Adolescence and mental health

Sleep Time and Depression Symptoms as Predictors of Cognitive Development Among Adolescents: A Cross-Lagged Study From China

Sleep time and depression symptoms are important factors affecting cognitive development in adolescents. Based on the China Education Panel Survey (CEPS) database, this study used a two-wave cross-lagged model to examine the bidirectional relationship between sleep time, depression symptoms, and cognitive development. Descriptive statistics showed that Chinese adolescents' cognitive development increased significantly from 7th to 8th grade in junior high school, but unfortunately, their depression level and average sleep time per night demonstrated a slightly deteriorating trend. Correlation analysis showed that there was a relatively stable negative correlation between cognitive development, sleep time, and depression symptoms. Moreover, the cross-lagged model revealed that there was a bidirectional relationship between cognitive development and sleep time, a bidirectional relationship between depression symptoms and sleep time, and a unidirectional relationship between depression symptoms and cognitive development. Male adolescents in the subgroup were consistent with the total sample. Among female adolescents, only cognitive development and sleep time have a bidirectional relationship, while depression symptoms and cognitive development, and depression symptoms and sleep time have a unidirectional relationship. Therefore, it is of significance to take targeted action to promote cognitive development and healthy growth in adolescents worldwide.

The effect of a universal mobile application on adolescents' mental health and well-being

Opp is a universal mental health-promoting mobile application (app) developed for adolescents, with the aim of promoting mental health and well-being and preventing mental health problems. In this randomized controlled trial, the effectiveness of Opp was tested among Norwegian adolescents aged 13 to 25 years. Mental health, well-being, self-efficacy, self-esteem, help-seeking behavior, and sleep quality were assessed at two measurement points (T1 and T2), that were approximately 11 weeks apart. Only the participants that answered at both measurement points were included in the main analyses (N = 399; 75 % girls; Mage = 16.90 years, SD = 1.40). The results demonstrated a statistically significant effect of the app on mental health, as measured by the SDQ Total Difficulties scale (F(1,790) = 4.35, p = .037), while no statistically significant effects were observed on the other outcomes. These results provide important insights, and a broader understanding of how mental health apps can influence the mental health and well-being of a general sample of adolescents.

Socioeconomic inequalities in mental health difficulties over childhood: a longitudinal sex-stratified analysis using the UK Millennium Cohort Study

Stark socioeconomic inequalities in childhood mental health have been widely reported. Understanding whether they vary with age, by type of difficulty or sex can inform public health policies to tackle socioeconomic inequalities. We investigated the effects of early life childhood socioeconomic circumstances (SECs) (maternal education and household income) on developmental trajectories of externalising and internalising difficulties in childhood and adolescence, in males and females from the UK-representative Millennium Cohort Study (N = 15383). We estimated the Slope Index of Inequality (SII) (absolute difference between the most versus least advantaged) using linear mixed-effects regression models, on parent-reported Strengths and Difficulties Questionnaire externalising and internalising difficulties score, at 5, 7, 11, 14, and 17 years(y). The mean externalising score was high at 5y (4.8 [95 %CI: 4.7, 4.9]) and decreased slightly, while mean internalising score increased over childhood, reaching 3.9 [3.8, 4.1] by 17y, with a steeper trend for females in adolescence. Lower maternal education was associated with greater externalising scores at 5y (SII, Male: 3.0 [2.7 to 3.3]; Female: 2.7 [2.4, 3.0]) with inequalities decreasing slightly up to 17y (SII Male: 2.4 [2.0 to 2.7], Female: 2.5 [2.1, 2.8]). Inequalities in internalising scores increased slightly over childhood (SII Female 5y: 1.3 [1.1, 1.6]; 17y: 1.9 [1.5, 2.3]; SII Male 5y = 1.6 [1.3, 1.8], 17y = 1.8 [1.5, 2.2]). Patterns were similar using household income. Disadvantaged SECs are associated with persistently higher levels of parent-reported mental health difficulties up to 17y, with larger effects on externalising than internalising difficulties, but little differences by sex or socioeconomic measure.

Physical activity, exercise, and mental health of healthy adolescents: A review of the last 5 ​years

The mental health of adolescents is a priority for successful development. Physical activity (PA) and exercise can have effects on the mental health of adolescents. This review analysed the effect that physical exercise interventions can have on the mental health of healthy adolescents between 10 and 19 years of age. The search was carried out in four databases. PubMed, Web of Science, Scopus and SportDiscuss, were searched up to December 31, 2022, following the general model. Eleven studies were selected, with a total sample of 23 ​681 participants in 2 435 studies published in the last 5 years involving healthy adolescents. The search process and review of the articles was performed by independent expert investigators. The risk-of-bias and the methodological quality were analysed using the Cochrane scale. The limited and heterogeneous studies conducted so far do not clearly establish the benefits of PA on adolescents' mental health. However, some PA interventions seem to improve subjective well-being, self-esteem, physical and mental well-being, anxiety, lifestyle, emotional intelligence, depressive mood, and perceived benefit and confidence in healthy adolescents. It is important to design an effective and appropriate physical exercise programme that can be implemented for adolescents to achieve significant effects on their mental health. Studies that did not implement an appropriate exercise program with improvements in adolescent physical fitness showed no changes in psychological variables. Further research is needed to clearly establish that exercise programmes have positive effects on mental health in healthy adolescents.

Adverse childhood experiences and problematic use of the internet among a child and adolescent psychiatric clinical population

BACKGROUND

Internet use, specifically problematic use of the internet (PUI), needs to be considered in child and adolescent psychiatric (CAP) settings. Besides psychological symptomatology, childhood trauma (intrafamilial abuse and neglect) has been associated with PUI. The impact of various adverse childhood experiences (ACEs) on PUI, particularly in CAP populations, is understudied.

OBJECTIVE

This study aimed to investigate associations between PUI and various ACEs in a CAP population, considering gender differences and psychological symptomatology.

METHODS AND MATERIALS

104 adolescents (69 girls) were included, aged 14-17 years, undergoing inpatient CAP treatment, between August 2018 and March 2020. Participants completed the Interview for the Assessment of Internet and Computer Game Addiction (AICA), the Youth Self-Report (YSR), and the Multidimensional Clinical Screening Inventory (MCSI). Statistical analyses examined associations between PUI and ACEs, after controlling for age, gender, and psychological symptomatology.

RESULTS

Extrafamilial emotional abuse was significantly associated with higher AICA scores and likelihood of PUI. Extrafamilial separation and loss was associated with a significant decrease in the internet use and to the likelihood of PUI. Suicide of a mother significantly increased the odds of moderate to severe PUI. School absenteeism and alcohol abuse were associated with higher AICA scores irrespective of age and gender, though these associations diminished when controlling for psychological symptomatology.

CONCLUSIONS

Extrafamilial emotional abuse, particularly social receptive environments and relationships, play a significant role in developing PUI among CAP populations. The complex interplay of emotional trauma, family dynamics, peer relationships and individual behaviors regarding PUI should be addressed in CAP interventions.

Alterations in fecal microbiota composition and cytokine expression profiles in adolescents with depression: a case-control study

Emerging evidence has highlighted that altered gut microbiota are associated with the onset and progression of depression via regulating the gut-brain axis. However, existing research has predominantly focused on children and adults, frequently neglecting adolescent depression. Given the rising prevalence and substantial impact of adolescent depression on functional impairment and suicidality, it is essential to focus more on this age group. In this study, we examined the fecal microbiota and inflammatory profiles of 99 depressed adolescents and 106 age-matched healthy controls using Illumina NovaSeq sequencing and multiplex immunoassays, respectively. Our findings revealed lower bacterial α-diversity and richness, alongside altered β-diversity in adolescents with depression. Gut dysbiosis associated with adolescent depression was characterized by increased pro-inflammatory genera such as Streptococcus and decreased anti-inflammatory genera like Faecalibacterium. These differential genera may serve as potential non-invasive biomarkers for adolescent depression, either individually or in combination. We also observed disruptions in the inferred microbiota functions in adolescent depression-associated microbiota, particularly in glycolysis and gluconeogenesis. Additionally, depressed adolescents exhibited systemic immune dysfunction, with elevated levels of pro-inflammatory cytokines and chemokines, which showed significant correlations with the differential genera. Our study bridges the gap between children and adults by providing new insights into the fecal microbiota characteristics and their links to immune system disruptions in depressed adolescents, which offer new targets for the diagnosis and treatment of depression in this age group.

Mechanism-based modular psychotherapy versus cognitive behavioural therapy for adolescents and young adults with childhood trauma experiences: study protocol for a feasibility trial within the German Center for Mental Health

INTRODUCTION

Patients with mental disorders and a history of childhood trauma show an early onset of psychopathology and often a poor response to standard disorder-specific treatments. They represent a patient group which requires more personalised interventions targeting the transdiagnostic mechanisms related to early trauma and its functional consequences. The mechanism-based modular psychotherapy (MeMoPsy) approach is conceptualised as an innovative framework for psychotherapy development. It comprises independent, flexibly applicable interventions from various theoretical backgrounds and evidence-based programmes within a systematic treatment algorithm, thereby tailoring module selection to the specific needs of traumatised adolescents.

METHODS AND ANALYSIS

In a randomised controlled feasibility trial (RCT), N=80 outpatients between 15 and 25 years of age diagnosed with various mental disorders will receive 28 individual sessions with MeMoPsy or standard cognitive behavioural therapy. MeMoPsy includes a basic module that addresses trauma history and three additional modules focusing on functional impairments known to be associated with childhood trauma: rejection sensitivity, emotion regulation and relationship difficulties. These modules are selected based on a self-report algorithm. Techniques from mentalisation-based therapy, cognitive behavioural analysis system of psychotherapy, dialectical behaviour therapy and systemic therapy are integrated in this personalised modular procedure. This proof-of-concept study aims to provide initial evidence for acceptability, feasibility and changes in self-rated and diagnostician-rated psychopathology (post-treatment and 3 months follow-up) of MeMoPsy and elucidate the mechanisms of change using psychotherapy process research, Ecological Momentary Assessment and functional magnetic resonance imaging (fMRI).

ETHICS AND DISSEMINATION

This RCT obtained approval from independent ethics committees of participating centres and is accompanied by a data and safety monitoring board. Findings will be communicated within the research community as well as with patients and the public by the dissemination strategies of the German Center for Mental Health.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register DRKS00034058.

Performance of Femininity as the Potential Determinant of Lower Well-Being Among Adolescent Girls in London, UK: An Exploratory Discourse Analysis

In the UK, girls are consistently found to have lower subjective well-being and higher rates of anxiety disorders/depression compared to boys. While the reasons for these gender disparities are complex, how girls conceptualize, experience, and "perform" femininity may be one pathway which exacerbates psychological stress. To explore this hypothesis, we conducted an in-depth exploratory study to examine how norms and experiences of femininity among seven adolescent girls aged 16-17 from London, England (external factors), relate to their behaviors and psychological experiences (internal factors). To do so, we conducted two online focus groups in July 2021, and conducted discourse analysis to explore their conceptualizations of femininity and its impact on participants. We identified two key discourses relating to the concepts and experiences around femininity among these girls: "Valued by Conformity to Femininity," or how girls are judged by others based on their presentation and performance of femininity, and "An Uncertain Perception of Self," relating to uncertain self-identity stemming from their performance of femininity. We reveal a potential social conditioning process of "performing femininity" experienced by our participants, leading to hypervigilance, anxiety, uncertainty, and confusion. Our results suggest that the paradoxical and conflicting expectations around femininity, reinforced by others, may cause cognitive distortions and dissonance, increasing vulnerabilities to low well-being and anxious cognition patterns. Thus, we believe that there are grounds for further research on a larger scale which explores whether there is a sociological mechanism which is creating the gender gap in mental health outcomes at adolescence in the UK.

The influence of social determinants and 5Cs of positive youth development on the mental health of Chilean adolescents

This study analyzes the influence of social determinants (SD) and positive youth development (PYD) on the mental health (MH) of Chilean adolescents. A non-experimental, cross-sectional, correlational-explanatory design was used to analyze data from 612 adolescents (43.46% male and 56.54% female), aged between 11 and 19 years (M = 14.92, SD = 1.50). The assessed SD variables included parental educational level, family affluence, gender, migratory status, and ethnicity. PYD was measured using the 5Cs model (Competence, Confidence, Connection, Character, and Caring). MH was conceptualized through the dual-factor model, which encompasses subjective well-being (SWB) and psychopathological symptoms (PTH). The analyses included confirmatory factor analysis to assess the measurement models and structural equation modeling to examine both the direct and indirect effects of the hypothesized relationships. The findings indicate that family affluence and gender are the factors most consistently associated with the dimensions of PYD and MH. Confidence and connection positively influence MH by enhancing SWB and reducing PTH. Furthermore, these two dimensions act as significant mediators between SD and MH. The study highlights the importance of considering both the socioeconomic context and individual capabilities in mental health promotion strategies, proposing an integrated approach that addresses both the positive and negative aspects of adolescent mental health.

The central mediating effect of inhibitory control and negative emotion on the relationship between bullying victimization and social network site addiction in adolescents

BACKGROUND AND OBJECTIVES

Bullying victimization is strongly associated with social network site addiction among adolescents. However, the underlying mechanisms between these variables remain unclear. This study aims to explore the psychological mechanisms linking bullying victimization to social network site addiction by examining the mediating roles of depression, anxiety, stress, and inhibitory control.

METHODS

A self-report survey was conducted among a sample of 1,005 adolescents in China. The survey included measures of bullying victimization, social network site addiction, depression, anxiety, stress, and inhibitory control. Descriptive and correlational analyses were performed, followed by the construction of a chain mediation model.

RESULTS

Bullying victimization was significantly positively associated with social network site addiction. However, this relationship became non-significant when negative emotional states (depression, anxiety, stress) and inhibitory control were introduced as mediating variables. Specifically, bullying victimization significantly predicted negative emotional states and was negatively associated with inhibitory control. Negative emotional states were also negatively related to inhibitory control, while inhibitory control was negatively associated with social network site addiction. Among the negative emotional states, stress and anxiety showed a significant negative correlation with social network site addiction.

CONCLUSION

This study sheds further light on the psychological mechanisms linking bullying victimization and social network site addiction among adolescents. Depression, anxiety, stress, and inhibitory control act as mediating factors in this relationship. These findings highlight the importance of targeting these variables in understanding and developing interventions for social network site addiction among adolescents.

Mental Health and Care Utilization Among Sexual and Gender Minority Youth by Race and Ethnicity

PURPOSE

Existing literature has provided limited and inconsistent findings regarding disparities in mental health and mental health care utilization among racial and ethnic subgroups of sexual and gender minority adolescents (SGMA). This study aimed to investigate racial and ethnic disparities in mental health and care utilization among SGMA.

METHODS

Data from a large national sample of SGMA who participated in the 2022 Lesbian, Gay, Bisexual, Transgender and Queer National Teen Survey (N = 9,691) were analyzed. Symptoms of depression and anxiety were assessed using the patient health questionnaire-4. Mental health care utilization was classified as follow: (1) received; (2) wished for but not received (indicating unmet mental health care needs); and (3) neither wished for nor received.

RESULTS

Compared to White SGMA, Black/African American SGMA were less likely to report anxiety symptoms (adjusted prevalence ratio = 0.89, 95% confidence intervals [CIs] = 0.82-0.97). No significant racial and ethnic differences in depression symptoms were observed among SGMA. Regarding mental health care utilization, Asian or Asian American (adjusted relative risk ratio [ARRR] = 2.07, 95% CIs = 1.62-2.64), Black/African American (ARRR = 1.80, 95% CIs = 1.41-2.28), and Hispanic/Latino SGMA (ARRR = 1.32, 95% CIs = 1.16-1.51) were more likely to report unmet mental health care needs than White SGMA.

DISCUSSION

Despite the lack of major and consistent racial and ethnic differences in anxiety and depression symptoms documented in our sample, Asian or Asian American, Black/African American, and Hispanic/Latino SGMA were more likely to report unmet mental health care needs than their White counterparts. This finding highlights the need to address barriers to mental health care for racially and ethnically minoritized SGMA.

Fast food and anxiety symptoms of Chinese multi-ethnic adolescents: The moderating role of regulatory emotional self-efficacy

BACKGROUND

Although previous studies demonstrated an association between fast food intake and anxiety symptoms in adolescents, this relationship has not been studied in Chinese multi-ethnic adolescents. The purpose of this study is to investigate the aforementioned association and the potential moderating effect of regulatory emotional self-efficacy (RESE) among Chinese multi-ethnic adolescents.

METHODS

A cluster random sampling of 8500 middle school students from 11 counties in Yunnan province was conducted. The Depression Anxiety Stress Scale-21 was utilized to assess anxiety symptoms, while the food frequency questionnaire was employed to gather data on eating behaviors. The association between fast food intake, RESE, and anxiety symptoms was analyzed using generalized linear models. The moderating effect of RESE on the association between fast food intake and anxiety symptoms was examined using structural equation models.

RESULTS

The positive rate of anxiety symptoms in middle school students was 48.5 % (4120/8500). The positive rate of depressive symptoms in females (53.3 %, 2301/4316) was higher than that in males (43.5 %, 1819/4184). Chinese fast food intake (males vs females: β = 0.26, 95%CI:0.14-0.39; β = 0.16, 95%CI:0.02-0.29), expressing positive affect (β = -0.04, 95%CI:-0.07-0.01; β = -0.06, 95%CI:-0.10-0.03) and managing anger/irritation affect (β = -0.11, 95%CI:-0.14-0.08; β = -0.16, 95%CI:-0.19-0.12) was associated with anxiety symptoms in males and females (all P < 0.05). Takeaway fast food intake (β = 0.19, 95%CI:0.02-0.35) and managing despondency/distress affect (β = -0.08, 95%CI:-0.12-0.04, P < 0.001) was associated with anxiety symptoms in females (all P < 0.05). RESE significantly inversely moderated the association between fast food intake and anxiety symptoms (all participants: β = -0.11; males: β = - 0.08; females: β = - 0.14; all P < 0.01).

LIMITATIONS

Association observed in the cross-sectional study is uncertain and need to be confirmed in cohort studies.

CONCLUSION

Our findings suggest that fast food intake may be associated with an increased risk of anxiety symptoms among Chinese multi-ethnic adolescents, while good RESE can potentially mitigate this risk.

Brief Reports: Influence of Friendship on Loneliness Among Adolescents with Autism Spectrum Disorders in Japan

PURPOSE

Previous studies have reported that people with autism spectrum disorder (ASD) have higher levels of loneliness than neurotypical (NTP) people, most likely because of their difficulties in social communication with their predominantly NTP peers. However, direct investigations on the causal influence of friendship on their feelings of loneliness is scarce.

METHODS

In the current study, using the causal mediation analysis, we investigated whether friendship among ASD individuals influences their feelings of loneliness, especially during adolescence when the importance of friendship is typically most elevated. Furthermore, we examined whether individual differences in autistic behavioral features or age affect feelings of loneliness or the qualities of friendship with linear regression analyses.

RESULTS

The results demonstrated that the higher levels of loneliness in adolescents with ASD were mediated by one aspect of friendship, companionship. We also found that positive aspects of friendship, but not negative aspects, influence the feelings of loneliness in both ASD and NTP populations. One subcategory of the measured autistic trait, difficulty in imagination, which is associated the ability to consider another's perspective, had a negative relationship with the positive aspects of friendship in the ASD group, but not in the NTP group.

CONCLUSION

These findings indicate that the quality of the positive aspects of friendship is similarly important for both adolescents with ASD and NTP adolescents, but the autistic behavioral features could interfere with the experience of such positive friendships.

Minocycline treatment attenuates neurobehavioural abnormalities and neurostructural aberrations in the medial prefrontal cortex in mice fed a high-fat diet during adolescence

A preference for and overconsumption of a high-fat diet (HFD) are common among adolescents and are recognized as risk factors for multiple mental disorders. The protracted maturation of the medial prefrontal cortex (mPFC), a key brain structure that plays a critical role in mental functions that are essential for both developing and mature individuals (including emotional processing, decision making, risk assessment, and creative thinking), during adolescence renders it more vulnerable to the environmental insults experienced during this critical developmental window. However, the effects of HFD consumption during adolescence on mPFC-related behaviours and the underlying mechanisms need to be further investigated. In this study, we observed that mice fed a HFD throughout adolescence developed depressive- and anxiety-like behaviours and distinctively increased risk-avoidance behaviour, accompanied by morphological aberrations of both pyramidal neuron and microglia in the mPFC. The systemic administration of minocycline, a well-known broad-spectrum antibiotic, effectively attenuated the adverse effects of HFD consumption during adolescence on neurobehaviours and the morphology of pyramidal neurons in the mPFC. This study provides new insights into the psychological effects of long-term HFD consumption during adolescence and indicates the existence of a window during which microglial stabilization may be a promising strategy to protect against the HFD consumption-induced increase in the risk of psychiatric disorders.

Adolescent Psychological Adaptation: The Impact of Daily Levels and Instability in Psychological Need Satisfaction and Frustration

INTRODUCTION

Psychological need satisfaction and frustration are distinct processes that have unique effects on adolescents' psychological adaptation. Beyond their average levels, psychological satisfaction and frustration exhibit meaningful daily instability that is expected to have implications for adolescents' psychological adaptation. However, research directly examining both average levels and instability in psychological need satisfaction and frustration is rare.

METHODS

A sample of 107 adolescents (ages 11-18; 38.3% female; 64.5% White/European American) across the United States was recruited via an online survey during 2020-2023. Using a 30-day diary and long-term design, this study aimed to capture both the level and instability of psychological need satisfaction and frustration, and their implications for adolescents' psychological adaptation (indicated by emotion regulation, resiliency, mental health, and self-esteem) 6 months later.

RESULTS

Psychological need satisfaction and frustration played distinct roles in adolescents' psychological adaptation: levels of autonomy and relatedness satisfaction, as well as levels of competence frustration, consistently predict overall adolescent psychological adaptation 6 months later. Beyond levels, instability in autonomy frustration predicted adolescents' emotion regulation, resiliency, and mental health; instability in relatedness frustration predicted adolescents' mental health.

CONCLUSIONS

Results emphasized the importance of simultaneously considering the differential roles of satisfaction and frustration in each psychological need. Also, findings highlighted the necessity of considering the dynamic nature of psychological needs.

The Healthy Minds, Thriving Kids Project: Educator perspectives on relevance and potential impact of a mental health skill building program

BACKGROUND

Healthy Minds Thriving Kids (HMTK) is a free to user mental health skill building program developed by the Child Mind Institute with the aim to normalize conversations about emotional health and provide educators with wellness tools. The aim of this study was to explore the applicability of the HMTK program for universal school-based delivery from the perspective of educators, specifically to understand acceptability of program materials, perception of the quality of the program, and impressions of the program's usefulness and relevance across K-12 settings.

METHODS

The HMTK program was available to view by educator registrants between 01/26/2022 and 09/07/2022 in the State of California. Educator participants viewed an introductory video for the program and a minimum of two skills videos before participating in an online survey.

RESULTS

Of 68,861 registrants to the website, 64,376 provided survey data. Post-pandemic levels of stress and anxiety were increased, and 89.5% of respondents said young people required a greater degree of support than in the past. Almost all educators (90%) endorsed a need for additional mental health skill building tools for students, and following review of HMTK, > 80% of respondents said they would use the program in their classrooms. Most (86.6%) found the program engaging, and 85.1% found the program relevant to and representative of their student cohorts. More than three quarters (79.6%) said their students would find the program engaging and beneficial. Post-exposure to HMTK, 18.8% more educators believed that the State of California was committed to supporting students' emotional learning.

CONCLUSION

This survey demonstrates that from the perspective of educators the HMTK program is a valuable and complementary resource to school curricula to improve the mental health skills of young people. It provides an easy-to-implement framework that school districts and administrators can integrate within their curriculum planning.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

DISCUSSION

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

Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma-Insights from the Network Approach

Background

Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma.

Methods

A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used.

Results

The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on "Worried" (DASS9), "Agitated" (DASS11), "Panic" (DASS15), and "Scared" (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, "Down-hearted" and "Agitated" appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, "Panic" also served as the most prominent symptom in the directed acyclic graph network.

Conclusion

The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress.

Preliminary findings on psychometric properties of the adolescent story stem profile

Introduction

The Adolescent Story Stem Assessment Profile (ASSP) is a newly developed narrative measure aimed at assessing the psychological wellbeing of adolescents. This study investigates the psychometric properties of the ASSP within the British population, with the goal of elucidating its unique strengths and limitations.

Methods

We conducted an exploratory factor analysis on the responses of a community sample of adolescents in the UK (N = 182) to identify the underlying factors that reflect adolescents' internal representations as measured by the ASSP. Following this, we performed a series of analyses on the responses from both the community sample and a high-risk sample of adolescents in care (N = 67) to investigate the psychometric properties of the ASSP.

Results

We demonstrated satisfactory internal consistency, construct reliability, and discriminant validity among adolescents with varying levels of risk factors. The findings suggest that the ASSP is a promising tool for measuring mental health in adolescents, providing an economical and practically accessible method for both preventative and clinical applications.

Discussion

Our results yield critical insights into the complex nature of adolescents' psychological development, highlighting the necessity for tailored measures and interventions that address the diverse psychological needs of this population. Overall, this study represents a significant initial step toward establishing the ASSP as a valuable resource in both research and clinical practice, with implications for future studies aimed at enhancing our understanding of attachment to carers, peer relations, mentalization and affect competences in adolescence. The insights gained from this research underscore the importance of developing assessment tools that are sensitive to the unique psychological experiences of adolescents, ultimately contributing to more effective interventions and support strategies.

Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses

Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

Metacognitive Interventions for mental health disorders in adolescents: a scoping review protocol

OBJECTIVE

The aim of this review is to map and summarize metacognitive interventions for adolescents with mental health disorders.

INTRODUCTION

Metacognitive interventions are widely implemented in adults across various types of mental health disorders. Use in adolescents (aged between 10 and 19 years) has already been proposed in the recent literature, despite this knowledge being scattered. Hence, it is necessary to summarize the types of metacognitive interventions, their key characteristics, the mental health disorders they are targeting, and their outcomes.

INCLUSION CRITERIA

This review will consider quantitative and qualitative, as well as mixed methods studies describing metacognitive interventions for adolescents with mental health disorders. All intervention settings will be eligible for inclusion.

METHODS

A 3-step search strategy will be adopted, in line with the JBI methodology for scoping reviews. Databases to search for peer-reviewed papers will include CINAHL Complete (EBSCOhost), PubMed, Web of Science Core Collection, PsycINFO, and Scopus, among others. Gray literature searched on OpenGrey and MedNar will also be included. The reference lists of all selected full-text reviews will be searched. There will be no limitations on the year or language of publication. Screening, selection, and data extraction will be performed by 2 independent reviewers, who will screen titles and abstracts of publications meeting the inclusion criteria as well as review the full text of eligible studies. Disagreements will be resolved through plenary discussion or with the help of an additional reviewer. The extracted data will be summarized narratively and presented in a table.

Detail of this review project can be found in Open Science Framework: https://osf.io/kh2bc.

Decoding Prejudice: Understanding Patterns of Adolescent Mental Health Stigma

Background/Objectives: Mental health problems are a major cause of disability, impacting nearly 20% of adolescents. Nevertheless, they are hesitant to seek help because of stigma and fear of being labelled. Adolescents often have low mental health literacy and perceive mental health problems as personal failures. To address it, our study aimed to identify subgroups within the adolescent population based on mental health knowledge, social stigma, experiences of intergroup anxiety, and endorsement of stereotypes. Methods: This cross-sectional study included 182 adolescents (50.6% male) aged 10 to 17 years (M = 13.8, SD = 2.4). Participants completed an online survey comprising the Mental Health Knowledge Schedule, Attribution Questionnaire (AQ-8-C), Intergroup Anxiety Scale, and a scale regarding stereotypes towards people with mental health problems. Cluster analysis was used to identify the subgroups. Results: We identified three subgroups: (1) "Potential Advocates", showing high mental health knowledge, low social stigma, low intergroup anxiety, and moderate endorsement of stereotypes; (2) "Ambivalents", manifesting high mental health knowledge, moderate social stigma, heightened intergroup anxiety, and low endorsement of stereotypes; and (3) "Stigmatizers", revealing low mental health knowledge, pronounced social stigma, moderate intergroup anxiety, and tendency to endorse stereotypes. Conclusions: The results highlight the multiplicity of perceptions regarding mental health and the pivotal role of knowledge, stigma, intergroup dynamics, and stereotypes in shaping attitudes. Implications for interventions targeting mental health stigma and fostering positive attitudes among adolescents are discussed, underscoring the importance of customised strategies to address the multiple needs and experiences characteristic of this developmental stage.

Scoping review: outpatient psychotherapeutic care for children and adolescents in Germany-status quo and challenges in assessment

Background

In the context of multiple global crises, including the COVID-19 pandemic, climate change, and global conflicts, children and adolescents worldwide are experiencing heightened psychological stress. As the foundation for lifelong mental health is established during childhood and adolescence, early prevention and treatment of mental health problems, such as through psychotherapy, are crucial. In Germany, current outpatient psychotherapeutic care capacities appear inadequate, while systematic evaluations of the care situation are lacking. This study investigates the state of statutory health insurance-funded outpatient psychotherapeutic care for children and adolescents in Germany and evaluates various methodological approaches for its assessment.

Methods

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications from January 2018 to December 2023 were sourced from PubPsych, PubMed, APA PsycInfo, Google Scholar, and ProQuest. Included studies report quantitative primary data on the mental health of community samples of children and adolescents in Germany or their outpatient psychotherapeutic care.

Results

We included 41 publications comprising epidemiological studies, administrative data, and psychotherapist and patient reports. A lack of systematic and standardised research approaches resulted in significant variance in data. Nonetheless, qualitative analysis revealed that approximately one four children and adolescents in Germany is affected by mental health problems, while one in six to seven children and adolescents requires psychotherapeutic treatment. Yet, only up to one in 50 receives guideline-based psychotherapy. Most requests for initial psychotherapeutic consultations are unmet, with waiting times for guideline-based psychotherapy exceeding 6 months for at least half of the patients.

Conclusion

Overall, our findings suggest that outpatient psychotherapeutic care for children and adolescents in Germany is still insufficient. They advocate for a systematic, multimodal, and longitudinal assessment of statutory health insurance-funded outpatient psychotherapeutic care, along with an expansion of treatment capacities to enhance access for children and adolescents in Germany.

Therapist Interpersonal Skills and Outcomes for Young People

OBJECTIVE

Our primary aim was to assess the associations between outcomes and therapist interpersonal skills (TIS) of empathy, congruence, regard, and unconditionality, as rated by young people. We also aimed to compare these associations against outcome-alliance associations, and to assess whether these associations were specific to a TIS-prioritizing therapeutic practice.

METHODS

Our primary sample was 167 13-16-year-olds who exhibited emotional symptoms and received up to 10 weeks of school-based humanistic counseling plus pastoral care as usual (SBHC + PCAU). Young people were predominantly female (76%), with 45% Black or other minoritized identity. We measured TIS with the Barrett Lennard Relationship Inventory; and used linear regression modeling to assess TIS associations with outcomes on psychological distress, wellbeing, and satisfaction.

RESULTS

TIS, most markedly congruence, were significantly associated with outcomes, contributing approximately 3% of change. TIS and alliance explained similar proportions of outcomes, with a model including only congruence showing the best fit on psychological distress and wellbeing. We did not find consistent evidence that the TIS-outcome association was specific to humanistic counseling.

CONCLUSION

Therapists and lay professionals working with young people should strive to develop their interpersonal skills-particularly congruence-within the context of other relationship skills, qualities, and characteristics.

Racial-Ethnic Discrimination and Early Adolescents' Behavioral Problems: The Protective Role of Parental Warmth

OBJECTIVE

The purpose of the study was to investigate the association between discrimination by multiple sources (ie, teachers, students, and other adults) and early adolescents' behavioral problems (ie, internalizing, externalizing, and attention problems), also considering the protective role of parental warmth in the association.

METHOD

Cross-sectional analyses were conducted with 3,245 early adolescents of color obtained from the Adolescent Brain Cognitive Development Study (ABCD Study) at year 1 follow-up (Y1), a large and diverse sample of children (mean age = 9.48 years) in the United States. Racially-ethnically minoritized adolescents reported sources of discrimination, parental warmth, and symptoms of psychopathology. Regression with interaction terms was conducted to investigate the associations among sources of discrimination, parental warmth, and behavioral problems among racially-ethnically minority adolescents. Sensitivity analyses were conducted to examine (1) race/ethnicity and sex/gender variations; (2) whether the associations between different sources of discrimination and behavioral problems were reliably different; and (3) effects of discrimination, parental warmth, and their interplay at Y1 in predicting adolescents' behavioral problems at year 2 follow-up.

RESULTS

Early adolescents experiencing interpersonal racial-ethnic discrimination by multiple sources, including teachers, students, and other adults, reported higher levels of attention, internalizing, and externalizing problems. Parental warmth was protective for the association between interpersonal racial-ethnic discrimination and early adolescents' behavioral problems.

CONCLUSION

Experiencing interpersonal racial-ethnic discrimination from teachers, peers, and other adults is related to heightened attention, internalizing, and externalizing problems among racially-ethnically minoritized early adolescents. Parental warmth may reduce the risk of developing behavioral problems among early adolescents who experience interpersonal racial-ethnic discrimination from students, teachers, and other adults outside of school.

PLAIN LANGUAGE SUMMARY

In this cross sectional analysis of 3,245 early adolescents of color obtained from the Adolescent Brain Cognitive Development (ABCD) Study, the authors found that early adolescents experiencing interpersonal racial-ethnic discrimination from multiple sources, including teachers, students, and other adults, reported higher levels of behavioral problems (ie, internalizing, externalizing, and attention problems). Parental warmth was found to be protective for the association between interpersonal racial-ethnic discrimination and early adolescents' behavioral problems. These findings emphasize the importance of assessing experiences of interpersonal racial-ethnic discrimination among racially-ethnically minoritized early adolescents and contribute to the understanding of parental warmth as a protective factor for early adolescents to cope with such experiences.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

The impact of interventions for depression on self-perceptions in young people: A systematic review & meta-analysis

Negative self-perceptions are implicated in the development and maintenance of depression in young people, but little is known about their receptiveness to change in response to treatment. This paper reports on a pre-registered meta-analysis examining the extent to which treatments for depression in young people aged 11-24 result in changes to self-perceptions. Controlled treatment trials examining outcomes related to self-perceptions were synthesised (k = 20, N = 2041), finding small reductions in both symptoms of depression (g = -0.30; 95 % CI: -0.52, -0.08) and self-perception outcomes (g = 0.33; 95 % CI: 0.16, 0.49) for interventions compared with control groups. Meta-regression analyses found no significant association between reductions in depressive symptoms and improvements in self-perception following treatment, suggesting that despite interventions generally improving both outcomes these changes may be unrelated to each other. Our results indicate that young people's self-perceptions are sensitive to change following treatment for depression, however effect sizes are small and treatments could be more effective in targeting and changing negative self-perceptions. Given the importance that young people place on integrating work on their sense of self into treatments for depression, future interventions could aim to support young people with depression to develop a positive sense of self.

Estimating adolescent mental health in the general population: current challenges and opportunities

Adolescence is a period of change and increased mental health difficulties, which are important for lifetime outcomes. Adolescent mental health is therefore an active research area, with large samples often drawing on self-report general measures (ie, not disorder-specific or focused on a narrow outcome). We argue that these measures have a key role in our understanding of issues such as prevalence, antecedents, prevention, and intervention, however, measurement has been given little attention and high-quality measures do not tend to be available or used. We offer insights into historical and psychometric challenges that have contributed to current problems and highlight the implications of relying on poor measures, which at their worst can be biased and unethical. We make recommendations for research and practice on selecting measures and improving the evidence base and make a call to action to reject low-quality measurement in this field.

The prevalence and correlates of sibling bullying victimisation in early adolescence: An investigation of over 30,000 adolescents in 18 countries

BACKGROUND

Sibling bullying is a common childhood experience. Recent studies have shown that correlates of sibling bullying are proximal and distal. However, a lack of cross-cultural understanding still exists on the prevalence and protective factors of sibling bullying.

OBJECTIVE

The objective of the current study was to examine the prevalence of sibling bullying and investigate whether positive environments protect against sibling bullying victimisation in 18 countries.

PARTICIPANTS AND SETTING

We analysed existing data from an international study of over 30,000 adolescents aged 10 and 12 years old, the Children's World Survey.

METHODS

Adolescents reported physical and verbal sibling bullying victimisation experiences and the positive aspects of their home, neighbourhood, and school environments. Regression models were fitted to investigate whether individual- and country-level positive home, neighbourhood, and school environments are associated with sibling bullying victimisation.

RESULTS

On average, the prevalence of sibling bullying victimisation was 28 %; 1 in 4 adolescents were physically hurt or called unkind names more than three times in the last month by a sibling (excluding fighting or play fighting). The prevalence varied by country; ranging from 9 %-59 %. Whilst, on the whole, individual-level positive home, neighbourhood, and school environments were associated with reduced sibling bullying victimisation (odds ratios, 0.68-0.85), these effects differed for each country. Country-level positive environments were not associated with sibling bullying victimisation.

CONCLUSION

These findings demonstrate that improving adolescents' home, neighbourhood, and school environments might serve to reduce sibling bullying victimisation.

Mental health outcomes, associated factors, and coping strategies among LGBTQ adolescent and young adults during the COVID-19 pandemic: A systematic review

LGBTQ adolescents and young adults have been disproportionately affected by the COVID-19 pandemic. This review aims to describe the impact of the COVID-19 crisis on mental health among LGBTQ adolescents and young adults, identify associated factors, and summarize coping strategies. A systematic review was conducted by searching six databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, MEDLINE). Eligibility criteria included (1) reported mental health outcomes, (2) conducted among LGBTQ adolescents and young adults, and (3) data collection occurred since January 2020. All studies were screened independently, and relevant data were synthesized following PRISMA guidelines. Of 395 records, 67 articles were screened for eligibility. Among these, 39 studies met the inclusion criteria. LGBTQ adolescents and young adults reported substantial mental health burdens, including depression, anxiety, stress, and loneliness during the pandemic. A pooled prevalence of depressive symptoms with a combined sample size of 7326 LGBTQ adolescents and young adults was 59% (95%CI: 0.48-0.70), (I2 = 98.95%, p < 0.001). Among anxiety outcomes, the pooled prevalence with a sample size of 3258 LGBTQ adolescents and young adults was 55% (95% CI: 0.46-0.63), (I2 = 95.70%, p < 0.001). Individual factors associated with mental distress included age, gender, and history of mental health disorders. Interpersonal and community-level factors included loss of safe spaces, family support, and discrimination on sexual and gender minority identity. Strategies to cope with distress include the use of social media and increased use of alcohol, tobacco, and other drugs. The pandemic has had a substantial negative impact on psychological distress among LGBTQ adolescents and young adults. Results substantiate the need for further research into social media as a coping instrument and the expansion of telehealth mental health services.

Associations Between Intrinsic Motivation, Exercise Attitudes, Physical Activity, and Mental Health in Young Adolescents: An Integrated Motivational Perspective

Purpose: Physical activity (PA) and mental health (MH) are priorities for health promotion during early adolescence. This study explored associations between intrinsic motivation for PA, exercise attitudes, PA and MH in young adolescents. Methods: Participants were 315 students (Mage = 11.41; SD = 2.09; 45.1% girls) conveniently sampled from two private British schools in Dubai. Data were collected via a survey and analyzed using structural equation modeling. Results: As hypothesized, higher intrinsic motivation was directly associated with more favorable exercise attitudes, and attitudes was directly associated with increased PA. Unexpectedly, however, PA was not associated with better MH outcomes. A better fitting model was specified in which attitudes was directly associated with both PA and MH. Conclusions: Further research examining associations between exercise attitudes, PA, and MH in young adolescents is warranted.

Longitudinal Relationships Across Bullying Victimization, Friendship and Social Support, and Internalizing Symptoms in Early-to-Middle Adolescence: A Developmental Cascades Investigation

Current understanding of the longitudinal relationships between different aspects of peer relationships and mental health problems in early- to mid-adolescence is limited. In particular, the role played by gender in these developmental cascades processes is unclear, little is known about within-person effects between bullying victimization and internalizing symptoms, and the theorized benefits of friendship and social support are largely untested. Addressing these important research gaps, this study tested a number of theory-driven hypotheses (e.g., interpersonal risk model, transactional model) regarding longitudinal relationships between bullying victimization, friendship and social support, and internalizing symptoms. The study sample was N = 26,458 adolescents (50.6% girls, average age 12 years 8 months (SD = 3.58 months) at baseline) attending k = 176 schools in Greater Manchester, England. Separating within-person effects from between-person effects, a random-intercept cross-lagged panel model (RI-CLPM) was applied to three annual waves of data. Analyses revealed that developmental cascade pathways varied across gender, as follows: higher rates of bullying victimization led to increased internalizing symptoms (partially for girls, fully for boys) and lower levels of friendship and social support (for girls only); higher levels of friendship and social support did not confer any protection against future bullying victimization (for girls or boys) but did lead to reduced internalizing symptoms (partially for girls, but not for boys); and, higher levels of internalizing symptoms led to increased rates of bullying victimization (for boys only) and lower levels of friendship and social support (partially for girls, fully for boys). Evidence of reciprocal relationships between bullying victimization and internalizing symptoms (for boys only) and between internalizing symptoms and friendship and social support (for girls only) was also found. Effect sizes of developmental cascade pathways varied but were mostly in the moderate-to-large range relative to the empirical distribution of cross-lagged effects in existing studies (i.e., 50th to 75th percentile). Sensitivity analyses indicated that findings were largely robust to a number of researcher-led analytic choices. The current study indicates that approaches to prevent or reduce the effects of bullying victimization should be prioritized, given the consistent evidence of its substantial role in increasing internalizing symptoms for both genders, in addition to its deleterious impact on girls' friendship and social support. Preregistration: This study was preregistered at https://osf.io/xrwfq . The study design, hypotheses, and target analyses were registered.

Humanistic Therapy for Young People: Client-Perceived Helpful Aspects, Hindering Aspects, and Processes of Change

This qualitative study aimed to establish aspects of humanistic therapy that young people (13-16 years old) perceived as helpful and hindering, and to test a novel method for identifying perceived processes of change. A "medium q" thematic analysis was conducted followed by a coding-based "process of change analysis." Participants were 50 young people in London schools who experienced moderate or severe emotional symptoms and had participated in up to 10 sessions of a school-based humanistic intervention. Participants were predominantly female and ethnically heterogeneous. Therapist qualities most often perceived as helpful were affiliative in nature. Unhelpful therapist activities were silences and a lack of input. Young people described feeling free to talk and open up. Helpful outcomes included feeling unburdened, gaining insight, and improving relationships. "Getting things off their chest," "Advice and guidance," "Modeling relationships," and "insights to behavior change" were identified as specific processes of change in over 50% of young people. Approximately one-third felt hindered by a lack of therapist input, silences, or not feeling able to open up or trust. These findings indicate the potential value of an active, "process guiding" stance in humanistic therapy. Our process of change analysis has potential for identifying perceived change mechanisms in therapy. This work was supported by the Economic and Social Research Council [grant reference ES/M011933/1]. Anonymized qualitative interview transcripts are available on request to the First Author/Chief Investigator. Quantitative, participant-level data for the ETHOS study (with data dictionary), and related documents (e.g., parental consent form), are available via the ReShare UK Data Service (reshare.ukdataservice.ac.uk/853764/). Access requires ReShare registration.

Effect of a Narrative-Based Online Course Aimed at Reducing Stigma Toward Transgender Children and Adolescents: Longitudinal Observational Study

BACKGROUND

Stigma toward transgender children and adolescents negatively impacts their health and educational outcomes. Contact with members of stigmatized groups can dismantle stereotypes and reduce stigma by facilitating exposure to the unique cognitive and emotional perspectives of individuals within the group. Recent evidence suggests that video-based contact interventions can be as effective as face-to-face encounters, but challenges lie in protecting the identities of transgender youth, since many of them live in stealth.

OBJECTIVE

This study aims to evaluate the impact of an animated online course, rooted in authentic, personal narratives, on course participants' stigma toward transgender youth.

METHODS

The online course was offered free of charge on Coursera and contained 19 teaching videos (3-7 minutes each), intermittent practice quizzes, and discussion prompts. Using real voice recordings of transgender children and their caregivers, the videos were designed to elicit empathy and transmit knowledge. All videos conveying the narratives of transgender youth were animated to protect their identities. A total of 447 course participants, distributed around the globe, completed pre- and postcourse surveys. While the course primarily targeted parents and caregivers of transgender youth, it was open to anyone with a Coursera account. The survey was based on the Transgender Attitudes and Beliefs Scale but modified to reflect the context of parents and caregivers. Using a 5-point Likert scale, it contained 5 questions that captured participants' levels of transgender stigma. Results of the pre- and postcourse surveys were then compared.

RESULTS

The results were obtained in January 2023. Baseline levels of stigma were relatively low (18/25 across all questions, with 25 representing the lowest possible levels of stigma) and decreased further after completion of the course (to 19/25 across all questions, P<.001). A multivariate ordinal probit regression showed that, depending on the question, participants were 7%-34% more likely to endorse statements that indicated the lowest levels of stigma after completing the course. The course was equally effective across all demographics represented in our participant population.

CONCLUSIONS

Our findings document a significant reduction in stigma toward transgender youth in participants who chose to enroll in the first animated, open online gender health course, rooted in the authentic narratives of transgender youth. Stigma levels decreased significantly after taking the course, even among participants whose baseline levels of stigma were low. Future interventions should include participants with more variable baseline levels of stigma, ideally in the setting of a randomized controlled trial. Despite its limitations, this evaluation adds to the existing evidence that digital, contact-based antistigma interventions, animated to protect the identity of the narrators, can effectively reduce stigma toward transgender youth.

Social jetlag and sleep habits in children and adolescents: Associations with autonomy (bedtime setting and electronics curfew) and electronic media use before sleep

For young people attending school, social jetlag (SJL) refers to discrepancy in sleep/wake timing between school days and weekends. This study investigated SJL in school-aged children and adolescents in England and whether this is associated with age, gender, and sleep habits including bedtimes and electronic media use. Students (school y 5-13; typical age 9-18 y) completed the 2021 OxWell Student Survey. In total 19,760 participants (55% female) reported on sleep/wake timing, rules concerning bedtime setting on school night/weekend, electronic media curfew, and frequency of social media use and video gaming before sleep intention. The mean SJL was 1 h 53 min (SD = 1 h 7 min) and peaked at 2 h 7 min at age 15. Multiple regression analysis revealed SJL was positively associated with age and being male was associated with slightly lower SJL than being female. After controlling for age and gender, weekend bedtime setting (β = 0.21), frequency of social media use before sleep (β = 0.16) and video gaming before sleep (β = 0.12) were the strongest predictors of SJL. Findings suggest that household rules regarding weekend bedtimes and less electronic media use before sleep may be connected with lower SJL as well as more regular sleep timing across the whole week.

Effectiveness of a universal resilience-focused intervention for children in the school setting: A randomized controlled trial

BACKGROUND

Psychological resilience can be augmented through the acquisition of specific cognitive or emotional regulation skills, enabling children to adapt to or recover from stressful events, disadvantages, or adversities. We aimed to evaluate the efficacy of a Tianchang Resilience-focused inTervention program (TRT1 program) on resilience and mental health conditions of Chinese children.

METHODS

This study was a two-arm cluster-randomized controlled trial, performed in Tianchang, a county in China. Students from 20 classes in a local primary school (aged 8.7-11.2 years) were randomly allocated to receive a resilience-focused intervention or waitlist group. The intervention comprised weekly 40-min sessions for 14 weeks and co-led by lay counsellors. Measures of emotional symptoms, behavioral difficulties, and resilience were collected at pre-, post-intervention, 6-months, and 12-months follow-up.

RESULTS

Between June 16, 2022, and September 4, 2022, 775 eligible students were recruited (mean age 9.93 years; 420 [54.2 %] boys). Relative to the waitlist group (N = 391), the intervention group (N = 384) reported a significant reduction in depressive and anxiety symptoms at post-intervention (all p < 0.001), 6-months (p = 0.007; p = 0.002) and 12-months follow-up (p = 0.018; p = 0.018), respectively. The intervention group effects were also observed on resilience at post-intervention follow-up (p = 0.006), and remained stable over 6-months (p < 0.001) and 12-months follow-up (p = 0.022).

CONCLUSIONS

This study demonstrated that the TRT program, a universal resilience-focused intervention for children in the school setting, showed long-term effectiveness in improving resilience and mental health conditions. This minimally trained laypersons-delivered intervention might enhance the program's generalizability to other communities.

Effects of maternal separation on punishment-driven risky decision making in adolescence and adulthood

Early life adversity (ELA) is associated with a multitude of neural and behavioral aberrations. To develop treatments to mitigate the effects of ELA, it is critical to determine which aspects of cognition are affected and when these disturbances manifest across the lifespan. Here, we tested the effects of maternal separation, an established rodent model of ELA, on punishment-driven risky decision-making longitudinally in both adolescence (25-55 days old) and adulthood (80-100 days old). Risk-taking was assessed with the Risky Decision-making Task, wherein rats choose between a small, safe reward and a large reward accompanied by an escalating risk of punishment (foot shock). We observed that rats exposed to maternal separation were more prone to risk-taking than controls during adolescence, and demonstrated reduced latency to make both risky and safe decisions. Interestingly, this augmented risk-taking was no longer evident in adulthood. Males and females displayed comparable levels of risk-taking during adolescence then diverged in adulthood, with adult males displaying a sharp increase in risk-taking. Finally, we observed that risk-taking changed across the lifespan in rats exposed to maternal separation, but not in control rats. Collectively, these data reveal that ELA engenders risk-taking in adolescence but not adulthood, and that sex differences in risky decision-making are not evident until adulthood. This has important implications for the development of both behavioral and biological treatments to improve decision-making during the vulnerable adolescent period.

Adolescent mental health in sub-Saharan Africa: crisis? What crisis? Solution? What solution?

Addressing adolescent mental health care across sub-Saharan Africa faces numerous challenges, including underfunded public health systems, a shortage of mental health professionals, barriers to access, and pervasive stigma. Untreated adolescents often experience worsening symptoms, academic and social difficulties, physical health risks, and engage in risky behaviours. Early detection and appropriate treatment of common mental health conditions can support adolescents in developing robust social and emotional foundations and enhancing their mental well-being. Ensuring adolescents receive the mental health care required for healthy development depends on collaborative, evidence-based solutions that consider the contextual challenges of sub-Saharan Africa. Innovative community-based solutions to mental health services may significantly improve accessibility and support adolescents close to their homes and schools. For example, co-creation and peer-delivered interventions with professional supervision may enhance uptake and reduce stigma. This short article adds to the current debate arguing for working with communities and implementing community mental health services for common mental health conditions. Sensitivity to community-specific challenges and building referral networks are crucial for effective care. Investing in these strategies, alongside increasing mental health literacy, could lead to affordable and significant interventions to address adolescent mental health.

Stress, mental symptoms and well-being in students: a gender analysis

Introduction

Stress is a major problem among students, threatening their health and well-being. The aim of the research is to analyze the sources of stress in students and to investigate whether there are gender differences and differences between university and non-university students in stress, coping styles, mental symptoms and well-being. A second aim is to know the relevance of age, education, stress, coping styles, self-esteem and social support on mental symptoms, psychological well-being and life satisfaction of boys and girls.

Methods

The study was cross-sectional. The sample consisted of 1,426 students between the ages of 16 and 26.

Results and discussion

The results of the ANOVAs showed that although there were some gender differences, being a university student or not explained more variance than gender. University students had more chronic stress than non-university students. However, they were more satisfied with their studies, had healthier coping styles, fewer mental symptoms, and greater well-being. For both genders, the main predictor of more mental symptoms was a higher emotional coping style. This was followed by lower self-esteem, a higher number of stressful life events, and higher chronic stress. Higher study dissatisfaction was associated with lower psychological well-being and lower life satisfaction. Higher chronic stress was associated with lower life satisfaction. It is concluded that stress and coping styles are relevant to students' mental health. The results of this study are relevant to the design of policies, strategies, and programs to improve students' mental health and well-being.

The development of Vi-Connect: An educational game for the social inclusion at school of students with vision impairment

Students with vision impairment experience multiple social emotional challenges at school which stem from communication difficulties in the social relationships they develop with teachers and classmates. This study took a multi-method, multi-informant participatory approach to develop "Vi-Connect: A Social School Journey", a digital intervention in the form of an educational game aimed at promoting school social inclusion of students with vision impairment by scaffolding advocacy and social communication skills. The study consisted of three phases: Co-production before developing Vi-Connect (Phase 1), development of the prototype (Phase 2) and assessment of Vi-Connect (Phase 3). Four and five adolescents with vision impairment participated in Phases 1 and 3 of the study respectively. A second group of young people from Eye-YPAG (N = 8), a youth advisory group for eye and vision research, participated in Phase 1. Six professionals in the field of vision impairment participated in Phases 1 and 3. Reflexive Thematic Analysis was used to analyse the findings of Phases 1 and 3. A prototype of Vi-Connect including three school-based scenarios was developed based on the Curriculum Framework for Children and Young People with Vision Impairment and the experiences and suggestions of all participants. The findings of this study indicated that digital interventions can be an additional supportive educational tool to support the social inclusion of students with vision impairment, as they can facilitate coping with challenging social situations and promote self-advocacy. This is one of the first studies to involve students with vision impairment in intervention development, prioritising the lived experiences of this student population. Additionally, acknowledging the key role of professionals in the school inclusion of students with Special Educational Needs and Disabilities, this study involved professionals in the field of vision impairment. This research opens the field for the development of more accessible educational interventions for students with sensory impairments.

"Instead of Building More Buildings, They Should Plant More Trees", a Photovoice Study of Determinants of Happiness and Sadness Among East London Adolescents

Globally, mental health problems in adolescents, alongside associated morbidity and mortality, have never been higher. Local living, working and environmental conditions, socio-economics, and intra-individual and inter-individual processes impact mental health. The risk of developing mental health problems is higher in certain areas, including East London. However, limited research explores East London adolescents' experiences of mental health. An in-depth and locally situated understanding of determinants shaping East London adolescents' happiness and sadness is needed. This study used Photovoice, a qualitative method within a community-based participatory research methodology, to generate photographic and textual data, which was analyzed using reflexive thematic analysis. This method allows participants to be part of knowledge production and authors to present the data. Our findings underscore the bidirectional interplay between environmental factors and adolescents' happiness and sadness. Gratitude for nature was described as increasing happiness: adolescents connected to nature to memories, appreciation, and leisure opportunities. Adolescents were concerned about the fragility of nature in response to urban development. The urban environment was perceived as imposing, inspiring, and offering therapeutic benefits blighted by pollution. Beautiful areas were described as paradisical and lacking, revealing urban development and economic productivity disparities. Our research documents the voices of an under-researched group, revealing novel insights while empowering adolescents as co-producers of mental health research. This study indicates participatory research is valuable for granting adolescents autonomy and addressing misrepresentation. The findings implicate multiple stakeholders, including "Health in All Policies." By deepening our understanding of adolescent mental health in East London, our study can be leveraged to bolster the effectiveness and relevance of interventions for East London adolescents.

Mechanisms underlying the development of eating disorders and disordered eating in adolescent females with type 1 diabetes

OBJECTIVE

People with Type 1 diabetes (T1D) face an increased risk of eating disorders/disordered eating (ED/DE), with adolescents being particularly vulnerable. Empirical knowledge on the mechanisms underlying development of ED/DE in T1D is crucial for evolving prevention strategies.

RESEARCH DESIGN AND METHODS

Fourteen semi-structured interviews with adolescent females with T1D and ED/DE between 14 and 18 years were conducted and analyzed using reflexive thematic analysis.

RESULTS

Analyses identified four main themes; 'Interconnected afflictions', 'Judgment', 'Feeling Different', and 'Chaos & Control', These themes explore the interconnectedness of T1D and ED/DE, with shame and guilt emerging as common underlying mechanism. The development of a biopsychosocial model was based on the integration of these data with existing models.

CONCLUSIONS

The study extends previous developmental pathways of ED/DE in adolescents with T1D. We propose a biopsychosocial model that incorporates various factors: predisposing factors such as parental management of T1D and weight gain during adolescence; precipitating factors including comments on weight, frequency of weighing, perceptions of surveillance; the perpetuating bilateral influence of ED/DE and T1D and finally highlighting the protective mechanisms of disease acceptance encompassing parental handling of diagnosis and the contribution of healthcare professionals (HCP's) role in psychoeducation. The present study highlight the vulnerability of adolescence in the presence of T1D, particularly concerning issues related to eating, weight, and body. It offers clinically relevant insights, with the aim to improve communication and management strategies for this very specific group.

Knowledge, Attitude, and Stigma Among Adolescents: Effect of Mental Health Awareness and Destigmatisation (MHAD) Program

BACKGROUND

Stigma against mental health problems is a common issue for adolescents aged 14-18 years. However, comprehensive programs that simultaneously address awareness and stigma reduction tailored to the specific needs of this age group are lacking.

METHOD

This study investigated the effectiveness of the Mental Health Awareness and Destigmatisation Program (MHAD) in reducing stigma and improving knowledge and attitudes towards peers with mental health problems. A quasi-experimental pre-post design was employed among adolescents aged 14-18 years from an educational institution in Bangalore. After excluding those with high baseline mental health symptoms (PSC-17 > 20), a preassessment was conducted on adolescents' knowledge, attitude, and stigma (n = 52) using the Mental Health Knowledge Schedule, Self-structured Case Vignettes, and Peer Mental Health Stigmatization Scale. After completing the 6-week program, three participants were excluded from the post-assessment, as their attendance was less than 50%. A total of 49 (mean age = 16 years) adolescents were included in the post-assessment.

RESULTS

The paired sample t-test revealed significant improvements in all stigma scores. The Wilcoxon signed-rank test indicated a significant improvement in Recognition of Mental Illness scores.

CONCLUSION

Findings showed that MHAD, an education-based program, was effective in reducing adolescents' stigma towards peers with mental health problems and improving their overall recognition of mental health symptoms. Research across larger adolescent populations is essential to enhance these interventions' long-term impact and sustainability. By closely monitoring and expanding research efforts, we can gain deeper insights into how these programs foster self-awareness, a crucial factor in recognizing mental health needs, challenging stigma, and promoting help-seeking behaviors among adolescents.

Improvement in Symptoms of Depression and Anxiety and Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity Following the Implementation of a Multidisciplinary Personalized Lifestyle Intervention Program

Background/Objectives: Childhood obesity is one of the most challenging contemporary public health problems. Children and adolescents with obesity experience multiple psychosocial difficulties, such as low self-esteem, depression, anxiety, and behavioral problems, which persist for a long time. The aim of the study was to assess the effect of a multidisciplinary personalized lifestyle intervention for depressive and anxiety symptoms, as evaluated by psychometric questionnaires, and their effect and association with cardiometabolic parameters in children and adolescents with overweight and obesity before and after the intervention. Methods: Six hundred and eleven (n = 611) children and adolescents (mean age ± SE: 10.39 ± 0.10 years; 51.5% females, 46.6% pubertal) were studied prospectively. Subjects were classified as being obese (50.2%), overweight (33.5%), or having a normal BMI (16.2%) according to IOTF criteria. All participants entered a 1-year lifestyle intervention program; laboratory investigations were obtained at the beginning and end of the study and two psychometric questionnaires were completed, the CDI and SCARED, which evaluate symptoms of depression and anxiety, respectively. Results: Following the lifestyle intervention, a significant decrease was noted in anxiety scores in all subjects and in depression scores in youth with obesity, as well as in adolescents with obesity, while females displayed a reduced response to the intervention. Insulin resistance and metabolic syndrome parameters, cortisol, PRL, and LH concentrations were positive predictors for depressive and anxiety symptoms. Conclusions: The implementation of a multidisciplinary personalized lifestyle intervention program in the management of childhood obesity is associated with a significant decrease in cardiometabolic and psychosocial comorbidities in children with and without excess adiposity. The improvement in mental health is likely mediated by an improvement in energy metabolism with subsequent improvement in neuroinflammation owing to lifestyle changes.

Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review

BACKGROUND

Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems.

OBJECTIVE

This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths.

METHODS

The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted.

RESULTS

The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education.

CONCLUSIONS

The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents' resilience skills.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58681.

Single-blinded, randomised, parallel-group, controlled trial comparing the efficacy and cost-effectiveness of therapist- and self-guided internet-delivered behavioural activation versus treatment as usual for adolescents with mild to moderate depression: study protocol

INTRODUCTION

The number of adolescents seeking professional help for depression is increasing and, despite advances in treatment, large unmet treatment needs remain. In the current protocol, we describe the design and methodology of a randomised controlled trial (RCT) to evaluate the clinical efficacy of two forms of internet-delivered behavioural activation (I-BA), with and without therapist support, in reducing depressive symptoms, compared with treatment as usual (TAU). Secondary objectives include examining the 12-month maintenance of the treatment effects and conducting a health economic evaluation of the interventions.

METHODS AND ANALYSIS

In this single-blinded RCT, we aim to include 215 participants aged 13-17 years with mild to moderate depression who will be randomised (1:1:1 ratio) to 10 weeks of either therapist-guided or self-guided I-BA, or TAU provided by regular mental health clinics. Data will be collected at baseline, weekly for the initial 10 weeks, post-treatment and at 3 and 12-month follow-ups. The primary endpoint is the 3-month follow-up. The primary outcome is blinded clinician-rated severity of depressive symptoms, measured by the Children's Depression Rating Scale-Revised. Treatment response is defined as a score of 'Much improved' or 'Very much improved' on the Clinical Global Impression-Improvement Scale, administered at the primary endpoint. Outcome assessors will be blinded to treatment conditions at all assessment points. A health economic evaluation of I-BA will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up).

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Swedish Ethical Review Authority in June 2021. The final participant was enrolled on 3 May 2024 and expected to reach the primary endpoint by November 2024. The results of this study will be disseminated through publication in peer-reviewed journals, presented at conferences and communicated to healthcare providers and the public.

TRIAL REGISTRATION NUMBER

NCT04977856.

The effectiveness of secondary-school based interventions on the future physical activity of adolescents in Aotearoa New Zealand: a modelling study

BACKGROUND

Secondary schools are important settings for promoting varied physical activity (PA) opportunities for adolescents to promote PA throughout life. However, research on the effect of secondary school-based interventions on future PA is limited. This study examined the potential impact of secondary school-based interventions on the determinants of future PA participation of Aotearoa New Zealand (NZ) adolescents using simulated modelling.

METHODS

We used data from a nationally representative sample of secondary school students (n = 5035) aged 12-17 between 2017 and 2020 in NZ. We modelled four secondary school-based interventions and their projected impact on five determinants of future PA. Modelled interventions were the technological augmentation of physical education (TAPE), a peer-led PA mentoring programme (PL), physically active learning (PAL) and the inclusion of a natural environment play area (NE).

RESULTS

Total weekly PA increased the most from the NE intervention (+ 0.2 h/week), followed by TAPE (+ 0.08 h/week), PAL (+ 0.05 h/week) and PL (-0.06 h/week). Current number of PA settings increased the most in NE (+ 1.75 settings/week), followed by TAPE (+ 1.29 settings/week), PAL (+ 1.21 settings/week) and PL (+ 0.73 settings/week). Current number of PA types increased the most in NE (+ 1.57 types/week), followed by PL (+ 1.05 types/week), TAPE (+ 0.34 types/week) and PAL (+ 0.15 types/week). Physical literacy scores increased the most from PL (+ 3.6%), followed by PAL (+ 3.3%), TAPE (+ 0.43%) and NE (+ 0.12%). Social support scores increased the most from PAL (+ 5%), followed by PL (+ 1.9%), TAPE (+ 1.46%) and NE (+ 0.57%).

CONCLUSIONS

On average, all interventions benefitted determinants of future PA participation to a small degree. Results show differing magnitudes of the intervention effect by determinant, indicating the complexities surrounding the promotion of PA adherence. Future interventions could be improved through detailed consultation alongside, and involving, adolescents and stakeholders within schools. Researchers should also prioritise the collection of longitudinal PA data and explore its connection with sociodemographic differences between adolescents.

Help-Seeking Behaviors of Young People with Problematic Sexualized Behaviors

A substantial proportion of all reported child sexual abuse is perpetrated by other young people, though it is challenging to accurately depict its prevalence. Even less is known about the help-seeking behaviors of young people. Understanding how they seek help for their own problematic sexualized behavior is crucial to better inform therapeutic interventions and early intervention opportunities. This study used an administrative dataset of contacts (N = 901) received by Kids Helpline over nine years. Given the paucity of research on this topic, our approach to draw upon the contacts made to Kids Helpline by young people concerned about their own sexualized interests or behaviors is innovative and exploratory. Descriptive analyses were conducted to examine the characteristics of each contact as well as the demographics of the young people making contact. The present study examined the characteristics of 695 males and 206 females (aged 10 to 25) seeking help for their own problematic sexualized behaviors. Young people who contacted Kids Helpline for problematic sexualized behavior reported the following specific concerns: sexual behaviors (40.50%) and pornography use (38.20%). A quarter of contacts (25.86%) raised multiple concerns. Results suggest that intervention should be provided early and in an age-graded way. Several implications for theory and practice are discussed.

Interplay Cognitive Emotion Regulation and Health-Promoting Lifestyle Profile on Poor Sleep Quality in Adolescents

Background and Objective Adolescence is an important period of development, the main goal of this research was to investigate whether lifestyle can mediate the relationship between cognitive emotion regulation strategies and sleep quality.Methods This multicenter study was conducted between December 2023 and March 2024. The target population was adolescent girls between 12–18 years old. A total of 318 adolescents participated in this study in person. Pearson’s correlation coefficient was first used to check the relationships between research variables. Next, linear regression was used to draw predictive relationships based on independent and dependent variables. To investigate the mediator variable, path analysis was used and the result of the Sobel test was used.Results The R2 showed that 22% of the variance of poor sleep quality was explained by the predictor variables. Among of predictor variables in the model, health-promoting lifestyle profile and maladaptive strategies were significant and predicted poor sleep quality. The mediation role of a health-promoting lifestyle in the relationship between adaptive emotion regulation strategies and poor sleep quality was significant, the coefficient of the indirect path was equal to -0.18 and the Sobel test was equal to -4.68.Conclusions Current research has shown that cognitive emotion regulation strategies are related to poor sleep quality and this effect is mediated by a healthy lifestyle.

Depression, anxiety and self-esteem in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis

Objective

Studies have shown the adverse psychological impact of polycystic ovary syndrome (PCOS), but the state of mental health in adolescents with PCOS remains unclear. Thus, we performed a systematic review and meta-analysis to investigate the prevalence and severity of depression and anxiety, as well as potential effects on self-esteem and quality of life (QoL) in this specific population.

Methods

We systematically searched four electronic databases: PubMed, Embase, Web of Science, and the Cochrane Reviews database for articles published until 25/8/2024. We considered observational studies in which the subjects were adolescent girls with PCOS who had reported symptoms including anxiety, depression, self-esteem, and QoL. The Review Manager version 5.4 was used to analyze the available data extracted. We used the Newcastle-Ottawa Quality Assessment Scale (NOS) to evaluate the quality of selected studies. A funnel plot was utilized to assess the risk of literature bias, and a forest plot was used to represent the combined outcomes. This systematic review was previously registered in PROSPERO with the registration number CRD42022382036.

Results

We included 11 studies in the systematic review and conducted meta-analyses on 10 of them. Adolescents with PCOS reported a higher risk of depression (OR = 2.21, 95% CI: 1.23 to 4.00, p = 0.008) and a higher level of depression scores (SMD = 0.43, 95% CI: 0.16 to 0.71, p = 0.002) than controls. There were no significant differences in anxiety (OR = 1.90, 95% CI: 0.52 to 6.96, p = 0.33; SMD = 0.19, 95% CI: -0.21 to 0.59, p = 0.36), self-esteem (SMD = -0.17, 95% CI: -0.85 to 0.52, p = 0.64), and QoL (SMD = -0.15, 95% CI: -0.42 to 0.11, p = 0.26) between the two groups.

Conclusions

Our research indicated that adolescents with PCOS experienced more severe depressive symptoms than those without PCOS. This highlights the importance of evaluation and early treatment of mental health in PCOS. More clinicians should pay attention to the mental health of adolescent girls with PCOS through this study.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022382036.

The severity of perceived stress associated with community violence exposure and its role in future posttraumatic stress: findings from a longitudinal study of U.S. adolescents

BACKGROUND

Community violence exposure (CVE) in adolescence is associated with poorer mental health although the situational factors that may impact on this relationship remain relatively unexplored. The present study aimed to investigate if the degree of perceived stress during CVE has an effect on future posttraumatic stress disorder (PTSD) symptoms in youth, and if this association differs between females and males.

METHODS

Data were analyzed from 760 U.S. adolescents (mean age = 14.00 years), who participated in two surveys, one year apart. Information about CVE (witnessing violence and violence victimization) and the stress severity associated with it was collected in the first survey, whereas data on PTSD symptoms were obtained in the second survey. Generalized Linear Models were used to examine the associations that were also adjusted for ethnicity, age and socioeconomic status.

RESULTS

The results showed a longitudinal association between CVE-related stress and future PTSD symptoms, with students who had higher levels of perceived stress during CVE (witnessing or victimization) reporting higher PTSD symptom levels subsequently. There was no interaction between sex and CVE-related stress and PTSD symptoms, although females reported more PTSD symptoms.

CONCLUSIONS

The severity of the perceived stress associated with CVE should be regarded as a potentially important prognostic factor for identifying those who might develop PTSD symptoms after CVE and this may facilitate early intervention and treatment for those exposed to community violence.