Age of onset of mental disorders: a review of recent literature

Life expectancy associated with specific mental disorders and the contribution of causes of death: a population-based study in the region of Catalonia

There is strong evidence that people with mental disorders have a premature mortality, with physical diseases, as well as suicide, accounting for it in large part. However, there is a lack of studies focused on common mental disorders in Southern Europe. This study aims to calculate the reduction in life expectancy for different mental disorders according to all-cause mortality and for specific causes of death using national registers from Catalonia (Spain). This population register-based study includes clinical information on all adults over 18 years of age using the Catalan public healthcare system from January 2005 to December 2016 (355,540 females and 182,529 males with mental disorders). Mental disorders were classified into eleven categories, and causes of death were grouped as natural and unnatural and then further divided into nine groups. For each disorder, the life-years lost were estimated for all-cause mortality and for each specific cause of death in males and females. All mental disorders showed a shorter remaining life expectancy after diagnosis than the reference population of the same age. The disorders associated with the largest reduction in life expectancy were alcohol and drug dependence and abuse, and schizophrenia. Natural causes and, to a lesser extent, suicide, were the predominant contributors to excess mortality for all types of mental disorders. Our findings suggest that mental disorders are associated with premature mortality in Catalonia. Furthermore, natural causes are the primary contributors to premature mortality, indicating the need for better management of medical conditions in this population.

Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial

BACKGROUND AND OBJECTIVES

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

METHOD

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

RESULTS

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

LIMITATIONS

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

CONCLUSIONS

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

Is university attendance associated with differences in health service use for a mental health problem in emerging adulthood? Evidence from the ALSPAC population-based cohort

PURPOSE

It is unclear whether attending university is associated with health service use for mental health problems in emerging adulthood. As this can be a marker of the onset of mental disorders, we aimed to investigate whether attending university was associated with health service use for a mental health problem by age 24.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). The analytic sample comprised of 2,649 individuals with data on university attendance reported approximately between ages 25 and 26, and health service use for a mental health problem reported around age 24. Logistic regression models were used to investigate the association between university attendance and health service use, employing confounder adjustment, multiple imputation and propensity score matching to assess the robustness of associations. The study was reported using STROBE guidelines.

RESULTS

University attendees were less likely to report having used services for mental health problems by 24 years compared to non-university attendees (6.5% vs. 11.4%, odds ratio (OR) = 0.54[95%CI = 0.40;0.72], p < 0.001). This association was robust in the fully adjusted model (aOR = 0.38[95%CI = 0.15;0.94], p = 0.04), propensity score matching and multiple imputation. There was evidence of a differential association among those who were and were not heterosexual and according to maternal education level.

CONCLUSIONS

Our findings suggest individuals who attend university are less likely to use a health service for a mental health problem. Further longitudinal research is needed to investigate potential explanations for these differences.

PRE-REGISTRATION

A study protocol was submitted to the ALSPAC team.

Navigating the Future of Polygenic Risk Scores: Insights from Child and Adolescent Psychiatrists

Polygenic risk scores (PRS) are a method of calculating genetic risk for polygenic, or multi-gene, disorders. These scores have potential impacts in the realm of child and adolescent psychiatry, given the high prevalence of psychiatric disorders among youth. However, there are concerns about PRS implementation among key stakeholders, namely child and adolescent psychiatrists (CAP). We conducted interviews with 29 U.S.-based CAP to investigate clinician attitudes toward the use of PRS. The data herein correspond to a future scenario we provided CAP in which PRS are accurate and portable to patients of different racial and ethnic backgrounds. We found that CAP envisioned some utility for PRS in regards to clinical surveillance and treatment; however, several desired further research demonstrating that PRS positively impact patient outcomes before they would consider implementing PRS in-clinic. The most cited concern about PRS deployment was the potential for misinterpretation and misuse of PRS on the part of patients, families, corporate entities, and clinicians themselves. CAP emphasized the need for support in the form of testing infrastructure, clinical guidelines, and collaboration with the involvement of PRS experts, when considering PRS applications in the future.

Chronic opioid use and incident opioid use disorders in survivors of adolescent and young adult cancer after cancer treatment

BACKGROUND

The use of opioids and its benefits and harms among cancer survivors are poorly understood. The authors examined opioid use and related outcomes among adolescent and young adult (AYA) cancer survivors after cancer treatment.

METHODS

The authors identified 2-year cancer survivors diagnosed between 15 to 39 years of age at Kaiser Permanente Southern California (2000-2012, followed through 2019). Individuals without cancer were matched to survivors on age, sex, and calendar year for comparison. The authors used robust Poisson regression to compare long-term (≥90 days) opioid use during follow-up and Fine-Gray hazard models to compare incident long-term high-dose use (≥50 morphine milligram equivalents daily dose ≥90 days), benzodiazepine co-use, opioid use disorder (OUD), opioid overdose, and opioid-related hospitalization. We also restricted analyses to individuals on long-term opioid therapy, and evaluated risk factors for opioid-related outcomes within cancer survivors.

RESULTS

Of 5908 AYA cancer survivors and 81,833 noncancer individuals, 5.2% and 1.8% had long-term opioid use during follow-up, respectively (prevalence ratio = 1.8, 95% confidence interval, 1.6-2.0). Cancer survivors had higher incidence of long-term high dose opioid use (hazard ratio [HR] = 2.2 [1.8-2.8]), benzodiazepine co-use (HR = 1.4 [1.3-1.5]), and opioid-related hospitalization (HR = 1.5 [1.1-2.2]) compared with noncancer individuals. Among those on long-term opioid therapy, cancer survivors had elevated risk for long-term high dose use (HR = 1.4 [1.1-1.8]) and benzodiazepine co-use (HR = 1.6 [1.2-2.1]), but lower OUD risk (HR = 0.6 [0.4-0.9]). Opioid use during cancer treatment phase most strongly predicted long-term high dose use and OUD/overdose during survivorship.

CONCLUSION

Findings call for risk-stratified patient monitoring and better understanding of the differential OUD risk in AYA cancer survivors.

Psychosocial factors and the development of childhood overweight and obesity: a UK cohort study

BACKGROUND

We examined the role of psychosocial factors in overweight and obesity development.

METHODS

UK Millennium Cohort Study data of children with normal weight at baseline were analysed. Weight changes were determined from baselines at ages 11 (n = 7979) and 14 (n = 6906) to follow-up at age 17. Baseline individual psychosocial factors were combined into two distinct indexes (caregiver-reported child mental health, child-reported psychosocial well-being). Regression models examined the associations between baseline indexes and individual psychosocial factors and overweight and obesity development (vs. no development) and body mass index (BMI) z-score changes.

RESULTS

Worse child mental health, but not psychosocial well-being, at age 11 was associated with overweight and obesity development (OR = 1.14; 95% CI = 1.02, 1.27) and increased BMI z-scores (β = 0.08; 95% CI = 0.04, 0.12) to age 17. No psychosocial indexes at age 14 predicted the outcomes. Further analyses showed that child mental health at ages 11 vs. 14 was more likely to predict the outcomes. Based on individual factors, externalising symptoms and experiencing peer bullying at age 11 may be important contributors to overweight and obesity development.

CONCLUSIONS

Poor child mental health at age 11 is associated with overweight and obesity development by age 17. Late childhood/early adolescence may be a sensitive period in which psychosocial factors predict body weight trajectories.

IMPACT

Worse psychosocial factors, particularly poor mental health, at ages 11, but not 14, were associated with overweight and obesity development and increased BMI z-scores by age 17. Late childhood/early adolescence may be a sensitive period for mental health in predicting future weight change. Future research will benefit from exploring this potential sensitive period and understanding potential mechanisms.

Patterns of intra-cluster correlation coefficients in school-based cluster randomised controlled trials of interventions for improving social-emotional functioning outcomes in pupils: a secondary data analysis of five UK-based studies

BACKGROUND

The cluster randomised trial (CRT) design is increasingly used to evaluate the impact of school-based interventions for improving social-emotional functioning outcomes in pupils. Good knowledge is required on plausible values of the intra-cluster correlation coefficient (ICC) of the outcome to calculate the required sample size in such studies. Using data from five school-based CRTs in the UK, we estimate, and describe patterns in, ICCs for social-emotional functioning outcomes.

METHODS

Mixed effects linear regression models were fitted to estimate the ICC and variance components. Estimates for baseline data were obtained by fitting "null" models that had no predictor variables; estimates at follow-up were adjusted for trial arm status.

RESULTS

Five hundred and twenty-nine (529) ICCs were estimated. Variation across clusters in the outcomes was present at the school, year group and classroom levels. Overall, the ICCs were not markedly different between the primary and secondary school settings. Most of the school- and classroom-level ICCs were less than 0.04 for pupil-reported outcomes and less than 0.035 for parent-reported outcomes; a notable exception for pupil-reported outcomes was for outcomes that reflect a common experience shared by children, such as school climate, where the ICCs were as large as 0.1. The ICCs for teacher-reported outcomes (up to 0.1 at the school level and 0.2 at the classroom level) were larger than for pupil- and parent-reported outcomes. In the CRT that allocated schools to trial arms and only sampled one classroom from each school, the nominal school-level ICCs for teacher-reported outcomes took values up to 0.25. ICCs for teacher-reported measures of internalising behaviour problems and pro-social behaviour were larger than for externalising behaviour problems.

CONCLUSIONS

When randomising school clusters, sub-sampling of lower-level clusters such as classrooms should be accounted for in the sample size calculation. Teacher-reported ICCs are likely to be greater than those for pupil- and parent-reported outcomes as teachers will often provide data for many or all pupils in a given school or classroom. Differences across reporter type and across outcomes need to be considered when specifying plausible values of the ICC to calculate sample size.

TRIAL REGISTRATION

STARS study (ISRCTN84130388); KiVa study (ISRCTN23999021); PACES study (ISRCTN23563048); PROMISE study (ISRCTN19083628); MYRIAD study (ISRCTN86619085).

[Barriers and facilitators to the use of mental health prevention programs among preschool- and elementary school-aged children]

BACKGROUND AND AIMS

Emotional and behavioural problems occur frequently in childhood and are usually associated with burdens on children, families, and society. Preventive interventions could reduce these burdens, but are rarely used despite their availability and effectiveness. The aim was to identify general, individual, structural, and family-related barriers/facilitators to potential and actual participation in prevention programs.

METHODS

As part of a prospective implementation study, n = 3,231 project folders were handed out to parents in 28 paediatric practices in Dresden and surrounding area during routine health check-ups (U9-U11) for children aged 5 to 10 years. In addition to screening for mental health problems, a questionnaire was used to identify potential barriers/facilitators to participation in prevention programs. Of n = 2,844 families agreeing to participate in the study n = 2,122 (74.6 %) completed the questionnaire at least partially. Regression analyses were used to test associations between potential barriers/facilitators and actual participation in (a) a pre-intervention interview (PII; in order to check indications with the program provider) or (b) the prevention program among children with a prevention recommendation.

RESULTS

Of the participating families, 1.8 % reported that they had already participated in a prevention program to improve mental health or had received a recommendation for it before. 59.5 % of the families expressed their general interest in such programs, and 95.7 % would participate if their paediatrician recommended it. At the structural level, a lack of knowledge about mental health prevention programs was identified as a barrier to potential participation; as only 9.2 % of the families were aware of such programs before participating in the study. 65.8 % of all the families considered full reimbursement of the participation fees after paying in advance a prerequisite for their potential program participation, and 56.7 % wanted to receive a voucher from their health insurance fund entitling them to participate without prepayment. At the individual level, the parents' attitude towards the usefulness of prevention programs predicted the actual utilisation of the PII after the paediatrician's recommendation. At the structural level, the acceptance of longer travel times (up to 60 minutes) as well as the assumption/reimbursement of the entire course fees were relevant predictors. Furthermore, male sex (of the children) and higher screening scores were also important predictors at the family-related level. After the PII, the only factor associated with actual participation in prevention programs was efficient public transport accessibility.

DISCUSSION

In order to increase participation in prevention programs, funding to cover participation fees should be secured through health insurance funds. In addition, advertising and educational measures in the public as well as by paediatricians in the context of screening could raise the awareness of and improve attitudes towards useful programs. Implementing the programs in children's environments could reduce structural barriers and create equal opportunities for participation.

Exploring mechanisms behind the increasing gender gap in adolescent psychological symptoms, 2002-2022: the role of national-level gender equality

BACKGROUND

Internalising problems have increased considerably among adolescents in the last decades, particularly among girls, resulting in widening gender gaps. This study examined whether the gender gap in psychological symptoms increased more in more gender-equal countries in the period 2002-2022, and if so, to what extent this could be explained by changes over time in the experience of stressors (i.e. schoolwork pressure, body dissatisfaction, low classmate support) among boys and girls in these countries.

METHODS

National data on gender inequality (UNDP Gender Inequality Index) were combined with aggregated individual-level data from the Health Behaviour in School-aged Children (HBSC) study (2002-2022) across 43 countries (N = 1,268,220). Absolute and relative gender gaps in psychological symptoms were regressed on survey cycle, GII and their interaction. Next, interactions of survey cycle and either schoolwork pressure, body dissatisfaction or classmate support were added to the model.

RESULTS

Increases in the absolute and relative gender gap in psychological symptoms between 2002 and 2022 were stronger in more gender-equal countries, mainly due to larger increases in psychological symptoms among girls in these countries. Also, less favourable time trends for schoolwork pressure and classmate support were found in more gender-equal countries for boys and especially girls. The larger increase in schoolwork pressure among girls in more gender-equal countries partly explained the increased absolute gender gap in psychological symptoms in these countries.

CONCLUSIONS

While national-level gender equality was positively associated with boys' and girls' mental health in the early 2000s, this association has become negative for girls in more recent years. The benefits of gender equality for girls' mental health may have become overshadowed by the increased experience of stressors, especially schoolwork pressure. Far from advocating that gender equality is a negative situation, these findings suggest that much work remains to achieve full gender equality, where men and women really share the burdens and stressors in everyday life.

Multiple emergency department visits and suicidal behavior in children and adolescents

BACKGROUND

Suicidal behaviour is a growing problem in child and adolescents, and the Emergency Department (ED) is often where the first contact with Mental Health occurs. Here we factors associated with suicidal behaviour in this children and adolescents attended at the ED.

METHODS

Our sample consisted of children and adolescents who attended the ED of Hospital 12 de Octubre for psychiatric reasons between January 1st and December 31st, 2022. Inclusion criteria were age under 18 years. No restrictions by diagnosis, ethnicity, nationality, gender or any other variables. We conducted an initial interview with patients in the ED and reviewed patients' digital patient records for the six months following their first visit during 2022.

RESULTS

We found that the variables that were independently associated with a repeated visits for suicidal behaviour were eating problems, transgender identity, emotional dysregulation and previous mental health follow-up.

CONCLUSION

In our study, we found that ED revisits were concentrated in the first month after the first visit. Just as associated factors and approaches have historically been studied in the adult population, the child and adolescent population needs an even more in-depth study of this alarming situation.

Can collaborative orientations strengthen or weaken effectiveness of improvisers' emergency response to an emergency incident? A conditional process model

Due to insufficient information on the on-site emergency incident, respondents face a huge challenge to react effectively. This may suggest that the individual response to emergency tasks is likely to differ from that in daily work contexts. This study aims to explore the conditional process of how individuals' improvisational cognitive appraisals (IICAs) in psychology affect their improvisational performance in an emergency setting and its consequences. Using the data garnered from the coal mine accident rescue teams we find that the level of IICAs positively impacts the individual's improvisational ability to effectively respond to the emergency incident and the improvisational performance of temporary emergency teams as a whole. Further, an individual's higher level of proclivity to seek cooperation with others in an emergency situation weakened the relationship between the individual's improvisational cognitive appraisals and the individual's improvisational performance team. Our work sheds light on how the improvisational performance of temporary emergency teams in a crisis setting is shaped, explaining why those who perform well in their day-to-day work often have difficulties in achieving the same good performance in a sudden crisis setting.

Sex-specific differences in the experience of adverse childhood experiences: transmission, protective, and risk factors from the perspectives of parents and their children-results of an 18-year German longitudinal study

THEORETICAL BACKGROUND

Adverse childhood experiences (ACEs) are strongly associated with mental and physical health problems across the lifespan, emphasizing the critical need for prevention. Sex-specific differences in both the prevalence and long-term consequences of ACEs have rarely been analyzed, especially in longitudinal studies, which are particularly needed.

OBJECTIVE

This longitudinal study explores risk and protective factors as well as the intergenerational transmission of ACEs from parents to children, with a focus on sex-specific effects.

METHODS

Data from 316 families participating in the 18-year German longitudinal project "Future Family" were analysed. The dataset included information from mothers (54 years), fathers (57 years), and their emerging adults (22 years).

RESULTS

Daughters and mothers reported significantly more ACEs than fathers and sons, particularly in the categories of abuse and neglect. Experiencing four or more ACEs was associated with higher levels of psychological distress and lower life satisfaction for both parents and children. Approximately half of the emerging adults experienced a similar number of ACEs as their parents; however, the types of ACEs often differed, with children encountering distinct ACEs. Protective factors, such as higher maternal socio-economic status, maternal participation in the Positive Parenting Program (Triple P), and fewer internalizing problems in early childhood, were associated with a reduced number of ACEs in children by the age of 18.

CONCLUSION

Although women report higher rates of ACEs, men are not less affected in terms of psychological distress. Sex-specific considerations appear to be crucial in the prevention of ACEs and should be integrated into targeted strategies. Our findings highlight the importance of considering both parents' perspectives in developing and implementing effective preventive interventions in families.

Informal care provision for mental versus somatic disorders in the Netherlands: a cross-sectional investigation of caregiving context and quality of life outcomes

OBJECTIVES

To investigate to what extent informal caregivers of persons with a mental disorder and a somatic disorder compare, in terms of their caregiving context and quality of life measures.

DESIGN

Cross-sectional analysis of an existing panel survey dataset.

SETTING

The Netherlands, 2020.

PARTICIPANTS

Informal caregivers that provided long-term care and support to a loved one with either a somatic disorder (n=428) or mental disorder (n=176).

OUTCOME MEASURES

Self-assessed care-related, health-related and mental health-related quality of life and the caregiving context, including background and contextual factors of the informal caregiver and care recipient, caregiving strains and coping and support.

RESULTS

A significant degree of variation was present among the two caregiving groups, in terms of their caregiving context. Notably, caregivers for individuals with mental disorders had a higher subjective burden (p<0.001), care recipient comorbidity (p<0.001), need for permanent surveillance (p=0.003) and total caregiving intensity (p<0.001). Significantly worse caregiver outcomes were reported for caregivers of individuals with mental disorders for care-related (p<0.001), health-related (p=0.011) and mental health-related quality of life (p<0.001). However, the presence of a mental disorder was only found to be significantly associated with worse care-related quality of life scores (B=-4.635, p=0.002).

CONCLUSIONS

Our findings established that informal caregivers of individuals with mental disorders not only provide care and support in more burdensome caregiving contexts, but also suffer from a worse quality of life compared with informal caregivers of individuals with somatic disorders. Particularly, the impact on care-related quality of life was concerning, with the presence of a mental disorder in the care recipient found to be directly associated with a significantly worse outcome.

Socioeconomic differences in adolescent health behaviors and their effect on inequalities in adult depressed mood: findings from a 27-year longitudinal study

BACKGROUND

Health behaviors have been posited to partly explain the association between socioeconomic status (SES) and health (i.e., the behavioral explanation of health inequalities), yet few studies have examined whether health behaviors serve as pathways from adolescent SES to adult depressive symptoms. This study aimed to explore the effects of adolescent health behaviors on adult depressed mood using the adolescent pathway model (APM).

METHODS

Our sample consisted of n = 1109 Norwegians [45.5% female], who were surveyed from ages 13 to 40 across ten time points. Using linear regression analyses, we examined (1) the association between parental SES [household income and parental education] and adolescent health behaviors [breakfast regularity, leisure time physical activity (LTPA), difficulties falling asleep, alcohol consumption, and smoking], and (2) the associations between adolescent health behaviors and adult depressed mood, and whether these were moderated by indicators of parental SES. We also assessed how health behaviors are associated with social inequality in adult depressed mood. In this context, social inequality was defined as the covariance between adult SES (i.e., income and education) and adult depressed mood.

RESULTS

Higher household income predicted higher levels of LTPA, and higher parental education predicted greater breakfast regularity. None of the health behaviors were associated with adult depressed mood, nor did they show moderation by SES. Adolescent health behaviors did not independently account for social inequality in adult depressed mood.

CONCLUSIONS

The study suggests minimal socioeconomic differences in adolescent health behaviors, which do not significantly account for social inequalities in adult depressed mood. This offers limited support for the behavioral explanation of health inequalities within the framework of the APM. However, adolescent depressed mood emerges as the strongest predictor of adult depressed mood, highlighting its importance as a key focus for early intervention efforts.

Escape Game to Promote Students' Mental Health Outcomes in the Aftermaths of COVID-19 Pandemic: Protocol for a Mixed Methods Study Evaluating a Cocreated Intervention

BACKGROUND

The COVID-19 pandemic and the protracted lockdowns have heavily impacted university students' mental health. Digital Escape Games represent a good means to reach students and propose them solutions for their psychological well-being.

OBJECTIVE

This study aimed to evaluate a cocreated digital Escape Game on students' mental health in the aftermath of the COVID-19 pandemic, called EscapeCovid Game. The evaluation of the effectiveness of this stand-alone intervention concerns mental health outcomes (mental health literacy, appraisal and change of beliefs about mental health, management of emotions, and development of coping strategies) and the appreciation and relevance of the game.

METHODS

A randomized controlled trial with pre- and posttest data collection (online questionnaires with validated scales) is conducted among 500 students in Bordeaux, France, to evaluate the EscapeCovid Game cocreated with students, researchers, health professionals, and web developers. A subsample of students is randomly selected for responding to a semistructured interview following a mixed methods design. Recruitment is done through mail invitations from student associations and presentations in university classes. Half of the sample of the trial plays the Escape Game, while the other half receives an email with mental health-related information. Within the game, students discuss their personal experiences. The text is further used for the qualitative analyses. The whole study is carried out online.

RESULTS

The EscapeCovid Game has been developed, tested, and finalized by the end of March 2023. As of November 4, 2024, a total of 191 students have answered the baseline questionnaire (90 intervention vs 101 control). A total of 23 students have played the game and 53 are in the control arm. Among participants, by the end of September 20, 2023, twenty were interviewed (10 intervention and 10 control) reaching sample saturation. According to preliminary results, the EscapeCovid Game has had a positive impact on all defined outcomes, while the email has been effective in increasing knowledge on resources available and on coping strategies and meditation techniques. We expect the trial to be completed by the end of June 2025.

CONCLUSIONS

The mixed methods findings of this study are due to demonstrate the effectiveness of the EscapeCovid Game in improving students' mental health outcomes. Preliminary results from the qualitative substudy are promising: in the aftermath of the COVID-19 crisis, this intervention is intended to promote players' mental health through gamification, knowledge transfer, and a learning-by-doing approach.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06720792; https://clinicaltrials.gov/study/NCT06720792.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64068.

Annual Research Review: Adolescent social media use is not a monolith: toward the study of specific social media components and individual differences

Social media have drastically changed the context of adolescent development. To date, the majority of research investigating the effects of these changes has measured time spent on social media, yielding inconclusive results-likely because this approach conceptualizes social media as a monolith. Social media experiences are complex and diverse, as are adolescents themselves. Emerging research has identified several specific components of social media that have varied associations with adolescent mental health, as well as individual difference factors that may alter these associations across adolescents. In this annual research review, we synthesize evidence regarding heterogeneity in social media effects related to (a) specific components of social media and (b) adolescents' individual differences regarding social media use and effects. We first focus on the specific social media components-content, features, and functions-that may be especially relevant for adolescent development. These include functions designed to foster relationships and social connections (e.g., social media feeds, 'friends'), hateful content, notifications, risky content, and algorithmically curated content, among others. Next, we provide an overview of for whom these effects may matter most. We review research on individual differences that may explain some heterogeneity in social media effects, including gender/sex, age, marginalized status, neurobiological and social sensitivities, and other preexisting vulnerabilities to mental health concerns. The nascent work in these areas suggests many specific constructs and considerations that could drive future research examining nuanced and precise questions that go beyond 'screen time'. We discuss avenues for researchers to leverage methodological advancements and address how specific social media experiences and individual differences shape developmental outcomes.

Interparental Relationship Discord and Adolescent Psychopathology in a United States Probability Sample

Exposure to interparental conflict and poor parental relationship adjustment (i.e., interparental relationship discord) has been associated with children's internalizing and externalizing symptoms throughout childhood and later life. However, the degree to which interparental relationship discord is associated with clinical levels of psychopathology in adolescents remains unclear. The association between parents' report of interparental relationship discord and mental disorders in adolescents was investigated in the National Comorbidity Survey-Adolescent Supplement, a United States probability sample of 13-17-year-old adolescents and their parents (N = 4,112 dyads). A hierarchical framework, consisting of 16 specific disorders, latent dimensions of internalizing and externalizing disorders, and a latent dimension of general psychopathology, was employed. Greater interparental relationship discord demonstrated small but significant associations with higher levels of general psychopathology and internalizing and externalizing psychopathology, as well as with several specific disorders. Overall, results are consistent with the perspective that interparental relationship discord may increase risk for clinical levels of psychopathology in adolescents.

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.

Social Capital and Depression Among Adolescents Relocated for Poverty Alleviation: The Mediating Effect of Life Satisfaction

Background: China's relocated for poverty alleviation policy has played a pivotal role in eradicating extreme poverty nationwide. However, adolescents relocating with their parents may face multifaceted challenges, including abrupt shifts in their living environments, the reconstruction of social capital, and the psychological turbulence inherent to adolescence. Objectives: We aimed to explore predictors of reducing depressive symptoms in relocated adolescents. We analyzed the associations between social capital, life satisfaction, and adolescent depression. Methods: This study investigated 631 adolescents aged 10-19 years from 24 relocation for poverty alleviation resettlement sites in Shanxi Province. Respondents completed basic demographic information and questionnaires on adolescent social capital, life satisfaction, and depressive symptoms. The mediating role of life satisfaction was assessed using PROCESS 3.4 analysis. Results: The mean social capital score of the adolescents was 31.96 ± 3.666, the mean life satisfaction score was 23.21 ± 6.282, the mean depression score was 4.03 ± 5.503, and the depression detection rate was 15.2%. We found that social capital was significantly positively correlated with life satisfaction (r = 0.363, p ˂ 0.05), both social capital and life satisfaction were negatively correlated with depressive symptoms (r = -0.362, p ˂ 0.05; r = -0.398, p ˂ 0.05), and life satisfaction partially mediated the association between social capital and depressive symptoms (mediating effect of 18.20%). Conclusions: Adolescents in communities relocated for poverty alleviation are overall satisfied with their lives, but some are experiencing some form of depression. Both social capital and life satisfaction are associated with lower depression levels, and those with higher life satisfaction are better able to cope with the changes in social capital associated with environmental changes after relocation, thus helping to reduce depressive symptoms.

Facilitators and Barriers to Digital Mental Health Interventions for Depression, Anxiety, and Stress in Adolescents and Young Adults: Scoping Review

BACKGROUND

Digital mental health interventions (DMHIs) offer unique strengths as emerging services with practical applications for adolescents and young adults (AYAs) experiencing depression, anxiety, and stress. Although promising, acceptance and participation in DMHIs vary across interventions, participants, and contexts. It is essential to delineate and synthesize the factors that promote or hinder DMHI use.

OBJECTIVE

This review aims to assess and synthesize the facilitators and barriers to accessing DMHIs for depression, anxiety, and stress in AYAs through a scoping review.

METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, PsycINFO, CNKI, OpenGrey, and APA PsycExtra, up to October 31, 2023. Articles examining facilitators and barriers to DMHIs among AYAs with disorders or symptoms of depression, anxiety, and stress were included. Data synthesis and analysis involved quality assessment, thematic analysis, and relative frequency meta-analysis.

RESULTS

A total of 27 records met the eligibility criteria, and 14 facilitators and 13 barriers were identified across the external, intervention, and individual levels. The relative frequency meta-analysis indicated that factors influencing AYAs' use of DMHIs varied based on delivery modes. Among these factors, "quality and effect" emerged as the predominant theme-high quality and effect served as the primary facilitator, while low quality and effect acted as a barrier across both portable and nonportable devices, as well as single and multiple platforms.

CONCLUSIONS

The uptake of DMHIs among AYAs is influenced by a complex interplay of facilitators and barriers, particularly those related to quality and effect. Our syntheses provide crucial guidance for intervention designers, emphasizing the importance of user-centered approaches that balance scientific rigor with engaging and adaptive features. Enhancing the alignment of DMHIs with adolescent needs can improve both adoption and real-world mental health impact.

TRIAL REGISTRATION

PROSPERO CRD42023479880; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023479880.

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.

Cross-sectional comparison of risk factors associated with mental illness and learning difficulties in kindergarten and elementary, middle, and high school children in the United States: a socio-ecological resilience framework

Aim

Mental illness and learning difficulties in children can be explained using the socio-ecological resilience (SER) model, which states that personal characteristics and an individual’s social relationships coupled with environmental factors of adverse life events influence mental health. We aimed to identify factors associated with anxiety, depression, and learning difficulties in kindergarten and elementary, middle, and high school children.

Subject and methods

This study utilized data collected from the 2019 National Health Interview Survey (NHIS) questionnaire administered across the United States. Children aged 4 to 17 were included. Risk factors were categorized into personal characteristics, lack of peer support, adverse family events, and socioeconomic status (SES). Logistic regression was used to estimate the risk for each risk factor and SER layers for anxiety, depression, and learning difficulties.

Results

In relation to the SER model, factors from personal, relational, and structural layers all influenced the likelihood of anxiety, depression, and learning difficulties in children across all ages. Negative personal characteristics of emotional dysregulation were the most significant risk factor associated with anxiety and depression. For children in kindergarten, relational factors of poor peer relations were more significant in influencing learning difficulties, while behavioural dysregulation measured by hyperactivity had a greater influence on learning difficulties for older children in elementary, middle, and high school. Having experienced adverse family events was significantly associated with worse mental health, while low SES was associated with worse depression and learning difficulties.

Conclusion

Comprehensive interventions that strengthen personal characteristics, peer interactions, and environmental stressors are needed to address mental illness in children.

Accelerated global burden of depressive disorders during the COVID-19 pandemic from 2019 to 2021

A thorough and current analysis of the burden and evolving trends in depressive disorders during the COVID-19 pandemic from 2019 to 2021 remains unavailable. Employing the Global Burden of Disease (GBD) 2021 database, we evaluated the burden of depressive disorders at the global, regional, and national levels, stratifying the analysis by age, gender, and socio-demographic index (SDI). To examine trends in depressive disorders during the epidemic, we calculated the estimated annual percentage change (EAPC) in age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALYs rates (ASDR) across all levels from 2019 to 2021. Furthermore, we performed a frontier analysis of depressive disorders across various countries, incorporating risk factor analyses at multiple levels. In 2021, the global incidence of depressive disorders stood at 357.43 million, while the prevalence was recorded at 332.41 million, accompanied by 56.33 million disability-adjusted life years (DALYs). Throughout the COVID-19 pandemic, there was a notable upward trend in ASIR (EAPC = 8.33 [-0.46 to 17.9]), ASPR (EAPC = 6.02 [0.28 to 12.09]), and ASDR (EAPC = 7.13 [-0.18 to 14.97]) for depressive disorders on a global scale. The burden of depressive disorders is most pronounced among females and individuals aged 60 to 64 within their respective subgroups. From 1990 to 2021, the burden of depressive disorders consistently remained highest in the low SDI region; however, it experienced the most significant increase in the high SDI region during the COVID-19 pandemic from 2019 to 2021. In 2021, the burden of depressive disorders was highest in central sub-Saharan Africa, Greenland, and Uganda, while the Andean region of Latin America, along with Bulgaria and Belarus, experienced the most significant increase in depressive disorders during the COVID-19 pandemic. Globally, bullying victimization, intimate partner violence, and childhood sexual abuse contributed to 6.47%, 4.91%, and 2.65% of the ASDR for depressive disorders, respectively. The global burden of depressive disorders has markedly increased during the COVID-19 pandemic, gradually shifting from low to high SDI regions, particularly in North America and Europe.

Large-scale effects of prenatal inflammation and early life circadian disruption in mice: Implications for neurodevelopmental disorders

Around 80 % of individuals with neurodevelopmental disorders such as schizophrenia and autism spectrum disorders experience disruptions in sleep/circadian rhythms. We explored whether environmental circadian disruption interacts with prenatal infection, a risk factor for neurodevelopmental disorders, to induce sex-specific deficits in mice. A maternal immune activation (MIA) protocol was used by injecting pregnant mice with viral mimic poly IC or saline at E9.5. Juvenile/adolescent male and female offspring (3-7 weeks old) were then subjected to a standard light:dark cycle (12:12LD) or to constant light (LL). Significant interactions between treatment (MIA, control) and lighting (12:12LD, LL) were evident in behaviors related to cognition, anxiety, and sociability. This pattern persisted in our RNA sequencing analysis of the dorsal hippocampus, where poly IC exposure resulted in numerous differentially expressed genes (DEGs) in males, while exposure to both poly IC and LL led to a marked reduction in DEGs. Through WGCNA analysis, many significant gene modules were found to be positively associated with poly IC (vs. saline) and LL (vs. LD) in males (fewer in females). Many of the identified hub-bottleneck genes were homologous to human genes associated with sleep/circadian rhythms and neurodevelopmental disorders as revealed by GWA studies. The MIA- and LL-associated modules were enriched in microglia gene signatures, which was paralleled by trends of effects of each of the factors on microglia morphology. In conclusion, in a mouse model of prenatal infection, circadian disruption induced by LL during adolescence acts as a modulator of the effects of MIA at behavioral, cellular, and molecular levels.

Associations between trajectories of depressive symptoms and cognitive performance in Chinese adolescents

Subclinical depressive symptoms and the associated risk of cognitive deficits have been overlooked. We aimed to investigate depressive symptom trajectories and the effect of depressive symptoms on cognitive performance among Chinese adolescents. The research population of our study was 1314 adolescents aged 10-15 years old from the China Family Panel Studies. The Center for Epidemiologic Studies Depression Scale was used to assess the depressive symptoms of adolescents. Vocabulary and mathematics tests were used to test fluid intelligence. Memory and number series tests were used to test crystal intelligence. The 6-year depressive symptom trajectories of adolescents were identified by the latent class mixed model. Linear regression models and Generalized Estimating Equation models were applied to test the associations between depressive symptom trajectories and cognitive performance. We identified three distinct trajectories of depressive symptoms: (a) low depressive symptom trajectory (88.51%), (b) remitting depressive symptom trajectory (5.86%), (c) decreasing depressive symptom trajectory (5.63%). We found that decreasing depressive symptom trajectory predicted worse fluid intelligence (β: -0.51, 95% CI: -0.88, -0.13) and crystal intelligence (β: -2.09, 95% CI: -3.78, -0.41) compared with low depressive symptom trajectory. Gender-stratified analysis showed that the negative association between depressive symptoms trajectory and crystal intelligence was only found in males. Depressive symptom episodes in early adolescence were associated with worse cognitive performance later. Performing mental health screenings, especially during the sensitive windows of cognitive development, is critical to reducing the negative impact of depressive symptoms.

Reliable multimodal brain signatures predict mental health outcomes in children

BACKGROUND

Inter-individual brain differences likely precede the emergence of mood and anxiety disorders, however, the specific brain alterations remain unclear. While many studies focus on a single imaging modality in isolation, recent advances in multimodal image analysis allow for a more comprehensive understanding of the complex neurobiology that underlies mental health.

METHODS

In a large population-based cohort of children from the Adolescent Brain Cognitive Development (ABCD) study (N > 10K), we applied data-driven linked independent component analysis to identify linked variations in cortical structure and white matter microstructure that together predict longitudinal behavioural and mental health symptoms. Brain differences were examined in a sub-sample of twins depending on the presence of at-risk behaviours.

RESULTS

Two multimodal brain signatures at age 9-10y predicted longitudinal mental health symptoms from 9-12y, with small effect sizes. Cortical variations in association, limbic and default mode regions linked with peripheral white matter microstructure together predicted higher depression and anxiety symptoms across two independent split-halves. The brain signature differed amongst depression and anxiety symptom trajectories and related to emotion-regulation network functional connectivity. Linked variations of subcortical structures and projection tract microstructure variably predicted behavioural inhibition, sensation seeking, and psychosis symptom severity over time in male participants. These brain patterns were significantly different between pairs of twins discordant for self-injurious behaviour.

CONCLUSIONS

Our results demonstrate reliable, multimodal brain patterns in childhood, before mood and anxiety disorders tend to emerge, that lay the foundation for long-term mental health outcomes and offer targets for early identification of children at-risk.

Minimizing patient burden in outcome monitoring: The case for abbreviated versions of PHQ-9, GAD-7 and WSAS

BACKGROUND

The Improving Access to Psychological Therapies (IAPT) program uses the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Work and Social Adjustment Scale (WSAS) as part of their unique outcome monitoring system. To reduce patient burden, this study explored whether abbreviated versions of these questionnaires can be used to derive relevant outcome statistics with minimal loss of information.

METHODS

Using two samples (training; n = 1530, validation; n = 766), we examined whether existing short-forms, PHQ-4 and GAD-R3, would provide enough information to calculate relevant outcomes with near perfect agreement with the outcomes based on the original scales. We also examined 1) whether additional items would further improve the agreement between the abbreviated and original scales, and 2) alternative short-forms based on the sample-derived item information curves. The latter was also used to derive an abbreviated version of WSAS.

RESULTS

The abbreviated version derived from the item information curves provided the closest match with the original scales. A 5-item version of PHQ, a 4-item version of GAD, and a 3-item version of WSAS were correlated 0.95 with their original counterpart. Agreement as expressed by Cohen's kappa also suggested near perfect agreement for the outcomes (reliable) recovery rate and reliable improvement rate (>0.80). The outcome point estimates also matched very well (<2 % difference). Results were replicated in the validation sample.

CONCLUSION

The derived abbreviated versions can be used for the purpose of routine outcome monitoring with minimal loss of information and reduce patient burden with nearly 50 %.

Research Review: Help-seeking intentions, behaviors, and barriers in college students - a systematic review and meta-analysis

BACKGROUND

The prevalence of mental health problems among college students has increased over the past decade. Even when mental health services are available, many students still struggle to access these services. This systematic review and meta-analysis aimed to identify the rates at which students actively seek or consider using formal help and to determine the main reasons for not seeking help.

METHODS

A comprehensive literature search was conducted on PubMed, PsycINFO, and Embase to identify studies on help-seeking behaviors, intentions, and barriers to help-seeking among college students with mental health problems. Random effect models were used to calculate the pooled proportions.

RESULTS

Of the 8,919 identified studies, 62 met the inclusion criteria and were included (n = 53 on help-seeking behaviors, n = 21 on help-seeking intentions, and n = 14 on treatment barriers). The pooled prevalence of active help-seeking behaviors was 28% (179,915/435,768 individuals; 95% CI: 23%-33%, I2 = 99.6%), and the aggregated prevalence of help-seeking intentions was 41% (62,456/80161 individuals; 95% CI: 26%-58%, I2 = 99.8%). Common barriers reported by students included a preference to address issues on their own, time constraints, insufficient knowledge of accessible resources, and a perceived lack of need for professional help.

CONCLUSIONS

The findings highlight the gap between the mental health needs of the students and their actual help-seeking rates. Although personal barriers are common, systemic or contextual challenges also affect college students' help-seeking behaviors.

Health behaviour interventions to improve mental health outcomes for students in the university setting: a systematic review of randomised controlled trials

BACKGROUND

University students incur significantly elevated levels of stress compared to the general population and their non-student counterparts. Health risk behaviours are important modifiable determinants for the onset and aggravation of various mental health disorders, in which, university students generally exhibit poor engagement. Thus, this study aims to determine the efficacy of health behaviour interventions in relation to change in health behaviour and mental health outcomes, the impact of interventions (i.e., penetration, fidelity, and implementation), intervention characteristics associated with improved outcomes (efficacy) and the economic evaluation of interventions.

METHODS

Six electronic databases were searched for randomised controlled trials (RCT) published from the 1st January 2012 to 11th July 2023. Eligible RCTs included university students, evaluated behavioural interventions targeting health behaviours (i.e. dietary intake, physical activity, sedentary behaviour, alcohol use, substance use, smoking, and sleep) and reported a change in both health behaviour and mental health outcomes.

RESULTS

Twenty-two RCTs met the study inclusion criteria. Overall, only seven studies were effective in improving both health behaviour and mental health outcomes, with most (n = 4) focused on improving sleep behaviours. Insufficient evidence was found regarding intervention impact, intervention characteristics associated with improved outcomes and the economic evaluation of interventions to guide future implementation of health behaviour interventions in universities due to inadequate reporting of outcomes.

CONCLUSIONS

There is limited evidence regarding the efficacy of health behaviour interventions in improving both health behaviour and mental health outcomes. There is also insufficient evidence regarding intervention impact, intervention characteristics associated with improved outcomes and economic evaluation to guide the implementation of these interventions in the university setting.

Universal, School-Based Mental Health Literacy Programs for Middle School Students: A Scoping Review

BACKGROUND

Universal, classroom-based mental health literacy (MHL) curricula are associated with improved mental health knowledge, attitudes, and help-seeking behaviors. Young adolescents are an ideal target given their need for and receptivity toward MHL education.

METHODS

We conducted a scoping review to identify universal, school-based MHL programs primarily for students aged 10-14 years, with adequate descriptions of curriculum implementation and content, and measured outcomes.

FINDINGS

Thirty-one articles describing 24 programs met the inclusion criteria. The content and educational strategies varied, with no two programs having the same curriculum. The studies show promising results for improvement in mental health knowledge, attitudes, help-seeking, and student mental health.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Collaborative work between educational and mental health professionals, along with rigorous study of outcomes, aiming to reach a consensus on a core MHL curriculum and best implementation practices, will advance efforts to improve MHL.

CONCLUSIONS

This scoping review confirmed that existing universal, school-based MHL programs for middle school-aged students improve mental health knowledge. The programs are diverse, and their outcomes are often challenging to compare. Ongoing study in this field to optimize design and implementation for improved effectiveness is needed.

Digital Mental Health Interventions for University Students With Mental Health Difficulties: A Systematic Review and Meta-Analysis

BACKGROUND

While third-level educational institutions have long provided counselling, a sharp rise in demand has led to limited access to mental health supports for many students, including those with ongoing difficulties. Digital mental health interventions represent one response to this unmet need, given the potential low cost and scalability associated with no-to-low human resources involved.

OBJECTIVE

The aim of this study was to conduct a systematic review and meta-analysis of the literature examining effectiveness of digital mental health interventions for university students with ongoing mental health difficulties.

METHODS

The following databases were searched: PubMed, EBSCOhost (CINHAHL/PsycINFO/PsycArticles) and Web of Science. Two-armed randomised-control trials were included in the meta-analysis. A random-effects meta-analysis was conducted and standardised mean differences were calculated. Effect sizes were then compared in terms of therapeutic approach, and whether interventions were fully automated or guided interventions. This study was registered with PROSPERO, CRD42024504265.

RESULTS

Thirty four eligible studies were included in this narrative synthesis, of which 21 randomised-controlled trials were included in the meta-analysis. Random-effects meta-analysis indicated an overall medium effect size in favour of digital interventions for both depression (Cohen's d = 0.55), and anxiety (Cohen's d = 0. 46). Of note, for anxiety outcomes, fully automated interventions appeared more effective (d = 0.55) than guided interventions (d = 0.35).

CONCLUSIONS

Digital mental health interventions are associated with beneficial effects for college students when measured in terms of anxiety and depression symptom severity. For anxiety, fully automated interventions may be more effective than guided interventions to reduce symptom severity.

Dark brain energy: Toward an integrative model of spontaneous slow oscillations

Neural oscillations facilitate the functioning of the human brain in spatial and temporal dimensions at various frequencies. These oscillations feature a universal frequency architecture that is governed by brain anatomy, ensuring frequency specificity remains invariant across different measurement techniques. Initial magnetic resonance imaging (MRI) methodology constrained functional MRI (fMRI) investigations to a singular frequency range, thereby neglecting the frequency characteristics inherent in blood oxygen level-dependent oscillations. With advancements in MRI technology, it has become feasible to decode intricate brain activities via multi-band frequency analysis (MBFA). During the past decade, the utilization of MBFA in fMRI studies has surged, unveiling frequency-dependent characteristics of spontaneous slow oscillations (SSOs) believed to base dark energy in the brain. There remains a dearth of conclusive insights and hypotheses pertaining to the properties and functionalities of SSOs in distinct bands. We surveyed the SSO MBFA studies during the past 15 years to delineate the attributes of SSOs and enlighten their correlated functions. We further proposed a model to elucidate the hierarchical organization of multi-band SSOs by integrating their function, aimed at bridging theoretical gaps and guiding future MBFA research endeavors.

"I Felt Like There Was Something Wrong in My Brain": Growing Up with Trauma - How Young People Conceptualise, Self-Manage and Seek Help for Mental Health Problems

Background

Youth mental health is an important global healthcare topic and early interventions that are timely and evidence-based to support young people can increase quality of life and lower deaths by suicide. Research exploring young people's mental health experiences and how they manage can further understanding into help-seeking processes.

Objective

This study aimed to explore young people's experiences of living with and managing mental health problems and how this impacts professional help-seeking.

Methods

Eighteen young people were recruited, aged 16-25 years, with experiences of help-seeking to services for mental health problems (N = 18). Data were analysed using Constructivist Grounded Theory methods (Charmaz, Constructing grounded theory, 2014).

Findings

The findings were presented across three sub-categories: (1) "Early experiences"; (2) "Conceptualising mental health" and (3) "Managing mental health". Findings expand understanding on the resource pressures that young people experience whilst managing persistent mental distress emanating from early experiences of trauma, life stressors, and developmental tasks. Findings also report lived experiences of pain, loneliness and stigma, and how individual conceptualisations of mental health are informed. The preference for self-reliance can be rooted in developmental needs or learned behaviours and how this impacts self-management and help seeking is discussed.

Conclusion

Through an enhanced understanding about how young people experience mental distress, developmental pressure points, marginalisation and stigma, mental health providers can prioritise individualised approaches to healthcare that can both respect a young person's individual conceptualizations and positively leverage self-management strategies, which can contribute positively to young people's development, quality of life, and healthcare outcomes.

Student mental health during Summer 2022 research experiences for undergraduates (REUs): Mentorship, remote engagement, and COVID-19

Objective: We examined how mentorship, remote participation, and COVID-19 challenges were associated with the mental health of college students participating in summer research programs. Participants: Participants were students participating in 78 National Science Foundation (NSF) Research Experiences for Undergraduate (REU) Sites during Summer 2022 (n = 516 students). Methods: We used multivariable generalized estimating equations that account for clustering by REU Site. Results: Students with more competent mentors had reduced depression severity. Students who spent ≥25% of their time doing remote research or ≥25% of their time in remote meetings and workshops had greater depression severity. Remote research was also associated with anxiety severity. Having a COVID-19 challenge that impacted students' research experience was associated with increases in depression and anxiety severity. Conclusions: Results suggest potential interventions: implement strategies to boost mentor competency and scaffold a support system into summer research programs to enhance student wellbeing. Additional research on remote engagement is needed.

Loneliness trajectories and psychological distress in youth: Longitudinal evidence from a population-based sample

This pre-registered secondary analysis aimed to examine distinct longitudinal loneliness trajectories in youth and whether these trajectories were associated with psychological distress at final follow-up in the UK Household Longitudinal Study. Participants (N = 827, 55.1% female, Time 1: M ± SD = 16.50 ± 0.50 years) provided data during Waves 9, 10 and 11. K-means longitudinal clustering analysis was used to identify clusters of participants with distinct loneliness trajectories across measurement waves. We identified four clusters demonstrating distinct trajectories of loneliness: stable low (40.7%), stable high (20.6%), moderate decreasing (19.6%) and low increasing (19.1%). Compared to 'stable low loneliness', 'stable high' and 'low increasing' loneliness clusters were significantly associated with psychological distress at Wave 11 following adjustment for sex, ethnicity, parent's highest educational achievement and Wave 9 psychological distress. The current study offers an important contribution to the literature on patterns of youth loneliness and mental health consequences.

Association Between Intellectual Disability and Hair Cortisol Concentration in Adolescents in a Brazilian Population-Based Birth Cohort

OBJECTIVE

Children with intellectual disability (ID) usually exhibit neuroendocrine functioning impairment, such as alterations in the hypothalamic-pituitary-adrenal (HPA) neuroendocrine axis, which can result in glucocorticoid cortisol release alterations. Indeed, many studies showed a positive association between ID and cortisol concentration. However, evidence is lacking on the relationship between child neurodevelopment and cortisol levels during adolescence in population-based studies. We aimed to test the association between ID and hair cortisol concentration (HCC) during adolescence in a prospective population-based cohort.

METHODS

Data from 1770 individuals in the 2004 Pelotas Birth Cohort were used. ID was diagnosed at age 6 through clinical examination. Hair cortisol was measured at age 15. Association was assessed using linear regression models adjusted for sex, socio-economic factors, hair-related variables and corticosteroid use.

RESULTS

Higher HCC were observed in individuals with ID (β: 1.120; 95% CI: 1.012, 1.241) in the analysis adjusted for sex, hair-related variables and corticosteroid use. Compared to the other aetiological groups, this was more evident in idiopathic ID. But this did not remain significant when demographics/socio-economic variables were controlled for.

CONCLUSION

Children with ID, particularly those with idiopathic ID, might exhibit dysfunction in the HPA axis or experience heightened stress levels during adolescence.

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.

Content Specificity of Interpretation Bias Related to Social and Emotional Loneliness in Emerging Adulthood

According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB. Sample 1 included an unselected university sample (N = 138, 81.9% female, M = 20.8 years, SD = 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels (N = 315, 69.5% female, M = 23.8 years, SD = 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB. The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness. Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

A scoping review of digital interventions for the promotion of mental health and prevention of mental health conditions for young people

Digital mental health (DMH) interventions leveraging digital technologies, such as mobile applications, web-based platforms, artificial intelligence and wearable devices, have emerged as a promising avenue for addressing the mental health needs of young people. This scoping review examines the landscape of primary and secondary preventive DMH interventions for young people aged 10-24 years. Six electronic databases were searched, leading to a final incorporation of 81 studies published between 2010 and 2022. Each of these studies corresponds to a unique DMH intervention. Our findings reveal that research activity in the area of promotive and preventive DMH interventions started gaining ground from 2019 onwards, with the majority of studies conducted in Australia and the USA. 70% of the total studies targeted the prevention of mental health conditions. Randomized controlled trials were the predominant study methodology, while mental well-being, depressive disorders, anxiety disorders, life skills and disorders specifically associated with stress were the most targeted mental health or well-being conditions. Finally, mobile applications and web interfaces were the most studied form of DMH interventions. Most of these applications have integrated advanced AI/ML algorithms to serve the purpose of personalization and real-time monitoring. However, there is a marked need for more emphasis on preventive and, especially, promotive mental health measures, as well as the active inclusion of low- and middle-income countries in future research.

Childhood allergy and anxiety/depression in early adulthood: A longitudinal study in the ALSPAC birth cohort

BACKGROUND

Allergic disease and common mental disorders frequently co-occur. However, little is known about the longitudinal impact of childhood allergy on the subsequent risk of developing anxiety or depression, and the possible biological mechanisms for this.

METHODS

We performed longitudinal analyses of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. The baseline sample comprised n = 5256 children with allergy data available at age 7yrs. We used multivariable regression to test associations between childhood allergy at age 7yrs and: a) four inflammatory markers at age 9yrs; b) depression and anxiety measures between ages 10-24yrs. Allergy measures included biological markers (total serum immunoglobulin E (tIgE), number of positive skin prick tests (SPTs)), and presence of eczema, asthma and/or food allergy (mother reported). Inflammatory markers were interleukin-6 (IL-6), C-reactive protein (CRP), IL-4 and IL-13. We used structural equation modelling to test whether inflammatory markers mediated the association between tIgE and depression/anxiety.

RESULTS

tIgE and having ≥ 1 positive SPT at age 7 were associated with IL-6 levels at age 9 (adjusted β = 0.09; 95 % CI 0.06-0.13; p < 0.001 and adjusted β = 0.06; 95 % CI 0.03-0.09; p < 0.001 respectively), but not with CRP, IL-4 or IL13 levels. We found no strong evidence of an association between childhood allergy and subsequent depression/anxiety during adolescence and early adulthood. This finding was consistent across biological and mother-reported allergy measures.

CONCLUSIONS

Biological markers of childhood allergy are associated with IL-6, a key inflammatory cytokine. However, childhood allergy may not have a large long-term effect on subsequent depression/anxiety.

Loneliness is associated with eating disorders among a national sample of U.S. college students during the COVID-19 pandemic

OBJECTIVE

To identify the association between loneliness and eating disorder symptomatology among a national sample of U.S. college students during COVID-19.

PARTICIPANTS

Cross-sectional data from the 2020-2021 Healthy Minds Study (N = 96,645) were analyzed.

METHODS

Loneliness was measured using the UCLA 3-item Loneliness Scale and eating disorder symptomology was measured using the SCOFF questionnaire. Multiple modified Poisson regression analyses were conducted, adjusting for confounding variables.

RESULTS

Greater loneliness was associated with both a positive eating disorder screen (risk ratio [RR] 1.09, 95% confidence interval [CI] 1.09-1.10) and greater number of eating disorder symptoms (RR 1.07, 95% CI 1.06-1.08). Gender modified this relationship, and men who endorsed greater loneliness had higher risk of eating disorder symptomatology compared to women.

CONCLUSIONS

Loneliness during the COVID-19 pandemic was associated with a greater risk of eating disorder symptomatology among college students. Findings underscore the need for social support and eating disorders programming on college campuses.

Neuroticism and extraversion as predictors of first-lifetime onsets of depression, anxiety, and suicidality in high-risk adolescents

There is substantial evidence that personality traits, in particular neuroticism and extraversions predict depressive and anxiety episodes as well as suicidal ideation. However, little research has examined whether these traits predict the first onset of depressive and anxiety disorders and suicidal ideation. Moreover, the few studies to date have not adjusted for pre-existing subthreshold symptoms, assessed dimensionally. In this study, 144 adolescents were assessed at baseline, 9-, and 18-month follow-ups. Neuroticism and extraversion were assessed via self-report, and depressive and anxiety disorders and suicidal ideation were assessed with diagnostic interviews. Adjusting for age, sex, and baseline symptoms, logistic regression analyses showed that neuroticism predicted the first onset of depressive disorders. However, neither neuroticism nor extraversion predicted first onsets of anxiety disorders, extraversion did not predict depressive disorders, and neither trait predicted suicidal ideation onset or severity after adjusting for baseline symptoms. Neuroticism and extraversion may respectively predispose youth to depressive or anxiety disorders but not to suicidal ideation over and above pre-existing symptoms. Results have implications for the early identification of at-risk youth and prevention of depressive and anxiety disorders and suicidal ideation.

Cognitive Remediation for Adolescents With Mental Health Disorders: A Systematic Review and Meta-Analysis

INTRODUCTION

The effects of cognitive remediation therapy (CRT) in adults with mental health disorders have been widely documented, but its effects in adolescents with mental health disorders remain poorly understood. This review aims to (1) determine the effects of CRT on cognition, symptoms and functioning for adolescents with mental health disorders and (2) evaluate the methodological quality of studies on CRT.

METHODS

A systematic review and meta-analysis were conducted of randomised controlled trials of CRT involving adolescents with mental health disorders. Searches were conducted in databases for studies pertaining to CRT effects on cognition, social functioning and clinical symptoms. Methodological quality was assessed using the Clinical Trials Assessment Measure.

RESULTS

Fourteen studies (N = 14) were included, with 11 independent samples (k = 11, 592 participants). Participants had various mental health disorders. CRT showed a small significant effect on cognition (g = 0.14, p = 0.02), particularly on processing speed, working memory and episodic memory. No significant effects were found for clinical symptoms (g = 0.04, p = 0.58) and social functioning (g = 0.06, p = 0.39). Methodological quality of included studies was variable, ranging from poor to good quality.

CONCLUSION

Included studies showed a small significant effect of CRT on cognition, and non-significant effects on clinical symptoms and social functioning in adolescents with mental health disorders. The lack of effects may be partly explained by limitations in the methodology of included studies. A critical analysis of current studies is presented and recommendations of core techniques to consider for future CRT studies are discussed.

Mental Health Experiences Among Undergraduate Nursing Students in a New Zealand Tertiary Institution: A Time for Change

Nursing students in undergraduate programmes exhibit comparable, sometimes higher, levels of poor mental health and substance use compared to the general population; however, this area remains under-researched in New Zealand. The study involved 172 nursing students enrolled in the Bachelor of Nursing programme at one tertiary institution in Auckland, New Zealand. Employing a mixed-methodology approach, a 29-question survey comprising both open and closed questions was administered to explore the students' experiences with mental health and substance use, as well as their access to support services. Quantitative data were analysed using SPSS version 29 descriptive statistics, while a general inductive approach guided the qualitative analysis. A significant proportion of participants (75%) reported experiencing emotional distress during their studies, with anxiety being the most prevalent (78.5%). A smaller percentage disclosed substance use (8.1%) including excessive alcohol use, cannabis use, nicotine use, vaping cannabis and some refusal to reveal substance use. Surprisingly, less than 1% (n = 0.6) utilised institutional support services. Three qualitative themes were identified including emotional distress and associated effects, emotional and psychological impacts on nursing students' academic journey and tertiary support systems. The findings highlight the urgent need to address the mental health and addiction challenges experienced by nursing students, given their potential adverse effects on academic success and overall well-being. Urgent action is needed to integrate mental health training into the curriculum and provide faculty support. In this study, the underutilisation and inadequacy of institutional support services signal a need for institutional reforms to provide access and personalised mental health support to nursing students. Providing essential skills and support for student success contributes to the overall well-being of the nursing workforce.

Mental Health Interventions in Middle Schools: A 10-Year Review of Research

Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.

Cognitive and psychiatric relevance of dynamic functional connectivity states in a large (N > 10,000) children population

Children's brains dynamically adapt to the stimuli from the internal state and the external environment, allowing for changes in cognitive and mental behavior. In this work, we performed a large-scale analysis of dynamic functional connectivity (DFC) in children aged 9~11 years, investigating how brain dynamics relate to cognitive performance and mental health at an early age. A hybrid independent component analysis framework was applied to the Adolescent Brain Cognitive Development (ABCD) data containing 10,988 children. We combined a sliding-window approach with k-means clustering to identify five brain states with distinct DFC patterns. Interestingly, the occurrence of a strongly connected state with the most within-network synchrony and the anticorrelations between networks, especially between the sensory networks and between the cerebellum and other networks, was negatively correlated with cognitive performance and positively correlated with dimensional psychopathology in children. Meanwhile, opposite relationships were observed for a DFC state showing integration of sensory networks and antagonism between default-mode and sensorimotor networks but weak segregation of the cerebellum. The mediation analysis further showed that attention problems mediated the effect of DFC states on cognitive performance. This investigation unveils the neurological underpinnings of DFC states, which suggests that tracking the transient dynamic connectivity may help to characterize cognitive and mental problems in children and guide people to provide early intervention to buffer adverse influences.

Mediterranean Diet and Mental Health in Children and Adolescents: A Systematic Review

CONTEXT

Childhood and adolescence are periods of critical importance in the development of mental health disorders. The Mediterranean diet (MD) has been linked to multiple positive health outcomes, including reduced incidence of mental health disorders and fewer psychiatric symptoms.

OBJECTIVE

This study aimed to investigate the association between adherence to an MD and mental health outcomes in children and adolescents.

METHODS

A systematic literature review was conducted of original research that explored the relationship between psychiatric symptoms or disorders and adherence to an MD. The literature search was conducted on PubMed, Scopus, Web of Science, MEDES, Dialnet, and Latindex from inception to November 2022, and the Newcastle-Ottawa Scale was used to evaluate the quality of studies.

RESULTS

A total of 13 studies (6 cross-sectional, 4 case-control, 2 randomized clinical trials, and 1 longitudinal cohort) out of 450 met the inclusion criteria. A total of 3058 children or adolescents with a mean age range from 8.6 to 16.2 years were included. Among the reviewed studies, 5 (71.42%) of those looking at attention-deficit/hyperactivity disorder, 4 (80%) examining depression, and 2 (50%) assessing anxiety found a significant protective association. Seven articles (53.84%) were found to be of high quality and 6 (46.15%) of moderate quality.

CONCLUSION

Adherence to an MD could be a protective factor for mental health in child and adolescent populations. This suggests that promoting an MD could help prevent the onset of clinical psychiatric symptoms, reduce symptom severity, and improve prognosis in young patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021276316.

An Argument for More High-Quality Research Focused on Mental Health in the Post-Secondary Context

We argue that while a substantial proportion of emerging adults are in post-secondary education, there is relatively little consideration of this context within research and policy around youth mental health. The unique challenges young adults face in post-secondary education overlay underlying risk factors experienced by emerging adults. While post-secondary education facilitates social mobility, it also introduces stressors such as academic demands, financial insecurity and social isolation. As we increasingly appreciate the social determinants of mental health and the influence of institutional systems, understanding the post-secondary context offers promise in transforming mental health in emerging adulthood. There are pockets of great practice. However, we argue that targeted efforts are now needed to bring together students, practitioners, policymakers and researchers to drive evidence-informed improvements in mental health within the post-secondary context.

Behavioural interventions targeting the prevention and treatment of young children's mental health problems in low- and middle-income countries: a scoping review

Background

Globally, 10% of children and adolescents live with mental health problems and often lack high-quality care. Over 80% of people facing mental health issues reside in low- and middle-income countries (LMICs). Failing to address children's mental health may prolong these challenges into adulthood, impeding their chances for a healthy life. This scoping review aims to describe the types, implementation strategies, effectiveness, and gaps of existing interventions for preventing and treating mental health problems in early childhood (<10 years) in LMICs.

Methods

The study employed a scoping review of experimental studies published 2007-2023. Major databases including PubMed, Embase, Web of Science, and PsycINFO were searched using key terms related to the population (children), intervention (mental and/or behavioural health programmes), and outcome (mental health problems). Three authors independently conducted search strategy, article screening, data extraction, and quality assessment. The findings were presented using descriptive analysis and narrative synthesis.

Results

Of 39 499 identified articles, 33 were included in the study, covering 7629 children and published between 2009-2022. Seventeen studies (51.5%) were from upper-middle-income countries, 13 (39.4%) were from lower-middle-income, and three (9.1%) were from low-income countries. Enrolment was community-based in 23 studies and health-facility based in 10 studies; the majority (79%) focused on children aged 3-8 years old. Almost two-third (63.6%) of studies were conducted in urban settings. Programmes encompassed various interventions such as parenting programmes (33.3%). A majority of studies (57.5%) employed group therapy for delivering the programme, with mental health professionals (21.2%) acting as the primary intervention providers. Interventions were primarily received by children (39.4%), followed by mothers/caregivers (33.3%). Most studies explored disruptive disorders (20 studies), social and behavioural problems (16 studies), and anxiety disorders (12 studies). Statistically significant intervention effects on child mental health outcomes were reported for 90% of published studies.

Conclusions

Diverse behavioural programmes that improve the mental health of young children are available and effective in LMICs. Most interventions were delivered in urban settings and focus was on the use of health care professionals. Diverse intervention approaches, including parenting programmes and group therapy, were effective in addressing various mental health issues among young children.