioeconomic status. After adjusting for background characteristics, behavioural problem diagnoses are linked to a 4.6 percentage point higher risk of payment problems (95% CI 4.1 to 5), mood disorder diagnoses to a 2.2 percentage point higher risk (95% CI 1.5 to 2.9), neurotic disorder diagnoses to a 2.5 percentage point higher risk (95% CI 2 to 3.1) and substance use disorder diagnoses to a 9.3 percentage point higher risk (95% CI 7.6 to 10.9). The associations between substance use and behavioural diagnoses and payment problems are stronger for people with low childhood socioeconomic status.

CONCLUSION

The associations between adolescent substance and behavioural diagnoses and adulthood payment problems are particularly strong among people with low childhood socioeconomic status. Reducing these associations is critical for preventing the accumulation of disadvantages.

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

Introduction

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

Methods

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

Discussion

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

Bayesian joint longitudinal and survival modeling of bipolar symptom burden and time to symptomatic recovery of patients with bipolar disorder at Jimma University Medical Center, Jimma, Ethiopia

BACKGROUND

Bipolar disorder is a mental health problem that primarily affects mood. Symptoms of bipolar disorder are extreme irritability or agitation, a period of feeling empty, loss of interest in usual activities, sleep problems Etc. Symptomatic recovery is a dimensional measure that refers to improvement in the magnitude of symptoms. This investigation aims to determine the association between the burden of symptoms and time to symptomatic recovery of bipolar disorder that may increase more awareness about this disorder.

METHODS

A Bayesian joint modeling of longitudinal and survival data was proposed to examine the association between the burden of symptoms and time to symptomatic recovery of bipolar disordered individuals at Jimma University Medical Center, Jimma, Ethiopia. The data in this investigation were retrospective longitudinal data and survival data from all the admitted follow-up of bipolar disorder patients from September 2018 to January 2020.

RESULTS

From the total of 257 bipolar disorders, about 116(45.1%) of them experienced an event of recovery. The time interval of follow up, age, the interaction between time interval of follow up and adolescent first onset of the disease, the interaction between time interval of follow up and event of relapse, the interaction between linear time interval of follow up and existence of other cofactors, and the interaction of substance abuse and chewing khat have significantly affected the log expected burden of bipolar symptoms. In survival sub-models, the covariates; divorced, event of relapse, mixed type of episodes significantly affect the time to symptomatic recovery at 95% confidence level. The association between burden of bipolar symptoms and time-to- symptomatic recovery is explained by α0 = - 8.403 with a [- 11.157,- 6.576]. It associates longitudinal count, the burden of symptoms, and time-to-symptomatic recovery of bipolar disorder using shared random effect parameters. There was a significant negative relationship between the subject-specific random intercept (baseline) of the burden of symptoms and the time to symptomatic recovery of bipolar disorder. Their 95% credible intervals exclude zero.

CONCLUSIONS

This study using the Bayesian joint modeling of longitudinal and survival has revealed a strong negative relationship between the event of recovery and the burden of bipolar symptoms at the baseline time. The study indicates that at the beginning, since the burden of bipolar symptoms is high, the chance of symptomatic recovery is low. And, we hypothesize that individuals with a higher initial symptom burden or a slower rate of symptom reduction (captured by bi) will experience a longer time to recovery. So, bipolar disorders at the initial follow-up need exceptional service and treatment.

Adolescents' screen time displaces multiple sleep pathways and elevates depressive symptoms over twelve months

Recently the Swedish Public Health Agency published recommendations of a maximum of two-to-three hours of daily leisure screen time for adolescents aged 13-18, partly to promote better sleep (2024-Sep-02). Biologically and socially, adolescence is characterized by belated sleep times, and depressive effects of screen time can arise through sleep displacements. Theorized links between screen time, sleep, and depression, merited examination of four sleep mediators to determine their relative importance and determine which of them mediate future depression. Hypotheses were preregistered. Three-wave psychometric health data were collected from healthy Swedish students (N = 4810; 51% Boys; ages 12-16; N = 55 schools; n = 20 of 26 Stockholm municipalities). Multiple imputation bias-corrected missing data. Gender-wise Structural Equation Modelling tested four sleep facets as competing mediators (quality, duration, chronotype, social jetlag). The primary model result included the three first mediators to achieve acceptable fit indices (RMSEA = 0.02; SRMR = 0.03; CFI = 0.95; TLI = 0.94). Screen time deteriorated sleep within three months and effect sizes varied between mediators (Beta weights ranged: 0.14-0.30) but less between genders. Among boys, screen time at baseline had a direct adverse effect on depression after twelve months (Beta = 0.02; p <0.038). Among girls, the depressive effect was mediated through sleep quality, duration, and chronotype (57, 38, 45% mediation). Social jetlag remained non-significant. This study supports a modernized 'screen-sleep-displacement theory'. It empirically demonstrates that screen-sleep displacements impact several aspects of sleep simultaneously. Displacements led to elevated depressive symptoms among girls but not boys. Boys may be more prone to externalizing symptoms due to sleep loss. Results could mirror potentially beneficial public health effects of national screen time recommendations.

An examination of sociodemographic and clinical factors influencing help-seeking attitudes and behaviors among adolescents with mental health problems

This study investigated sociodemographic and clinical factors influencing help-seeking attitudes and behavior among adolescents with mental health problems. As part of the ProHEAD ("Promoting Help-seeking using E-technology for ADolescents") consortium a school-based, online assessment of sociodemographic information, psychopathology, risk-taking and self-harming behavior, help-seeking attitudes and behavior, and barriers to help-seeking was conducted in adolescents aged ≥ 12 years recruited from randomly selected schools in five regions of Germany. Linear regression analyses with the LMG formula were performed to explore predictors of help-seeking attitudes and behavior and assess their relative importance. Nine thousand five hundred and nine participants (95.5%) completed the online assessment (mean age: 15.1 years, 58.6% female). In total, 1606 participants (16.9%) showed relevant mental health problems (e.g., depressive and eating disorder symptoms, alcohol problems, and thoughts of self-harming behavior). Among them, 895 (55.7%) reported having sought help (lifetime), with higher rates for informal (n = 842, 52.4%) compared to professional (n = 380, 23.7%) sources. High help-seeking propensity emerged as the most important factor contributing to professional help-seeking, followed by elevated levels of psychopathology and perceived barriers, with sociodemographic factors being less impactful. Psychopathological severity also outweighed sociodemographic factors in predicting negative help-seeking attitudes. These findings indicate that attitudes towards seeking professional help, perceived barriers, and psychopathology severity critically influence limited adolescent help-seeking behavior. This emphasizes the need for initiatives that promote help-seeking, reduce negative attitudes, and address structural barriers in adolescent mental health care.

Trends in mortality, disability-adjusted life years, and years of healthy life lost due to self-harming in Brazilian states from 1990 to 2019

OBJECTIVES

To compare rates, disability-adjusted life years (DALYs), and years of healthy life lost due to disability (YLDs) associated with deaths due to self-harm in Brazil.

METHODS

This epidemiological study utilized secondary data obtained from the Global Burden of Disease Study. Analytical examinations were conducted to provide detailed descriptions of national and subnational rates.

RESULTS

We identified mortality rates, DALYs, and YLDs resulting from deaths due to self-harm - national data from 26 states and the Federal District - between 1990 and 2019. The national rates in 1990 and 2019 were the same for mortality = 6.2 deaths per 100.000 inhabitants, reduced for DALYs = 312-289 DALYs, and the same for YLDs = 1.6 YLDs. Four united federations had higher mortality rates, DALYs, and YLDs caused by self-harm compared to national rates throughout the analyzed period (between 1990 and 2019) - Goiás (mortality = 11-67%, DALYs = 13-73%, and YLDs = 4-45%), Mato Grosso do Sul (mortality = 23-42%, DALYs = 28-46%, and YLDs = 13-64%), Minas Gerais (mortality = 5-25%, DALYs = 7-25%, and YLDs = 19-35%), and Rio Grande do Sul (mortality = 73-98%, DALYs = 55-84 %, and YLDs = 52-70%).

CONCLUSION

Although national mortality rates and YLD caused by self-harm have been maintained, there has been a decrease in the incidence of DALYs. However, certain states in Brazil have rates higher than the national average, indicating the need for multiple strategies to be implemented to reduce mortality rates, DALYs, and YLDs resulting from self-harm in these specific states.

Substance use among young people in the West Arsi Zone, Ethiopia: A cross-sectional study

INTRODUCTION

Substance use is a pressing public health concern in young Ethiopians, impacting their physical, psychosocial, and emotional well-being and productivity. However, there is a limited understanding of the prevalence and factors associated with substance use in this population both across Ethiopia and in the West Arsi zone specifically. This study investigates the prevalence of substance use and associated factors among young people in the West Arsi Zone, Ethiopia.

METHODS

A community-based cross-sectional survey was conducted among 427 randomly selected young people aged 14-29 in the West Arsi zone of the Oromia region, Ethiopia. Data were collected using structured interviewer-administered questionnaires. Logistic regression analysis was performed to determine the association between the outcome and independent variables. Ethical approval was obtained from the University of Technology Sydney, Australia, and Madda Walabu University, Ethiopia.

RESULTS

A total of 424 participants were included in the analysis, giving a response rate of 99.3%. The overall lifetime prevalence of any substance use among the study participants was 48.1% (95% CI: 43.3%, 53.0%) and the prevalence of current substance use was 72.5% (95% CI: 65.9, 78.5). Among lifetime users, 76.5% reported chewing khat, 49.0% drinking alcohol, 33.3% using various forms of tobacco, and 23.0% using cannabis. Being male, having a single marital status, a family history of substance use, low perceived social support, and the presence of mental health conditions were associated with an increased likelihood of substance use.

CONCLUSIONS

About half of the study participants reported a history of use of at least one substance from alcohol, khat, tobacco, or cannabis in their lifetime, highlighting the need for appropriate focused interventions to help address the growing challenges of substance use amongst young people in Ethiopia.

Global, regional, and national burden of self-harm among adolescents aged 10-24 years from 1990 to 2021, temporal trends, health inequities and projection to 2041

Background

Self-harm ranks as the third leading cause of disability-adjusted life years (DALYs) among adolescents globally, imposing substantial disease and economic burdens. Comprehensive analyses of global temporal trends, health inequities, and future projections are crucial for developing effective public health policies and interventions.

Methods

This study analyzed the global, regional, and national age-standardized incidence, mortality, and DALYs for self-harm among adolescents using data from the Global Burden of Disease (GBD) 2021 database. Significant disease burdens and temporal trends were assessed. Projections and evaluations employed a combination of health inequities analysis, age-period-cohort (APC) analysis, socio-demographic index (SDI) analysis, Joinpoint regression analysis, and Bayesian APC modeling.

Results

The global burden of self-harm among adolescents demonstrated an overall downward trend. However, in 2021, the burden increased with age and is projected to decline further by 2041. Joinpoint regression analysis revealed a generally decreasing temporal trend, although some regions exhibited stable or slightly increasing trends. Significant regional and national heterogeneities were identified. The High SDI region showed a slight upward trend in incidence, Southern Latin America experienced the largest increase, and the Middle SDI region showed the largest decrease. Conversely, East Asia demonstrated the most significant reductions in both incidence and mortality. Age effects were most pronounced in Low-middle SDI regions, while period and cohort effects exhibited greater fluctuations in High SDI regions. Notably, SDI analysis revealed a positive, fluctuating nonlinear relationship with age-standardized DALYs (r = 0.324, P < 0.001). Gender and regional disparities were also significant. Male adolescents in Middle and High SDI regions bore a higher burden of mortality, whereas female adolescents in Low SDI regions experienced a disproportionately high incidence. Adolescents aged 15-24 carried the greatest burden, with females exhibiting a higher incidence and males experiencing higher mortality rates.

Conclusion

Despite an overall decline, significant gender and regional disparities persist. Male adolescents in higher SDI regions and females in lower SDI regions are particularly vulnerable. These findings underscore the need for targeted interventions addressing gender and regional inequalities, optimizing healthcare resource allocation, improving health education, and reducing the socioeconomic costs associated with self-harm in adolescents.

Child eating disorder examination (ChEDE) interview and child eating disorder examination questionnaire (ChEDE-Q): psychometric properties of the Italian versions

PURPOSE

To examine the psychometric characteristics of the Italian language versions of the child eating disorder examination (ChEDE) interview and child eating disorder examination questionnaire (ChEDE-Q).

METHODS

ChEDE (from EDE 17th edition) and ChEDE-Q were first translated, and then administered to 147 patients with eating disorders under the age of 18, along with 80 age-matched controls. Their internal consistency (Cronbach alpha), inter-rater reliability (Spearman rho), short-term (7-23 days) test-retest reliability (Spearman rho), and criterion validity (group differences by Mann-Whitney U) were evaluated.

RESULTS

Patients with eating disorders displayed significantly higher ChEDE/ChEDE-Q scores than age-matched controls, demonstrating the adequate criterion validity of the instrument (all subscales and global scores significant at p < 0.001). Internal consistency was high for all original ChEDE/ChEDE-Q subscales (minimum Cronbach alpha 0.752), apart from Eating Concerns (minimum Cronbach alpha 0.591). Inter-rater reliability was excellent for global ChEDE/ChEDE-Q scores and each subscale (minimum Spearman rho 0.999). Test-retest reliability was excellent for global ChEDE/ChEDE-Q scores and each subscale (minimum Spearman rho 0.791).

CONCLUSIONS

The Italian versions of the ChEDE interview and ChEDE-Q exhibited excellent psychometric properties and may, therefore, be recommended for the assessment of Italian patients with eating disorders less than 18 years old, both in clinical practice and research settings. Level of evidence III evidence obtained from cohort or case-control analytic studies.

Lipid oxidation in young patients with newly diagnosed bipolar disorder and their relatives

BACKGROUND

Oxidative stress may be involved in the pathophysiology of bipolar disorder (BD). Malondialdehyde (MDA), a product of fatty acid peroxidation has been proposed as a trait marker of BD associated with familial risk. However, little is known about MDA levels in young patients newly diagnosed with BD and their unaffected first-degree relatives (UR).

METHODS

In this substudy of the ongoing longitudinal "Bipolar Illness Onset study", we included baseline data and first, we compared fasting blood MDA levels in 130 young patients aged 15-25 years newly diagnosed with BD, 57 UR, and 88 healthy control individuals (HC). Second, we investigated associations between levels of MDA and illness variables in patients with BD. Third, we investigated associations between MDA levels and nucleoside damage by oxidation measured in urine. Fasting MDA levels from blood samples were measured using high-performance liquid chromatography (HPLC).

RESULTS

In linear mixed effect models, adjusted for age and sex, MDA levels did not differ between patients with BD, UR, and HC, respectively. In patients with BD, we found no associations between levels of MDA and duration of illness, number of affective phases, illness onset or oxidatively damaged RNA and DNA.

CONCLUSION

Against expectations, MDA levels did not differ between young patients with BD, UR, and HC, thus, our findings did not support MDA being a state or a trait marker of BD associated with familial risk.

Preschool children of parents who screen positive for mental health problems have an increased risk of subsequent mental disorders: Findings from a longitudinal follow-up study in Sweden

Research has shown associations between parental and child mental health problems. However, there is a paucity of Swedish studies on this topic. Investigating this link in a Swedish context could inform preventive interventions aimed at reducing mental health problems in affected families. This longitudinal cohort study aimed to explore the association between parental mental health problems and children's subsequent mental disorders in Sweden. We used data on children, 3-5 years old, whose mothers (n = 6379) and fathers (n = 6218) had responded to the 12-item General Health Questionnaire for assessment of parental mental health problems using a cut-off of ≥12 points. The children were followed for approximately seven years with regard to subsequent mental disorders, collected from the Swedish National Patient Register. The associations between parental mental health problems and children's mental disorders were explored through Cox-regression models. In unadjusted Cox regression models, mothers (HR: 1.63, 95% CI: 1.37-1.94) and fathers (HR: 1.36, 95% CI: 1.12-1.65) with mental health problems were more likely to have children diagnosed with a subsequent mental disorder than mothers and fathers with no mental health problems. In adjusted models controlling for children's emotional and behavioral problems and parental sociodemographic factors, the associations remained significant for mothers' mental health problems (AHR: 1.33, 95% CI: 1.12-1.59), but not for fathers' (AHR: 1.14, 95% CI: 0.93-1.40). Children with emotional and behavioral problems, whose parents were single or living apart and whose parents had lower educational levels also had an elevated risk of being diagnosed with a mental disorder. Maternal mental health problems and child emotional and behavioral problems during the preschool years may serve as risk factors for subsequent child mental disorders. Assessment of these problems at child health services in Sweden could facilitate delivery of interventions to promote parental and child mental health.

Socio-demographic and clinical characteristics associated with mental health-related support and service contact in children and young people aged 5-16 in England

Mental health problems are common in children and young people (CYP) in England, yet evidence suggests high levels of unmet need. Understanding of the determinants of mental health-related service contact is needed to identify gaps in provision and areas for targeted intervention to improve access. A secondary analysis of the Mental Health of Children and Young People in England 2017 (MHCYP-2017) cross-sectional survey dataset was performed. This analysis describes mental health-related support and service contact amongst a national stratified probability sample of 6681 participants aged 5-16. A range of socio-demographic and clinical characteristics were analysed as explanatory variables and their relationships with different types of support and service contact were examined through multivariable multinomial logistic regression. Analyses were stratified by age group: 5-10- and 11-16-year-olds. Analyses revealed strong associations between participant socio-demographic/clinical characteristics and mental health-related support and service contact, independent of CYP mental health status and parental perception of difficulties. Among these associations, socio-economically disadvantaged and Black, Asian and Minority Ethnic CYP were less likely to have had professional contact for mental health problems in both age groups. Findings suggest there may be higher levels of unmet need in socio-economically disadvantaged and Black, Asian and Minority Ethnic CYP, warranting further investigation and efforts to address inequalities.

Interventions for suicidal and self-injurious related behaviors in adolescents with psychiatric disorders: a systematic review and meta-analysis

As a leading cause of adolescent death, suicidal and self-injurious related behaviors (SSIRBs) is a devastating global health problem, particularly among patients with psychiatric disorders (PDs). Previous studies have shown that multiple interventions can alleviate symptoms and reduce risks. This review aimed to provide a systematic summary of interventions (i.e., medication, physical therapy, psychosocial therapy) for the treatment of SSIRBs among Chinese adolescents with PDs. From inception to September 17, 2023, twelve databases (PubMed, CINAHL, ScienceDirect, PsycINFO, EMBASE, Cochrane Library, Clinical Trial, Web of Science, CEPS, SinoMed, Wanfang and CNKI) were searched. We qualitatively and quantitatively synthesized the included studies. Standardized mean differences (SMDs), risk ratios and their 95% confidence intervals (CIs) used the Der Simonian and Laird random-effects model. Fifty-two studies covering 3709 eligible participants were included. Overall, the commonly used interventions targeting SSIRBs and negative feelings in PDs adolescents with SSIRBs included psychosocial therapy (e.g., cognitive behavioral therapy), medication (e.g., antidepressants), and physiotherapy (e.g., repetitive transcranial magnetic stimulation). Importantly, quetiapine fumarate in combination with sodium valproate (SV) had positive effects on reducing self-injury behaviors score [SMD: -2.466 (95% CI: -3.305, -1.628), I2 = 88.36%], depression [SMD: -1.587 (95% CI: -2.505, -0.670), I2 = 90.45%], anxiety [SMD: -1.925 (95% CI: -2.700, -1.150), I2 = 85.23%], impulsivity [SMD: -2.439 (95% CI: -2.748, -2.094), I2 = 0%], as well as its safety in comparison with SV alone. No significant difference of adverse reactions was found by low-dose QF (P > 0.05). This review systematically outlined the primary characteristics, safety and effectiveness of interventions for Chinese PDs adolescents with SSIRBs, which could serve as valuable evidence for guidelines aiming to formulate recommendations.

Hospital admissions in adolescents with mental disorders in Spain over the last two decades: a mental health crisis?

Mental disorders account for a large and increasing health burden worldwide. Characterizing the spectrum of mental disorders and trends over time in adolescents should influence education policies and support preventative strategies at schools. Retrospective study of all hospitalizations in Spain in adolescents 11-18-years old, including mental disorders as diagnosis using the Spanish National Registry of Hospital Discharges. Information was retrieved from 2000 to 2021. During the 22-year study period there were 2,015,589 hospitalizations in adolescents in Spain, of which 118,609 (5.9%) had mental disorders. The rate of psychiatric diagnoses significantly increased from 3.9% in 2000 to 9.5% in 2021. Females accounted for 55.1% of admissions. Mean age at admission declined from 17 to 15 years-old from 2000 to 2021. Mean hospital stay was 10.6 days. Mean in-hospital mortality was 0.24%. By rate order, diagnoses were: substance use disorders (SUD) (40%) > eating disorders (15%) > anxiety/posttraumatic stress disorder (PTSD) (13%) > attention deficit hyperactivity disorder (ADHD) (9%) > major depression (8%) > schizophrenia/psychosis (6%) > autism spectrum disorder (ASD) (6%) > sleep disorder (3%) > suicidal behavior (2%) > sexual disorders (1%). A significant gender dichotomy was noticed, with female predominance for internalizing disorders (i.e., anxiety, depression, suicidal behavior and eating disorders) whereas externalizing disorders (i.e., SUD, ADHD, ASD, schizophrenia and other psychoses) predominated in males. Suicidal behavior and male sex were independent predictors of in-hospital death in multivariate analysis. After the first year of the COVID-19 pandemic, hospitalizations due to mental disorders in adolescents increased by 51% in 2021. There is a growing crisis of mental health among adolescents in Spain. Although the COVID-19 pandemic has unveiled the high rate and severity of psychiatric disorders among youth, a steadily increase has occurred since the beginning of the millennium. Primary preventative strategies should be adapted to distinct and more prevalent mental disorders in adolescents.

Self-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study

OBJECTIVE

To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care.

DESIGN

Observational study.

SETTING

A sentinel network of seven emergency primary care centres throughout Norway.

SUBJECTS

Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021-10/2022).

MAIN OUTCOME MEASURES

Contacts due to self-injurious thoughts and behaviours.

RESULTS

Self-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours.

CONCLUSION

Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts.

IMPLICATIONS

The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel's limited exposure.

Physical Activity as a Mediator in the Relationship Between Body Image Perception and Low Mood in Adolescents

Body image (BI) plays a critical role in mental health, with negative perceptions often linked to feelings of low mood. Physical activity (PA) has been shown to enhance self-acceptance and reduce negative emotions, suggesting it may help mitigate the impact of BI on low mood. This study examines the relationship between BI and low mood among adolescents, and explores the role of PA as a mediator in this relationship. The study had a cross-sectional design. Data were collected from 154,183 adolescents (average age 13.6 ± 1.6 years) across 43 countries, using the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. BI was assessed through self-perceived body size, low mood was measured on a scale from "about every day" to "rarely or never", and PA was evaluated by the number of days per week participants engaged in at least 60 min of activity. The study used multinomial logistic regression and a mediation model to analyze the relationships of BI, PA, and BMI with low mood. The multinomial logistic regression showed that daily PA reduces the risk of low mood, especially with higher PA frequency, such as PA on 6 days (OR = 0.72) and PA on 5 days (OR = 0.86). Age, BMI, BI, and sex also influence low mood, with males showing lower odds (OR = 0.40 to 0.77), normal weight individuals having a reduced risk, and thinner individuals having lower odds of low mood (OR = 0.12 to 0.50), with PA partially mediating the relationship between BI and low mood (p < 0.001), contributing to 9% of the total effect. PA partially mediates the relationship between BI and low mood, with a direct negative impact of BI on low mood. In addition, girls, older adolescents, and those with negative BI and irregular PA have a higher risk of low mood.

Independent and joint associations of dietary diversity and physical activity on mental health among older adults in China: a cross-sectional study

BACKGROUND

The joint association of dietary diversity (DD) and physical activity (PA) on anxiety, depressive symptoms, and their comorbidity have not been extensively explored. Hence, this study focused on examining this association.

METHODS

Data in this cross-sectional study was derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Based on self-reported dietary diversity score (DDS) questions were used to assess DD, ranging from 0 to 8. DDS < 5 was defined as insufficient DD and DDS ≥ 5 was defined as sufficient DD. PA was based on a self-reported binary question. Anxiety was assessed using the Generalized Anxiety Disorder Scale-7 (GAD-7), and depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). The independent and joint associations of DD and PA on anxiety, depressive symptoms, and their comorbidity were examined by multivariable-adjusted binary logistic regression models.

RESULTS

In this cross-sectional study, sufficient DD was independently associated with a decreased risk of anxiety (adjusted OR = 0.57, 95% CI = 0.50-0.65), depressive symptoms (adjusted OR = 0.69, 95% CI = 0.63-0.77), and their comorbidity (adjusted OR = 0.58, 95% CI = 0.49-0.68). Similarly, exposure to current exercise was also a significant protective factor for mental health. Importantly, co-exposure to sufficient DD and current exercise may amplify the protective effects on mental health (adjusted OR = 0.47, 95% CI = 0.38-0.57 for anxiety; adjusted OR = 0.36, 95% CI = 0.31-0.42 for depressive symptoms; adjusted OR = 0.37, 95% CI = 0.29-0.48 for their comorbidity). The robustness of these associations was demonstrated in four sensitivity analyses.

CONCLUSIONS

Our study found that sufficient DD and current exercise were associated with a decreased risk of mental health disorders. Importantly, the combination of both appeared to enhance this protective effect. Our findings promote the joint assessment of DD and PA to provide new insights into health-related behaviors for prevention strategies for mental health disorders in older adults.

Family therapy and systemic interventions for child‐focussed problems: The evidence base

This 25th anniversary review updates previous similar papers published in JFT in 2000, 2009, 2014 and 2019. It presents evidence from meta‐analyses and systematic reviews for the effectiveness of systemic interventions for families of young people with common mental and physical health problems and other difficulties where children are the primary focus of concern. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent‐implemented interventions. There is now a substantial evidence base supporting the effectiveness of systemic interventions either alone or as part of multimodal programmes for infant mental health and sleep and feeding problems in infancy; recovery from child abuse and neglect; externalising and internalising problems; eating disorders; somatic problems; and psychosis.

Gender and Lower Economic Status Moderate the Relation between Positive Youth Development and Mental Health

Adolescent mental health problems account for almost half of overall health problems globally with a risk to mental health in adulthood. Since most mental health problems begin in adolescence, this developmental period should be a focus of strengths-based approach and prevention. The most researched positive youth development framework shown to be associated with youth mental health is The Five C model which distinguishes five indicators: competence, character, confidence, caring, and connection. The aim of the present study is to examine whether sociodemographic differences moderate the association of Five Cs positive youth development indicators and depression and anxiety symptoms in adolescence. The participants of the study were 3,438 students enrolled in the first year of secondary schools in Croatia who completed the Short Measure of the Five Cs, Depression Anxiety and Stress Scales and reported the perception of the socioeconomic status of their family. Gender and socioeconomic status main effects were shown for seven out of ten models with depression and anxiety as criterion variables. Results show that girls with lower levels of competence, confidence, and connection and lower socioeconomic status reported the highest depression and anxiety scores. These results imply that confidence, competence, and connection could be sensitive to equality and distribution of resources for youth. Reducing youth mental health problems should include social justice perspective and more available public services for families. Supportive environments are key for positive development; therefore, promotive and preventive efforts should target factors operating on societal level as well.

The potential of non-psychedelic 5-HT2A agents in the treatment of substance use disorders: a narrative review of the clinical literature

INTRODUCTION

Substance use disorders (SUDs) are a public health issue, with only some having FDA-approved indicated treatments and these having high attrition. Consequently, there has been interest in novel interventions (e.g. psychedelics that target 5-HT2A receptors) with some promising results. In this narrative review, we aim to focus on the role of the 5-HT2A receptors on the effectiveness of the treatment of SUDs.

AREAS COVERED

We evaluated the clinical evidence of the treatment of SUDs with non-psychedelic medications with a primary affinity for the 5-HT2A receptor.

EXPERT OPINION

The reviewed literature showed some positive effects on craving and abstinence but, overall, results were mixed. Comparison of this work with work on psychedelic agents suggests that mixed results are not unique to non-psychedelic agents. Both psychedelic and non-psychedelic drugs with 5-HT2A affinity are not exclusively selective for 5-HT2A receptors. The observation that most agents reviewed are 5-HT2A receptor antagonists instead of agonists and that psychedelics (typically 5-HT2A receptor agonists) may have more homogenous positive results gives more support to 5-HT2A receptor agonists as a promising group for treating SUDs. Mechanisms may target a common denominator across SUDs (e.g. chronic hypodopaminergic states).

Editorial Perspective: A systems approach to addressing young people's mental health

This editorial explores how adopting a social determinants and systemic perspective can enhance preventative measures to boost the mental health of young people. It argues that to effectively elevate the mental health of young people, it is essential to tackle both the overarching influences and their specific local impacts. We maintain that a strategy combining systems thinking with evidence tailored to the local environment and participatory design is essential.

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

AIMS

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

METHODS

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

RESULTS

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

DISCUSSION

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

The association between maternal diabetes and the risk of attention deficit hyperactivity disorder in offspring: an updated systematic review and meta-analysis

Mixed results have been reported regarding the link between different types of maternal diabetes and attention deficit hyperactivity disorder (ADHD) in offspring. Hence, we conducted a systematic review and meta-analysis to explore these associations. Relevant studies on the subject were retrieved from six major databases, including PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale, and between-study heterogeneity was assessed using the I2 statistic. Subgroup, sensitivity, and meta-regression analyses were conducted to identify the sources of heterogeneity between studies. In total, seventeen observational studies (five case-control and twelve cohort studies) with 18,063,336 study participants were included in the final analysis. Our random-effects meta-analysis revealed that exposure to any form of maternal diabetes was associated with an increased risk of ADHD in children. Specifically, we observed a heightened risk of ADHD in children exposed to gestational diabetes mellitus, any pre-existing diabetes, pre-existing type 1 diabetes mellitus, and type 2 diabetes mellitus. Our study suggests that children exposed to diabetes during prenatal development are at a higher risk of developing ADHD. These findings underscore the critical importance of early screening and timely interventions for exposed offspring.

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND

The burden of mental disorders (MD) in the Western Pacific Region (WPR) remains a critical public health concern, with substantial variations across demographics and countries.

AIM

To analyze the burden of MD in the WPR from 1990 to 2021, along with associated risk factors, to reveal changing trends and emerging challenges.

METHODS

We used data from the Global Burden of Disease 2021, analyzing prevalence, incidence, and disability-adjusted life years (DALYs) of MD from 1990 to 2021. Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.

RESULTS

Between 1990 and 2021, the prevalence of MD rose from 174.40 million cases [95% uncertainty interval (UI): 160.17-189.84] to 234.90 million cases (95%UI: 219.04-252.50), with corresponding DALYs increasing from 22.8 million (95%UI: 17.22-28.79) to 32.07 million (95%UI: 24.50-40.68). During this period, the burden of MD shifted towards older age groups. Depressive and anxiety disorders were predominant, with females showing higher DALYs for depressive and anxiety disorders, and males more affected by conduct disorders, attention-deficit hyperactivity disorder, and autism spectrum disorders. Australia, New Zealand, and Malaysia reported the highest burdens, whereas Vietnam, China, and Brunei Darussalam reported the lowest. Additionally, childhood sexual abuse and bullying, and intimate partner violence emerged as significant risk factors.

CONCLUSION

This study highlights the significant burden of MD in the WPR, with variations by age, gender, and nation. The coronavirus disease 2019 pandemic has exacerbated the situation, emphasizing the need for a coordinated response.

Trends and prevalence of eating disorders in children and adolescents

BACKGROUND

Eating disorders (EDs) have increasingly become a public health problem globally, especially among children and adolescents.

AIM

To estimate the burden of EDs in children and adolescents (ages 5-19 years) at the global, regional, and national levels.

METHODS

Retrieved from Global Burden of Disease Study 2019 for EDs, including anorexia nervosa and bulimia nervosa, we extracted the disability-adjusted life years (DALYs) and prevalence rates with 95% uncertainty intervals between 1990-2019. The temporal trends of the DALYs and prevalence rates of EDs were assessed according to the estimated annual percentage changes.

RESULTS

In our study, we found that the burden of EDs continuously increased globally from 1990 to 2019. Although females accounted for more EDs cases, the burden of EDs in males had a greater increment. Meanwhile, the burden of EDs was associated with the high sociodemographic index (SDI) over the past 30 years and the human development indexes in 2019.

CONCLUSION

EDs, predominantly in high-income countries, are rising globally, especially in Asia, highlighting the need for resource planning and medical policy prioritization across all SDI quintiles.

When and Why Adults Abandon Lifestyle Behavior and Mental Health Mobile Apps: Scoping Review

BACKGROUND

With 1 in 3 adults globally living with chronic conditions and the rise in smartphone ownership, mobile health apps have become a prominent tool for managing lifestyle-related health behaviors and mental health. However, high rates of app abandonment pose challenges to their effectiveness.

OBJECTIVE

We explored the abandonment of apps used for managing physical activity, diet, alcohol, smoking, and mental health in free-living conditions, examining the duration of app use before abandonment and the underlying reasons.

METHODS

A scoping review was conducted based on the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and eligibility criteria were designed according to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. In total, 4 databases were searched (MEDLINE, Scopus, Embase, and PsycINFO) to identify quantitative and qualitative studies with outcome measures related to app abandonment in adults with free-living conditions, including reasons for abandonment and duration of use, for mobile apps related to WHO (World Health Organization) modifiable health behaviors and mental health. The included studies' risk of bias was appraised based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and COREQ (Consolidated Criteria for Reporting Qualitative Research) checklists. To enable data synthesis across different methodologies, app domains, demographic data, and outcome measures were categorized. Results are presented in 2 sections: quantitatively in a scatterplot to understand when users abandon apps and qualitatively through basic qualitative content analysis to identify the underlying reasons.

RESULTS

Eighteen eligible studies (525,824 participants) published between 2014 and 2022, predominantly from the United States, Canada, the United Kingdom, and Germany, were identified. Findings revealed a curvilinear pattern of app abandonment, with sharper abandonment soon after acquisition, followed by a slowing rate of abandonment over time. Taken together, a median of 70% of users discontinued use within the first 100 days. The abandonment rate appeared to vary by app domain, with apps focusing on alcohol and smoking exhibiting faster abandonment, and physical activity and mental health exhibiting longer usage durations. In total, 22 unique reasons for abandonment were organized into six categories: (1) technical and functional issues, (2) privacy concerns, (3) poor user experience, (4) content and features, (5) time and financial costs, and (6) evolving user needs and goals.

CONCLUSIONS

This study highlights the complex nature of health app abandonment and the need for an improved understanding of user engagement over time, underscoring the importance of addressing various factors contributing to abandonment, from technical issues to evolving user needs. Our findings also emphasize the need for longitudinal studies and a consistent definition of app abandonment to better understand and mitigate this phenomenon, thereby enhancing the effectiveness of health apps in supporting public health initiatives.

Trends and associated factors of mental health diagnoses in Catalan Primary Care (2010-2019)

BACKGROUND

The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns.

METHODS

Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann-Whitney tests, and a multivariate binary logistic regression were employed to analyze the data.

RESULTS

Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression.

CONCLUSIONS

This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effectiveness of Attachment-Based Family Therapy for Suicidal Adolescents and Young Adults: A Systematic Review and Meta-Analysis

Background

Suicide is a leading cause of death among adolescents and young adults. While only few evidence-based treatments with limited efficacy are available, family processes have recently been posed as a possible alternative target for intervention. Here, we review the evidence for Attachment-Based Family Therapy (ABFT), a guideline-listed treatment targeting intrafamilial ruptures and building protective caregiver-child relationships.

Method

PubMed, PsycINFO, Embase, and Scopus were searched for prospective trials on ABFT in youth published up until November 6th, 2023, and including measures of suicidality. Results were independently screened by two researchers following PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB-2 framework. A random effects meta-analysis was conducted on suicidal ideation and depressive symptoms post-intervention scores in randomized-controlled trials (RCTs).

Results

Seven articles reporting on four RCTs (n = 287) and three open trials (n = 45) were identified. Mean age of participants was M pooled = 15.2 years and the majority identified as female (~80%). Overall, ABFT was not significantly more effective in reducing youth suicidal ideation, gpooled = 0.40, 95% CI [-0.12, 0.93], nor depressive symptoms, gpooled = 0.33, 95% CI [-0.18, 0.84], compared to investigated controls (Waitlist, (Enhanced) Treatment as Usual, Family-Enhanced Nondirective Supportive Therapy).

Conclusion

Evidence is strongly limited, with few available trials, small sample sizes, high sample heterogeneity, attrition rates, and risk of bias. While not generally superior to other treatments, ABFT might still be a clinically valid option in specific cases and should be further investigated. Clinicians are currently recommended to apply caution when considering ABFT as stand-alone intervention for suicidal youth and to decide on a case-by-case basis.

Community-based interventions on the social determinants of mental health in the UK: an umbrella review

Purpose

There is growing evidence that several social determinants influence mental health outcomes, but whether or not community-based prevention strategies are effective in intervening on these social determinants to improve mental health is unclear. We synthesised the state of knowledge on this topic in the UK context, by conducting an umbrella review of the relevant systematic review literature.

Methodology

We searched five electronic databases for systematic reviews of community-based interventions that addressed any social determinant of mental health (SDOMH) in the UK, provided that mental health outcomes were measured. We reported the results according to PRISMA guidelines and synthesised narratively.

Findings

Our search yielded 1,101 citations, of which 10 systematic reviews met inclusion criteria. These reviews included 285 original studies, of which 147 ( 51.6%) were from the UK. Two reviews focussed on children and young people, with the remainder based on working-age adult populations. We identified five categories of SDMOH, where financial insecurity and welfare advice interventions were addressed by the largest number of reviews (N=4), followed by reviews of interventions around social isolation and support (N=3), and housing regeneration initiatives (N=2). Results across all social determinants and mental health outcomes were highly heterogenous, but evidence most consistently supported the effectiveness of interventions addressing financial and welfare support on mental health outcomes.

Originality

Our review highlights the paucity of high quality, causal evidence from the UK and beyond on the effectiveness of interventions on the social determinants of mental health; severe methodological heterogeneity hampers progress to identify scalable interventions to improve population mental health.

Psychometric Evaluation of the Dutch Version of the Substance Use Recovery Evaluator (SURE-NL)

INTRODUCTION

Patient-reported outcome measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The substance use recovery evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD.

METHODS

The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N = 171 participants were recruited as part of a naturalistic multicenter study in inpatient (N = 149) and outpatient (N = 22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL.

RESULTS

The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from 0.61 to 0.76; internal consistency of the total score was 0.83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21.

CONCLUSIONS

Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.

INTRODUCTION

Patient-reported outcome measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The substance use recovery evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD.

METHODS

The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N = 171 participants were recruited as part of a naturalistic multicenter study in inpatient (N = 149) and outpatient (N = 22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL.

RESULTS

The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from 0.61 to 0.76; internal consistency of the total score was 0.83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21.

CONCLUSIONS

Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.

Cost-effectiveness of psychological and psychosocial interventions for adults, children and young people who have self-harmed

BACKGROUND

Self-harm is a major health issue resulting in high societal costs. Few psychological and psychosocial interventions have shown effectiveness in reducing repeat self-harm.

OBJECTIVE

To assess the cost-effectiveness of psychological and psychosocial interventions that have shown evidence of effectiveness in adults and CYP (children and young people) who have self-harmed.

METHODS

Using effectiveness data from Cochrane reviews, we developed two decision-analytical models to compare costs and quality-adjusted life years (QALYs) of cognitive behavioural therapy (CBT)-informed psychological therapy added to treatment as usual (TAU) versus TAU alone for adults who have self-harmed, and of dialectical behavioural therapy for adolescents (DBT-A) versus enhanced TAU for CYP who have self-harmed, respectively, from a National Health Service and personal social services perspective in England. Other model input parameters were obtained from published sources, supplemented by expert opinion.

FINDINGS

The incremental cost-effectiveness ratio (ICER) of CBT-informed psychological therapy added to TAU versus TAU alone for adults who have self-harmed was £9088/QALY. The ICER of DBT-A versus enhanced TAU for CYP who have self-harmed was £268 601/QALY. Results were overall robust to the alternative scenarios tested.

CONCLUSIONS AND CLINICAL IMPLICATIONS

CBT-informed psychological therapy appears to be cost-effective for adults who have self-harmed, which contributes to evidence for its implementation in services. Currently, DBT-A does not seem to be cost-effective for CYP who have self-harmed. The economic analyses were informed by clinical evidence of moderate-to-low (CBT) and low (DBT-A) quality. Further clinical and economic evidence for DBT-A and other psychological and psychosocial interventions for people who have self-harmed is required.

Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province

OBJECTIVE

To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021.

METHODS

A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021.

RESULTS

There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period.

CONCLUSION

An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.