Validation of the Hospital Anxiety and Depression Scale for use with adolescents

The effectiveness of targeted preventive interventions for depression symptoms in children and adolescents: Systematic review and meta-analyses

BACKGROUND

Targeted interventions are needed to prevent depression in at-risk children and adolescents. Children and adolescents are commonly at risk of depression due to subsyndromal depressive symptoms or problems in their social environment.

METHODS

This review was conducted according to the Cochrane guidelines (2023) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was done in December 2023 using three electronic databases and a manual search. The methodological quality of all eligible studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias.

RESULTS

This review includes 77 intervention studies of which 13 are follow-ups. Of the 64 identified main studies (n = 11,808), 19 were selective interventions targeting the problems in a social environment. Of the participants 63.6 % were girls and the mean age ranged between 9 and 17. Most of the studies were conducted in a Western school setting using psychological interventions, with the majority being CBT (cognitive behavioral therapy) based programs. Targeted interventions reduced the symptoms of depression statistically significantly at postintervention (SMD 0.27, 95 % confidence interval 0.16-0.37) and 6-month follow-up (SMD 0.32, 0.18-0.45) compared to any comparator. Intervention effects were not statistically significant at the 12-month follow-up.

CONCLUSION

Indicated and selective interventions targeted to children and adolescents at risk of depression due to their social environment have a small effect on depressive symptoms. Interventions should be delivered by mental health experts.

Protocol for a feasibility and acceptability study for UK general population paediatric type 1 diabetes screening-the EarLy Surveillance for Autoimmune diabetes (ELSA) study

AIM

The EarLy Surveillance for Autoimmune (ELSA) study aims to explore the feasibility and acceptability of UK paediatric general population screening for type 1 diabetes.

METHODS

We aim to screen 20,000 children aged 3-13 years for islet-specific autoantibodies through dried blood spot sample collection at home, hospital or community settings. Children with two or more autoantibodies are offered metabolic staging via oral glucose challenge testing. Feasibility assessments will compare recruitment modalities and uptake according to demographic factors (age, gender, ethnicity, level of deprivation and family history of diabetes) to determine optimal approaches for general population screening. The study is powered to identify 60 children (0.3%) with type 1 diabetes (stage 1-3). Parents are invited to qualitative interviews following ELSA completion (child screened negative or positive, single autoantibody or multiple, stage 1-3) to share their screening experience, strengths of the programme and any areas for improvement (acceptability assessments). Parents who decline screening or withdraw from participation are invited to interview to explore any concerns. Finally, we will interview professional stakeholders delivering the ELSA study to explore barriers and facilitators to implementation.

CONCLUSION

Early detection of type 1 diabetes allows insulin treatment to be started sooner, avoids diagnosis as an emergency, gives families time to prepare and the opportunity to benefit from future prevention trials and treatments. ELSA will provide essential feasibility and acceptability assessments for UK general population screening to inform a future national screening programme for paediatric type 1 diabetes.

Suicide risk, mentalizing and emotion regulation in adolescents: The role of maternal maladaptive emotion regulation

OBJECTIVE

While a substantial body of research has demonstrated associations between family factors and adolescent suicide risk, little is known about whether maternal mentalizing and emotion regulation play a role in adolescent suicide risk. The objective of this study was to test whether maternal mentalizing and maternal emotion regulation strategies are related to adolescent suicide risk through adolescents' mentalizing ability and emotion regulation strategies.

METHOD

A total of 130 adolescents and young adults (63.6 % female; aged 15-23 years) and their mothers completed a series of self-report questionnaires assessing their suicide risk, anxiety and depression, mentalizing difficulties and cognitive emotion regulation strategies.

RESULTS

Structural equation modeling revealed significant indirect effects between adolescent mentalizing and adolescent suicide risk through adolescent adaptive and maladaptive emotion regulation. The results also showed a moderating effect of adolescent anxiety and depression on the relationships between adaptive emotion regulation strategies and suicide risk in adolescents and young adults. Importantly, maternal maladaptive emotion regulation strategies (i.e., self-blame and catastrophizing) have significant effects on suicidal risk through mentalizing difficulties and adaptive and maladaptive emotion regulation strategies in adolescents and young adults.

CONCLUSIONS

Our findings provide preliminary support for the specific roles of maternal emotion regulation strategies by demonstrating that a higher use of maternal maladaptive emotion regulation strategies are associated with less adolescent mentalizing, which in turn contributes to a higher use of maladaptive strategies and a lower use of adaptive strategies among adolescents, thus increasing the risk of suicide in adolescence and young adulthood.

The Relationship Between Digital Game Addiction and Levels of Anxiety and Depression in Adolescents Receiving Cancer Treatment

BACKGROUND

Adolescents diagnosed with cancer are vulnerable to symptoms of anxiety, depression, and posttraumatic stress.

OBJECTIVE

To examine the relationship between digital game addiction and levels of anxiety and depression in adolescents receiving cancer treatment.

METHODS

This analytical cross-sectional study was carried out with 120 adolescents aged 12-17 years who were receiving cancer treatment. Data were collected using the Digital Game Addiction Scale (DGAS-7) and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using independent-samples t test, 1-way analysis of variance, Pearson correlation analysis, and simple linear regression.

RESULTS

The mean age of the adolescents participating in the study was 15.21 ± 1.64 years. The mean DGAS-7 score was 15.19 ± 5.58, whereas the mean HADS Anxiety subscale score was 8.54 ± 4.33, and the mean HADS Depression subscale score was 7.72 ± 3.96. A positive, statistically significant relationship was found between the DGAS-7 mean score and the HADS Anxiety and Depression subscale mean scores ( P < .001).

CONCLUSIONS

As the addiction levels increased in adolescents diagnosed with cancer, their anxiety and depression levels also increased.

IMPLICATIONS FOR PRACTICE

Health professionals should be mindful that in adolescents diagnosed and treated for cancer, digital game addiction and levels of anxiety and depression may mutually reinforce each other.

Serial Paediatrics Omics Tracking in Myalgic Encephalomyelitis (SPOT-ME): protocol paper for a multidisciplinary, observational study of clinical and biological markers of paediatric myalgic encephalomyelitis/chronic fatigue syndrome in Australian adolescents aged 12-19 years

INTRODUCTION

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling condition that can affect adolescents during a vulnerable period of development. The underlying biological mechanisms for ME/CFS remain unclear and have rarely been investigated in the adolescent population, despite this period representing an age peak in the overall incidence. The primary objective of this is to provide a foundational set of biological data on adolescent ME/CFS patients. Data generated will be compared with controls and over several time points within each patient to potentially develop a biomarker signature of the disease, identify subsets or clusters of patients, and to unveil the pathomechanisms of the disease.

METHODS AND ANALYSIS

This protocol paper outlines a comprehensive, multilevel, longitudinal, observational study in paediatric ME/CFS. ME/CFS patients aged 12-19 years and controls will donate biosamples of urine, blood, and peripheral blood mononuclear cells for an in-depth omics profiling analysis (whole-genome sequencing, metabolomics and quantitative proteomics) while being assessed by gold-standard clinical and neuropsychological measures. ME/CFS patients will then be provided with a take-home kit that enables them to collect urine and blood microsamples during an average day and during days when they are experiencing postexertional malaise. The longitudinal repeated-measures study design is optimal for studying heterogeneous chronic diseases like ME/CFS as it can detect subtle changes, control for individual differences, enhance precision and boost statistical power. The outcomes of this research have the potential to identify biomarker signatures, aid in understanding the underlying mechanisms, and ultimately, improve the lives of children with ME/CFS.

ETHICS AND DISSEMINATION

This project was approved by the Royal Children's Hospital's Human Research Ethics Committee (HREC 74175). Findings from this study will be disseminated through peer-reviewed journal publications and presentations at relevant conferences. All participants will be provided with a summary of the study's findings once the project is completed.

Different activation in dorsolateral prefrontal cortex between anxious depression and non-anxious depression during an autobiographical memory task: A fNIRS study

OBJECTIVE

Using functional near-infrared spectroscopy (fNIRS) previous studies have found that activation differences in the dorsolateral prefrontal cortex (DLPFC) during an autobiographical memory task (AMT) under the condition of different emotional valences may be neurophysiological markers of depression and different depression subtypes. Additionally, compared with non-anxious depression, anxious depression presents abnormal hemodynamic activation in the DLPFC. This study aimed to use fNIRS to investigate hemodynamic activation in the DLPFC of depression patients with and without anxiety during AMT triggered by different emotional valence stimuli.

METHODS

We recruited 194 patients with depression (91 with non-anxious depression, 103 with anxious depression) and 110 healthy controls from Chinese college students. A 53-channel fNIRS was used to detect cerebral hemodynamic differences in the three groups during AMT.

RESULTS

The results showed that: (1) the activation of oxy-Hb in the left DLPFC was significantly higher under positive emotional valence than under negative emotional valence for healthy controls and patients with non-anxious depression, while there was no significant difference between positive and negative emotional valence observed in response to anxious depression; and (2) Oxy-Hb activation under negative emotional valence was significantly higher in the anxious depression group than in the non-anxious depression group.

CONCLUSIONS

This study revealed that the hemodynamic hyperactivation of negative emotional valence in the left DLPFC may be due to the neurophysiological differences between anxious and non-anxious patients with depression.

Anxiety symptoms without depression are associated with cognitive control network (CNN) dysfunction: An fNIRS study

Anxiety is a common psychological disorder associated with other mental disorders, with depression being the most common comorbidity. Few studies have examined the neural mechanisms underlying anxiety after controlling for depression. This study aimed to explore whether there are differences in cortical activation in anxiety patients with different severities whose depression are normal. In the current study, depression levels were normal for 366 subjects-139 healthy subjects, 117 with mild anxiety, and 110 with major anxiety. Using the Hospital Anxiety and Depression Scale (HADS) and a verbal fluency task (VFT) to test subjects' anxiety and depression and cognitive function, respectively. A 53-channel guided near-infrared spectroscopic imaging technology (fNIRS) detected the concentration of oxyhemoglobin (oxy-Hb). Correlation analysis between anxiety severity and oxy-Hb concentration in the brain cortex was performed, as well as ANOVA analysis of oxy-Hb concentration among the three anxiety severity groups. The results showed that anxiety severity was significantly and negatively correlated with oxy-Hb concentrations in the left frontal eye field (lFEF) and in the right dorsolateral prefrontal area (rDLPFC). The oxy-Hb concentration in the lFEF and the rDLPFC were significantly lower in the major anxiety disorder group than that in the control group. This suggests that decreased cortical activity of the lFEF and rDLPFC may be neural markers of anxiety symptoms after controlling for depression. Anxiety symptoms without depression may be result from the dysfunction of the cognitive control network (CCN) which includes the lFEF and rDLPFC.

Transition readiness assessment in Portuguese adolescents and young adults with pediatric-onset rheumatic diseases: a single-center study

OBJECTIVE

In this study, we aimed to assess the transition readiness levels amongst patients with childhood-onset rheumatic diseases. Additionally, we sought to identify and analyze predictive factors associated with better transition readiness skills in adolescent and young adult (AYAs) patients.

METHODS

This is a monocentric cross-sectional study that includes patients between 14 and 26 years of age who attended outpatient pediatric and young adult rheumatology appointments between October and December of 2023 and that were diagnosed with an immune-mediated rheumatic disease before reaching 18 years of age, with at least 1 year of disease duration. Patients were presented with a questionnaire that contained demographic and clinical questions, TRACS (Questionário de Preparação da Transição para a Autonomia nos Cuidados de Saúde) questionnaire - a validated Portuguese version of the Transition Readiness Assessment Questionnaire (TRAQ), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Data was analyzed to assess the significant associations between the different variables and transition readiness outcome measured by the TRACS. Descriptive statistics, statistical comparisons and logistic regression analysis were performed.

RESULTS

A total of 69 patients with a median age of 20 [17.5-22.5] were included in this study. The median TRACS score was 4.41 [4.09-4.74]. Significantly higher TRACS scores were observed in patients who were female, 18 years of age or older, had a higher level of education, were employed, had active disease or that belonged to middle-class (when compared to patients belonging to upper- middle class). The logistic regression analysis demonstrated that being a female or having an educational status equal to 12th grade or superior emerged as predictors of higher transition readiness levels.

CONCLUSIONS

Our study identified female sex and higher level of education as predictors of increased transition readiness levels. Therefore, healthcare providers should consider these variables when assessing patients for transition readiness and focus on improving transition process, especially in male and less educated AYAs.

Association of parent-child health parameters and lifestyle habits - the "epi-family health" longitudinal study protocol

BACKGROUND

Lifestyle and habits, cardiovascular risk factors (CRF), bone and mental health, dietary habits, physical activity, among others are developed in childhood and adolescence. Family environment has shown to play an important role in these outcomes. However, whether the parent-child relationship lifestyle habits and health parameters can be influenced by physical activity patterns still unclear. The objective of this study will be to monitor and investigate the associations between lifestyle habits between parents and their children longitudinally, as well as verify whether in more active parents, the possible associations with lifestyle habits are different from those of parents considered less active.

METHODS

The sample will consist of parents (father, mother, or both) and their children /adolescents. The participants will be recruited through public call by flyers spread across all the regions of the city and also through social media. The health parameters will include cardiovascular (cardiac autonomic modulation, blood pressure and resting heart rate), bone mineral density, anthropometric indices, handgrip strength, mental health (quality of life, anxiety and depression symptoms and stress), self-reported morbidities and musculoskeletal pain. Lifestyle habits will include physical activity levels, sedentary behavior, sleep parameters, eating patterns, smoking and alcohol consumption. Sociodemographic variables of age, sex, ethnicity and socioeconomic status will be considered as covariates. The follow-up visits of data collection will be scheduled after a period of 12 months from the baseline assessment during every twelve months.

DISCUSSION

The family environment has great potential to determine lifestyle habits in children and adolescents. Based on the results presented in the present study, we hope that health promotion actions can be better designed in the family environment.

Dose‒Response Effects of Patient Engagement on Anxiety and Depression in a Cognitive-Behavioral Intervention: Secondary Analysis of a Pilot Randomized Controlled Trial and a Clinical Controlled Trial

Understanding the dose‒response relationship between patient engagement in cognitive behavioral therapy (CBT) and health outcomes is critical for developing and implementing effective CBT programs. In studies of CBT interventions, patient engagement is measured only at a single time point, and outcomes are typically assessed before and after the intervention. Examination of the dose‒response relationship between patient engagement in CBT and outcomes is limited. It is unclear whether a dose‒response relationship exists between patient engagement in on-site CBT intervention and anxiety and depression in people living with HIV (PLWH). If present, does this dose‒response relationship occur early or later in the intervention? This study aimed to address this gap by examining the dose‒response relationships between patient engagement and anxiety and depression in CBT interventions among PLWH. Utilizing data from a pilot randomized trial (10 participants) and a clinical controlled trial (70 participants), our secondary analysis spans baseline, 3-month, and 6-month assessments. Both trials implemented the nurse-led CBT intervention. Cluster analysis identified two groups based on on-site attendance and WeChat activity. Patients with good adherence (6-10 times) of on-site attendance exhibited significantly lower anxiety and depression scores at 3 months (β = 1.220, P = 0.047; β = 1.270, P = 0.019), with no significant differences observed at 6 months. WeChat activity did not significantly influence anxiety or depression scores. The findings highlight a significant short-term dose‒response relationship, endorsing nurse-led CBT interventions for mental health in PLWH. Organizational strategies should focus on incentivizing and facilitating patient engagement, particularly through enhancing WeChat features.

Distinguishing Clinical From Statistical Significances in Contemporary Comparative Effectiveness Research

OBJECTIVE

To determine the prevalence of clinical significance reporting in contemporary comparative effectiveness research (CER).

BACKGROUND

In CER, a statistically significant difference between study groups may or may not be clinically significant. Misinterpreting statistically significant results could lead to inappropriate recommendations that increase health care costs and treatment toxicity.

METHODS

CER studies from 2022 issues of the Annals of Surgery , Journal of the American Medical Association , Journal of Clinical Oncology , Journal of Surgical Research , and Journal of the American College of Surgeons were systematically reviewed by 2 different investigators. The primary outcome of interest was whether the authors specified what they considered to be a clinically significant difference in the "Methods."

RESULTS

Of 307 reviewed studies, 162 were clinical trials and 145 were observational studies. Authors specified what they considered to be a clinically significant difference in 26 studies (8.5%). Clinical significance was defined using clinically validated standards in 25 studies and subjectively in 1 study. Seven studies (2.3%) recommended a change in clinical decision-making, all with primary outcomes achieving statistical significance. Five (71.4%) of these studies did not have clinical significance defined in their methods. In randomized controlled trials with statistically significant results, sample size was inversely correlated with effect size ( r = -0.30, P = 0.038).

CONCLUSIONS

In contemporary CER, most authors do not specify what they consider to be a clinically significant difference in study outcome. Most studies recommending a change in clinical decision-making did so based on statistical significance alone, and clinical significance was usually defined with clinically validated standards.

The state of art on the use of patient reported outcomes in migraine

PURPOSE OF REVIEW

This review aims to explore the use of patient-reported outcome measures (PROMs) in migraine. Traditionally assessed through specific features, recent adoption of PROMs allows for a more objective and quantifiable evaluation. PROMs, which are standardized questionnaires collecting health information directly from a patients' perspective, cover various aspects, including migraine specific aspects. The review focuses on delineating the applications and interpretation of commonly used PROMs in migraine research, with an emphasis on their integration in clinical care.

RECENT FINDINGS

Generic and migraine-specific PROMs play a crucial role in clinical research, particularly in assessing health-related quality of life, disability, impact, and associated comorbidities. Some of these measures are strongly recommended to be used by the International Guidelines and are, in fact, mandated by the FDA for product labeling. Recently, there has been an expansion in the use of PROMs to assess migraine in diverse populations, in particular pediatric patients. However, the application of these measures in clinical care shows considerable heterogeneity, and some have not been validated specifically for migraine. The existing multitude of PROMs, coupled with ongoing development of new ones to better capture patient concerns, creates complexity in their research and clinical application. To address these challenges, it becomes imperative to streamline their use, focusing on those that are more validated and better aligned with the patients' perspective including different populations' needs.

SUMMARY

The utilization of PROMs in evaluating migraine enables a more holistic assessment, helps quantify the impact of the disease facilitating change measurement, improves communication between healthcare providers and patients and, guides treatment decisions for improved outcomes. However, the increasing number of PROMs questionnaires, underscores the importance of validating these tools for migraine and, the dynamic nature of the disease makes it relevant to decide with whom, why and when these should be used.

Subtyping at-risk adolescents for predicting response toward insomnia prevention program

BACKGROUND

Previous study has shown that a brief cognitive-behavioral prevention insomnia program could reduce 71% risk of developing insomnia among at-risk adolescents. This study aimed to evaluate the differential response to insomnia prevention in subgroups of at-risk adolescents.

METHODS

Adolescents with a family history of insomnia and subthreshold insomnia symptoms were randomly assigned to a 4-week insomnia prevention program or nonactive control group. Assessments were conducted at baseline, 1 week, and 6- and 12-month after the intervention. Baseline sleep, daytime, and mood profiles were used to determine different subgroups by using latent class analysis (LCA). Analyses were conducted based on the intention-to-treat approach.

RESULTS

LCA identified three subgroups: (a) insomnia symptoms only, (b) insomnia symptoms with daytime sleepiness and mild anxiety, and (c) insomnia symptoms with daytime sleepiness, mild anxiety, and depression. The incidence rate of insomnia disorder over the 12-month follow-up was significantly reduced for adolescents receiving intervention in subgroup 3 compared with the controls (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.13-0.99; p = .049) and marginally for subgroup 2 (HR = 0.14; 95% CI: 0.02-1.08; p = .059). In addition, adolescents who received intervention in subgroups 2 and 3 had a reduced risk of excessive daytime sleepiness (subgroup 2: adjusted OR [AdjOR] = 0.45, 95% CI: 0.23-0.87; subgroup 3: AdjOR = 0.32, 95% CI: 0.13-0.76) and possible anxiety (subgroup 2: AdjOR = 0.47, 95% CI: 0.27-0.82; subgroup 3: AdjOR = 0.33, 95% CI: 0.14-0.78) compared with the controls over the 12-month follow-up.

CONCLUSIONS

Adolescents at risk for insomnia can be classified into different subgroups according to their psychological profiles, which were associated with differential responses to the insomnia prevention program. These findings indicate the need for further phenotyping and subgrouping at-risk adolescents to develop personalized insomnia prevention.

Optimizing Dietary Habits in Adolescents with Polycystic Ovary Syndrome: Personalized Mediterranean Diet Intervention via Clinical Decision Support System-A Randomized Controlled Trial

The hypothesis of this randomized controlled trial was that a clinical decision support system (CDSS) would increase adherence to the Mediterranean diet (MD) among adolescent females with polycystic ovary syndrome (PCOS). The objective was to assess the impact of personalized MD plans delivered via a CDSS on nutritional status and psychological well-being. Forty adolescent females (15-17 years) with PCOS were randomly assigned to the MD group (n = 20) or the Control group (n = 20). The MD group received personalized MD plans every 15 days via a CDSS, while the Control group received general nutritional advice. Assessments were conducted at baseline and after 3 months. Results showed significantly increased MD adherence in the MD group compared to the Control group (p < 0.001). The MD group exhibited lower intakes of energy, total fat, saturated fat, and cholesterol, and higher intakes of monounsaturated fat and fiber (p < 0.05). Serum calcium and vitamin D status (p < 0.05), as well as anxiety (p < 0.05) were improved. In conclusion, tailored dietary interventions based on MD principles, delivered via a CDSS, effectively manage PCOS in adolescent females. These findings highlight the potential benefits of using technology to promote dietary adherence and improve health outcomes in this population. ClinicalTrials.gov registry: NCT06380010.

Psychological distress, wellbeing and resilience: modelling adolescent mental health profiles during the COVID-19 pandemic

There has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13-24 (N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing. Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.

Health-related quality of life of adult and adolescent patients living with alopecia areata in Australia

INTRODUCTION

To understand the experiences of adolescent and adult patients living with alopecia areata (AA) in Australia regarding symptom severity and the impact on psychosocial well-being and work/classroom productivity.

MATERIALS AND METHODS

A cross-sectional online patient survey among adolescent and adult patients diagnosed with AA was recruited via the Australia Alopecia Areata Foundation. Patient-reported outcomes were also assessed.

RESULTS

A total of 337 patients (49 adolescents; 288 adults), with a mean ± standard deviation age of 14.7 ± 1.55 and 38.9 ± 13.31 years for adolescents and adults, respectively, were included. In the group with extensive hair loss (Scalp Hair Assessment Patient-Reported Outcome, categories 3 + 4, n = 172), we observed higher emotional symptom and activity limitation scores (Alopecia Areata Patient Priority Outcomes, emotional symptoms: adults 2.5 ± 1.03, adolescents 2.2 ± 1.15; activity limitations: adults 1.4 ± 1.15, adolescents 1.2 ± 0.99). Additionally, in adults, the Alopecia Areata Symptom Impact Scale global score was 4.0 ± 2.10 (symptoms subscale score 4.1 ± 1.91; interference subscale scores 3.8 ± 2.73). Hospital Anxiety and Depression Scale scores were high across participants, irrespective of hair loss extent (adults: anxiety 9.2 ± 3.85, depression 6.6 ± 3.95; adolescents: anxiety 9.7 ± 4.65, depression 5.2 ± 3.59). Work and classroom productivity were substantially impaired due to AA, with 70.5% of adults and 57.1% of adolescents reporting activity impairment, and overall work/classroom impairment reported at 39.2% and 44.9%, respectively.

CONCLUSIONS

AA impacts the physical, emotional and psychosocial well-being of both adult and adolescent patients. More extensive hair loss more profoundly impacts those living with AA. Patients may benefit from patient-centred care approaches addressing the impact of hair loss on mental and emotional well-being, daily activities and work productivity.

Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome/myalgic encephalomyelitis: pragmatic randomized controlled trial

The MAGENTA pragmatic parallel groups randomized controlled trial compared graded exercise therapy (GET) with activity management (AM) in treating paediatric myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Children aged 8-17 years with mild/moderate ME/CFS and presenting to NHS specialist paediatric services were allocated at random to either individualised flexible treatment focussing on physical activity (GET, 123 participants) or on managing cognitive, school and social activity (AM, 118 participants) delivered by NHS therapists. The primary outcome was the self-reported short-form 36 physical function subscale (SF-36-PFS) after 6 months, with higher scores indicating better functioning. After 6 months, data were available for 201 (83%) participants who received a mean of 3.9 (GET) or 4.6 (AM) treatment sessions. Comparing participants with measured outcomes in their allocated groups, the mean SF-36-PFS score changed from 54.8 (standard deviation 23.7) to 55.7 (23.3) for GET and from 55.5 (23.1) to 57.7 (26.0) for AM giving an adjusted difference in means of -2.02 (95% confidence interval -7.75, 2.70). One hundred thirty-five participants completed the mean SF-36-PFS at 12 months, and whilst further improvement was observed, the difference between the study groups remained consistent with chance. The two study groups showed similar changes on most of the secondary outcome measures: Chalder Fatigue, Hospital Anxiety and Depression Scale: Depression, proportion of full-time school attended, a visual analogue pain scale, participant-rated change and accelerometer measured physical activity, whether at the 6-month or 12-month assessment. There was an isolated finding of some evidence of an improvement in anxiety in those allocated to GET, as measured by the Hospital Anxiety and Depression Scale at 6 months, with the 12-month assessment, and the Spence Children's Anxiety scale being aligned with that finding. There was weak evidence of a greater risk of deterioration with GET (27%) than with AM (17%; p = 0.069). At conventional UK cost per QALY thresholds, the probability that GET is more cost-effective than AM ranged from 18 to 21%. Whilst completion of the SF-36-PFS, Chalder Fatigue Scale and EQ-5D-Y was good at the 6-month assessment point, it was less satisfactory for other measures, and for all measures at the 12-month assessment.  Conclusion: There was no evidence that GET was more effective or cost-effective than AM in this setting, with very limited improvement in either study group evident by the 6-month or 12-month assessment points.  Trial registration: The study protocol was registered at www.isrctn.com (3rd September 2015; ISRCTN 23962803) before the start of enrolment to the initial feasibility phase.

Associations between immune biomarkers and symptoms of anxiety, depression, and insomnia in paediatric inflammatory bowel disease: A preliminary longitudinal analysis

Innate immunity may influence the onset of affective symptoms and alter sleep patterns in chronic inflammatory conditions. Here, we tested the prospective associations between baseline serum C-reactive protein (CRP), albumin, and CRP/albumin ratio (CAR, i.e., an emerging biomarker of disease activity), and self-reported symptoms of anxiety, depression, and insomnia at 1-year follow up in paediatric inflammatory bowel disease (n = 17). After controlling for baseline values, CAR (ρ = 0.591, p = 0.026) predicted anxiety symptoms, while albumin predicted both anxiety (ρ = -0.687, p = 0.007) and insomnia symptoms (ρ = -0.648, p = 0.012). Current findings preliminarily suggest that inflammation may influence anxiety and sleep disturbance in paediatric IBD.

Back Pain in Adolescents and Young Adults with Idiopathic Scoliosis-Identifying Factors Associated with Significant Pain-A Multivariate Logistic Regression Analysis

(1) Background: Previous data show that patients with idiopathic scoliosis (IS) can be classified into two groups according to pain intensity. This paper aims to determine which factors can independently predict the likelihood of belonging to a high-level pain group. (2) Methods: The study used a prospective, multicenter, cross-sectional design. Two-hundred and seventy-two patients with IS (mean age 18.1 years) (females 83.5%) were included. The sample was divided into two groups. The PAIN group comprised 101 patients (37.1%) with an average NRS of 5.3. The NO-PAIN group consisted of 171 patients (62.9%) with an average NRS of 1.1. Data on various factors such as comorbidities, family history, curve magnitude, type of treatment, absenteeism, anxiety, depression, kinesiophobia, family environment, and social relationships were collected. Statistical analysis consisted of multivariate logistic regression analysis to identify independent predictors of high-level pain. (3) Results: In the final model, including modifiable and non-modifiable predictors, age (OR 1.07 (1.02-1.11)); Absenteeism (OR 3.87 (1.52-9.87)), HAD anxiety (OR 1.18 (1.09-1.29)) and an indication for surgery (OR 2.87 (1.28-6.43)) were associated with an increased risk of pain. The overall model is significant at p = 0.0001 level and correctly predicts 72.6% of the responses. (4) Conclusions: Age, an indication for surgery, anxiety, and work/school absenteeism are the variables that independently determine the risk of belonging to the high-level pain group (NRS > 3).

Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.

Mediating effect of sleep in the association between social media use and mental health among French adolescents during the COVID-19 sanitary crisis

OBJECTIVE/BACKGROUND

Social media use could have deleterious effects on mental health through short sleep duration and poor sleep quality among adolescents. This study aimed to investigate the mediating role of both sleep duration and sleep quality in the association between social media use and mental health among adolescents.

PATIENTS/METHODS

We used cross-sectional data collected from adolescents in the EXIST pilot project conducted during COVID-19 pandemic. Adolescents self-reported wellbeing (WEMWBS), anxiety and depression (HADS) as mental health outcomes. We used ad-hoc questionnaires to assess social media use during weekdays and weekend days, and sleep duration and quality. Mediation analyses were carried out following Baron and Kenny's method, using adjusted linear regression models.

RESULTS

A total of 340 adolescents (13.5 ± 0.6 years, 45.3 % girls) were included. Greater social media use, poorer sleep quality, and shorter sleep duration were associated with poorer mental health. Greater social media use was associated with poorer sleep quality only during the weekend days. The total effect of social media use during weekend days on anxiety (β = 2.54; 95%CI [-1.59; 6.68]) was significantly conveyed through sleep quality (β = 1.22; 95%CI [0.17; 2.62]; mediated proportion = 48.0 %) and duration (mediated proportion = 46.8 %). Mediated proportions ranged from 12.5 % to 20.6 % for wellbeing and depression. Mediating effects were not evident during weekdays.

CONCLUSIONS

Sleep duration and quality mediated the association between social media use and mental health among adolescents during weekend days but not weekdays. Our findings highlight the importance of promoting healthy social media habits, especially during periods of increased reliance on digital platforms, such as COVID-19 pandemic.

Investigating the factors associated with meaningful improvement on the SF-36-PFS and exploring the appropriateness of this measure for young people with ME/CFS accessing an NHS specialist service: a prospective cohort study

OBJECTIVES

Paediatric myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is relatively common and disabling, but little is known about the factors associated with outcome. We aimed to describe the number and characteristics of young people reaching the 10-point minimal clinically important difference (MCID) of SF-36-Physical Function Subscale (SF-36-PFS) and to investigate factors associated with reaching the MCID.

DESIGN

Prospective observational cohort study.

SETTING

A specialist UK National Health Service ME/CFS service, Southwest England; recruitment between March 2014 and August 2015.

PARTICIPANTS

193 eligible patients with ME/CFS aged 8-17 years reported baseline data. 124 (65%) and 121 (63%) with outcome data at 6 and 12 months, respectively.

OUTCOME MEASURES

SF-36-PFS (primary outcome). Chalder Fatigue Questionnaire, school attendance, visual analogue pain scale, Hospital Anxiety and Depression Scale, Spence Young People Anxiety Scale, Clinical Global Impression scale and EQ-5D-Y (secondary).

RESULTS

At 6 months 48/120 (40%) had reached the MCID for SF-36-PFS. This had increased to 63/117 (54%) at 12 months. On the Clinical Global Impressions, 77% and 79% reported feeling either a little better, much better or very much better. Those with worse SF-36-PFS at baseline assessment were more likely to achieve the MCID for SF-36-PFS at 6 months (odds ratio 0.97, 95% confidence interval 0.96 to 0.99, p value 0.003), but there was weaker evidence of effect at 12 months (OR 0.98, 95% CI 0.97 to 1.00, p value 0.038). No other factors at baseline were associated with the odds of reaching the MCID at 6 months. However, at 12 months, there was strong evidence of an effect of pain on MCID (OR 0.97, 95% CI 0.95 to 0.99, p value 0.001) and SF-36-PFS on MCID (OR 0.96, 95% CI 0.94 to 0.98, p value 0.001).

CONCLUSIONS

40% and 54% of young people reached the MCID at 6 and 12 months, respectively. No factors at assessment (other than SF-36-PFS at 6 months, and pain and SF-36-PFS at 12 months) are associated with MCID of SF-36-PFS at either 6 or 12 months. Further work is needed to explore the most appropriate outcome measure for capturing clinical meaningful improvement for young people with ME/CFS.

Examining the associations between physical activity, self-esteem, perceived stress, and internalizing symptoms among older adolescents

INTRODUCTION

In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self-esteem in adolescents. As greater self-esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self-esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self-esteem, stress, and mental health.

METHODS

A cross-sectional design was employed, and path analysis was implemented. PA, self-esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15-19, M = 16.75 [SD = 0.82], 145 female).

RESULTS

Path analysis revealed that PA was associated with lower perceived stress through increased self-esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (-0.25 to -0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p < .001 [2.65-4.0] and depressive symptoms (standardized direct effect; p < .001 [0.33-0.63]).

CONCLUSIONS

Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self-esteem and more adaptive appraisals of stress.

Depression and Anxiety Mediate the Associations between Nutritional Status, Functional Capacity, and Quality of Life in Patients with Cancer

Cancer patients are at risk of malnutrition, which influences their functional status, mental health (MH), and quality of life (QoL). This study aimed to examine the associations between nutritional status, functional capacity, and aspects of QoL in cancer patients, as well as the potential mediating role of depression and anxiety in these associations. Patients with various types of cancer (n = 152) were recruited from the Attikon University Hospital, Greece. Validated questionnaires were used to assess nutritional status (PG-SGA), QoL (SF-36 and EQ-5D-3L), functional capacity (ECOG), depression, and anxiety (HADS and BEDS). Handgrip strength (HGS) was also measured. Poor nutritional status was inversely associated with functional capacity, QoL, depression, and anxiety, after adjusting for confounding factors (all P ≤ 0.05). Mediation analysis indicated a significant indirect effect of nutritional status on various parameters of functional capacity and QoL through depression and anxiety, after adjusting for age and sex. Mediated proportion ranged from 26.3-34% to 23.1-82.8% for functional capacity and QoL, respectively. A significant proportion of the effect of nutritional status on QoL and functional capacity can be partly attributed to psychological effects, highlighting the significance of integrating all aforementioned aspects in the nutritional intervention for cancer patients.

Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

BACKGROUND

Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.

METHODS

A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.

RESULTS

Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred.

CONCLUSION

General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.

Sleep quality and associated factors among adult people living with HIV on follow-up at Dessie Town Governmental Health Facilities Antiretroviral Therapy Clinics, Northeast, Ethiopia, 2020, a multicenter cross-sectional study

BACKGROUND

Poor sleep quality is an important health problem in people living with HIV. The exact cause of sleep disturbance is not well known, but it may relate to HIV itself, antiretroviral drug side effects, and other HIV-related disorders. As a result, the purpose of this study was to assess sleep quality and associated factors among adult HIV patients on follow-up at Dessie Town governmental health facilities' antiretroviral therapy clinics in Northeast Ethiopia in 2020.

METHODS

A multi-center cross-sectional study was conducted among 419 adult people living with HIV/AIDS from February 1/2020 to April 22/2020 in Dessie Town governmental antiretroviral therapy clinics. A systematic random sampling method was used to select the study participants. An interviewer-administered method of data collection with a chart review was used. The Pittsburgh Sleep Quality Index was used to evaluate sleep disruption. A binary logistic regression was conducted to see the relationship between a dependent variable and independent variables. Variables with a p-value of < 0.05 and a 95% confidence interval were used to declare an association between factors and a dependent variable.

RESULTS

A total of 419 study participants were enrolled in this study, with a response rate of 100%. The mean age of the study participants was 36 ± 6.5 SD years and 63.7% of the participants were female. The prevalence of poor sleep quality was found to be 36% (95% CI, 31-41%). Being female (AOR = 3.45, 95% CI: 1.52-7.79), viral loads 1000 copies/ml (AOR = 6.88, 95% CI: 2.79-16.9), CD4 cell count 200 cells/mm3 (AOR = 6.85, 95% CI: 2.42-19.39), WHO stage II and III (AOR = 4.29, 95% CI: 1.05-17.53), having anxiety (AOR = 10, 95% CI: 4.21-23.9.

CONCLUSION

The findings of this study showed that more than one-third of the study participants had poor-quality sleep at the Dessie Town Health Facility ART clinic. Being female, low CD4 cell counts, viral load ≥1000 copies/ml, WHO stage II and III, depression, anxiety, sleeping in a communal bedroom, and living alone were predictors of poor sleep quality.

[Quantitative survey on French teenagers' sleep: Insomnia, anxiety-depression and circadian rhythms]

INTRODUCTION

Insomnia is a sleep disorder that particularly affects teenagers. Its psychic and physical consequences are major and make it a public health priority. The main purpose of the study was to provide contemporary data on adolescent sleep and to explore the intrications between insomnia and mood disorders while investigating the chronotype responsibility.

METHOD

A battery of questionnaires was offered to 1,036 French teenagers, enrolled in secondary school, aged between 12 and 20 years old and living in urban areas for middle school students and in rural areas for high school students. It was mainly composed of the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and the - Morningness-Eveningness Questionnaire (MEQ). The authorities responsible for ethics and professional conduct have issued a favorable opinion.

RESULTS

This study demonstrated that anxiety, depression, gender and age were factors linked to insomnia, reaffirming a female predisposition and asserting a high school entry effect (especially at 15 years old). The results also indicated that a tendency to vesperality increased the risk and the level of insomnia, thus evoking the responsibility of circadian typologies in this sleep disorder.

CONCLUSION

This study underlines the importance of prevention and screening for insomnia when entering high school, as well as the need, in sleep disorder clinics and in psychotherapy, to deal with individual circadian rhythms, their consequences and organizational choices in the sleep/wakefulness articulation.

Assessing Anxiety and Depression Among Students Post-COVID-19: Exploring Associating Factors

Background

The COVID-19 pandemic has had a large impact on global mental health including anxiety and depression rates, many factors affected the vulnerability to these psychological conditions amongst university students.

Aim

To explore the level of anxiety and depression of university students living in Jordan.

Methods

A cross-sectional study design was conducted in which an electronic survey was created and distributed, university students residing in Jordan participated in the study.

Results

A total of 1241 students were enrolled in the study. The mean anxiety score among males and females was (9.68 (SD = 4.10)) and (10.46 (SD = 4.14)), respectively. 42.1% of males had "abnormal" anxiety score compared to 48.4% females. The mean depression score among males (7.77 (SD = 4.31)) was similar to that for the females (7.64 (SD = 4.14)), and 26.0% of the males had "abnormal" depression score compared to 22.6% of the females. Factors affecting anxiety scores included younger age, being a female, taking medication/s, or drinking two cups of coffee or more a day.

Conclusion

With 46% and 24% of students suffering from abnormal anxiety and depression respectively, it is important for education policy makers to take immediate measures to allocate students in need of psychological assessment and help to deliver suitable interventions.

Pain Widespreadedness, and Not Primary Pain Location, is Associated With Comorbid Symptoms in Children With Chronic Pain

OBJECTIVES

Pediatric chronic pain represents heterogeneous diagnoses; often, primary pain location informs research classifications and treatment. In contrast, recent research has highlighted the role of widespread pain and this perspective has been adopted in assessments in specialty pediatric pain clinics. The lack of direct comparison between these 2 methods of categorizing pediatric chronic pain may hinder the adoption of evidence-based practices across the spectrum of care. Therefore, this study aimed to compare whether primary pain location or pain widespreadedness is more informative for pain-related symptoms in pediatric chronic pain.

METHODS

Youth (n=223) between the ages of 8 to 23 years (M=15.93, SD=2.11, 83% female) completed surveys upon intake at the pediatric chronic pain clinic. Free-text entries of primary pain location were coded into categories: headache, abdominal pain, and musculoskeletal pain. Additional domains assessed included widespread pain, pain interference, kinesiophobia, catastrophizing, anxiety, depression, sleep, and fatigue.

RESULTS

Differences based on primary pain location only emerged for kinesiophobia, F(2150)=8.20, P<0.001, with the highest scores among those with musculoskeletal pain. In contrast, controlling for sex, age, and pain intensity, pain widespreadedness was associated with pain interference, pain catastrophizing, fatigue, anxiety, and depression (P<0.05).

DISCUSSION

Pain widespreadedness was more consistently associated with pain-related outcomes among pediatric chronic pain patients than primary pain location, and body maps may be useful in determining a nociplastic pain mechanism to inform treatment. Improved assessment of pediatric pain mechanisms may help advance more precise treatment delivery.

Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training?

BACKGROUND

Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome.

METHODS

This study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15-18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS.

RESULTS

Three moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes.

CONCLUSIONS

The SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification.

TRIAL REGISTRATION

https://doi.org/10.1186/ISRCTN17366720 , retrospectively registered.

Subjective and objective cognitive function in adolescent with chronic fatigue following Epstein-Barr virus infection

OBJECTIVE

Cognitive difficulties are among the most disruptive and disabling problems reported by chronic fatigue syndrome (CFS) sufferers. Acute Epstein-Barr virus (EBV) infection is a trigger of chronic fatigue (CF) and CFS. The aim of this study was to investigate subjectively reported and objectively measured cognitive functioning in fatigued and non-fatigued adolescents six months after EBV infection.

METHODS

A total of 195 adolescents (12-19 years) with acute EBV infection were followed prospectively for six months, after which they were grouped as chronically fatigued (CF⁺) and non-fatigued (CF^-) cases based on questionnaire score; the CF⁺-group was further subgrouped according to CFS diagnosis. A group of 70 healthy controls was also included. Groups were cross-sectionally compared on objective measures of processing speed, executive functions and memory, and subjective cognitive functioning.

RESULTS

There were no group differences regarding objective cognitive measures, but the CF⁺-group reported significantly (p < 0.001) more cognitive problems (cognitive symptoms sum score = 9.5) compared to the CF^--group (cognitive symptoms sum score = 5.3) and the healthy control group (cognitive symptoms sum score = 6.4). The CFS subgroup rated symptoms scores even higher but did not differ on cognitive performance tests.

CONCLUSION

Subjective experiences of cognitive difficulties characterize adolescents with CF and CFS six months after acute EBV infection, whereas objective measures of cognitive impairment are inconspicuous.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts

BACKGROUND

Child sexual abuse (CSA) is a form of early-life trauma that affects youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative to investigate the potential impact of added stress on already vulnerable populations.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a multimodal treatment program on mental health outcomes for youth CSA survivors aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 on treatment outcomes.

PARTICIPANTS AND SETTING

Participants of this study were children and youth aged 8-17 who were engaged in a complex multimodal treatment program specifically designed for youth CSA survivors.

METHODS

Participants were asked to complete self-report surveys at baseline and at the end of two subsequent treatment rounds. Surveys consisted of measures pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and (5) self-esteem.

RESULTS

Median scores improved for all groups at all timepoints for all five domains. For the pre-Covid participants, the largest improvements in the child program were reported in depression (36.6 %, p = 0.05); in the adolescent program anxiety showed the largest improvement (-35.7 %, p = 0.006). Improvements were generally maintained or increased at the end of round two. In almost every domain, the improvements of the pre-COVID group were greater than those of the COVID-I group.

CONCLUSIONS

A complex multimodal treatment program specifically designed for youth CSA survivors has the capacity to improve a number of relevant determinants of mental health and well-being. The COVID-19 pandemic may have retraumatized participants, resulting in treatment resistance.

When perfectionists adopt health behaviors: perfectionism and self-efficacy as determinants of health behavior, anxiety and depression

Background

The study aims to show interrelations between self-efficacy, perfectionism (adaptive and maladaptive), health behavior, and mental health outcomes such as anxiety and depression as an exponent in maintaining optimal health. In the analyses, we focused on one category of health behaviors – preventive practices.

Participants and procedure

Of the gathered data, 295 complete datasets were analyzed (age: M = 28.16, SD = 9.41; 72.8% participants female). We pro-posed two path models with personality traits (as exogenous variables) and health behaviors (as endogenous variables) in predicting depression and anxiety.

Results

Multiple regression analysis revealed that maladaptive perfectionism and generalized self-efficacy significantly predicted health behaviors in general and mental health outcomes whereas adaptive perfectionism and generalized self-efficacy were significant predictors of preventive practices. The path analyses showed that generalized self-efficacy and perfectionism are related directly to mental health outcomes as well as indirectly, through health behaviors. Interestingly, we found a negative indirect effect of an interaction between generalized self-efficacy and preventive practices as well as of an interac-tion between adaptive perfectionism and preventive practices on mental health outcomes. The model fitted well with the data.

Conclusions

The findings show that a balanced and more holistic approach to maintaining health is beneficial for people high in self-efficacy in comparison with high focus on disease prevention. Additionally, the results demonstrate that adaptive perfec-tionists and people high in self-efficacy may also be prone to anxiety and depression (not just maladaptive perfectionists) when their health focus is too narrow.

The right prefrontal cortex (PFC) can distinguish anxious depression from non-anxious depression: A promising functional near infrared spectroscopy study (fNIRS)

BACKGROUND

Anxious depression is a serious mental disorder characterized by comorbidity of anxiety and depression, and its symptoms are similar to those of non-anxious depression. This study aimed to use functional near-infrared spectroscopy (fNIRS) as a tool to distinguish between patients with anxious and non-anxious depression based on differences in hemodynamic changes in the right prefrontal cortex during the verbal fluency task. It is helpful to improve the diagnostic accuracy of the two disorders to further promote their therapeutic effect and prognosis.

METHODS

A total of 105 subjects, comprising 39 patients with anxious depression, 32 patients with non-anxious depression, and 32 healthy controls, were evaluated using 53-channel fNIRS and the Depression and Anxiety Clinical Scale.

RESULTS

Hemodynamic activation was significantly enhanced in the right dorsolateral prefrontal cortex (DLPFC) and right frontopole cortex (FPC) in the anxious depressed group compared with the non-anxious depressed and healthy groups.

LIMITATIONS

First, Hospital Anxiety and Depression Scale (HADS) was used to evaluate the scores of anxiety and depression among the three groups in our study. Different scales may result in different research results. Therefore, other scales (HAM, the Montgomery Asberg Depression Rating Scale, or the Beck Depression Inventory) should be used for further verification. Second, although all the samples we have chosen were patients with the diagnosis of anxious depression or no-anxious depression, we did not distinguish between different severity of anxious depression or no-anxious depression. Third, pure anxiety was not included as the control condition in our study.

CONCLUSIONS

There are significant differences in activation patterns of the right DLPFC and right FPC areas between patients with and without anxious depression. Moreover, the right FPC area is promising as a brain region to assess the severity of anxious depression. fNIRS may be a potential tool to improve diagnostic accuracy for both disorders.

A Pilot Randomized Control Trial of Teens Taking Charge: A Web-based Self-management Program for Adolescents with Cancer

Background: There is a lack of self-management tools for adolescents with cancer (AWC). This study evaluated the feasibility of Teens Taking Charge Cancer, a web-based self-management program. Methods: A pilot randomized control trial (RCT) was conducted across 4 pediatric oncology clinics. AWC (12-18 years) and their caregivers were randomized to either the intervention or control group. All were asked to complete 12 website modules over 12 weeks (at their own pace) and received monthly calls from health coaches. The intervention website was based on cognitive behavioral principals, designed as an interactive self-guided online program, while the control consisted of education and included links to 12 general cancer websites. Outcome assessments occurred at enrollment and 12 weeks post-intervention. The primary outcomes included rate of accrual and retention, adherence to the protocol, acceptability and satisfaction with intervention using questionnaire and semi-structured interviews, adverse events and engagement with the intervention. Results: Eighty-one teen-caregiver dyads were enrolled with a retention rate of 33%. In the intervention group 46% (n = 18) logged in at least once over the 12-week period. A mean of 2.4 of 12 modules (SD 3.0) were completed; and no one completed the program. Thirty-three percent of caregivers in the intervention logged into the website at least once and none completed the full program. Discussion: The results from this pilot study suggest that the current design of the Teens Taking Charge Cancer RCT lacks feasiblity. Future web-based interventions for this group should include additional features to promote uptake and engagement with the program.

A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients

Introduction

Exercise is recognised as integral in mitigating a myriad negative consequences of cancer treatment. However, its benefit within adolescent and young adult (AYA) cancer cohorts remains relatively under researched, and caution should be taken in extrapolating outcomes from adult and paediatric populations given AYA distinctly different physiological and psychosocial contexts. This study sought to evaluate the impact of an exercise intervention on mitigating the expected decline in fitness, strength, physical functioning, and quality of life (QOL) in AYA undergoing cancer treatment.

Methods

This prospective, randomised controlled trial (FiGHTINGF!T) allocated 43 participants (63% male, mean age 21.1 years) to a 10-week, multimodal, bi-weekly exercise intervention (EG) or control group (CG) undergoing usual care. Pre- and post-intervention assessments included cardiopulmonary exercise tests, one-repetition maximum (1RM) strength, functional tests, and QOL patient-reported outcome measures. Data were analysed via linear mixed models and regression.

Results

While no significant group differences (p > 0.05) were observed, neither group significantly declined (p > 0.05) in any outcome measure over the 10-week period. No significant (p˃0.05) strength or functional improvements were observed in the CG, though the EG demonstrated significant improvements in their 1RM leg press (p = 0.004) and chest press (p = 0.032), maximal push ups (p = 0.032), and global QOL (p = 0.011). The EG reported a significant increase in fatigue (p = 0.014), while the CG reported significant positive changes in anxiety measures (p = 0.005).

Conclusion

The exercise intervention produced superior improvements in strength and global QOL, compared with the CG. Regardless of group allocation, enrolment in the exercise study appeared to mitigate the treatment-related decline expected in AYA undergoing cancer treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07217-w.

Adolescent social media user types and their mental health and well-being: Results from a longitudinal survey of 13-14-year-olds in the United Kingdom

Background

There is mixed evidence as to the effects of different types of social media use on mental health, but previous research has been platform-specific and has focused on an oversimplified distinction between active and passive use. This study aimed to identify different underlying subgroups of adolescent social media user based on their pattern of social media activities and test associations between user type and future mental health.

Methods

Students from 19 schools (N = 2456) in south-west England completed an online survey measuring 13 social media activities and four psychosocial outcomes (past year self-harm, depression, anxiety and poor well-being) at age 13 years (October 2019) and repeated a year later (October 2020; aged 14 years). Latent class analysis using Mplus identified distinct classes of social media user and stability of these classes was examined using latent transition analysis. A bias-adjusted three-step model was used to test associations between class membership at baseline and mental health at follow-up. Analyses were adjusted for gender, ethnicity, sexual orientation, socioeconomic status, disability, social media screen-time and baseline mental health.

Results

A four-class model of social media user at baseline was selected based on fit statistics and interpretability. User types were labelled High Communicators; Moderate Communicators; Broadcasters; and Minimal users. Users became more active over time. Broadcasters at age 13 had the poorest mental health outcomes at age 14, with mental health and well-being generally better among the High and Moderate Communicators.

Conclusions

Findings suggest that broadcasters-adolescents with high levels of content sharing in addition to messaging and browsing online-are most likely to be experiencing poor mental health a year later. Recommendations regarding social media use should expand to consider different user types, and mental health implications of their engagement with different online activities in addition to screen-time.

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey

School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being.

Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort

BACKGROUND

The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort.

METHODS

Participants aged 12-24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models.

RESULTS

Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1-2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1-2.3) compared to 1-2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2-2.5) compared to <2 months.

CONCLUSIONS

Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.

Neuropathic-like Pain in Fibrous Dysplasia/McCune-Albright Syndrome

CONTEXT

Pain is a major symptom in adults with fibrous dysplasia/McCune-Albright syndrome (FD/MAS) and response to current treatments, including bisphosphonates and standard analgesics (nonsteroidal anti-inflammatory drugs and opiates) is unpredictable. No studies have explored whether the type of pain is variable in this patient group.

OBJECTIVE

To determine the frequency of neuropathic-like pain in patients with FD/MAS.

DESIGN

Retrospective, dual registry study.

SETTING

Community.

PATIENTS

FD/MAS online registries: the US-based Familial Dysautonomia Foundation (FDF) and the UK-based Rare and Undiagnosed Diseases (RUDY) study.

INTERVENTION

Subjects completed questionnaires to evaluate the presence of features of neuropathic-like pain (painDETECT) and the impact on sleep quality (Pittsburgh Sleep Quality Index) and mental health (Hospital Anxiety and Depression Scale). Descriptive statistics were used to characterize the prevalence and associated burden of neuropathic-like pain.

MAIN OUTCOME MEASURES

Incidence of neuropathic, nociceptive, and unclear pain.

RESULTS

Of 249 participants, one third experienced neuropathic-like pain. This group had statistically significantly (P < 0.001) worse mental well-being and sleep in comparison to those with predominately nociceptive pain.

CONCLUSIONS

Neuropathic-like pain is common in patients with FD/MAS and associated with worse quality of life. Evaluation of pain in patients with FD/MAS should include assessment of neuropathic-like pain to guide personalized approaches to treatment and inform future research.

How back pain intensity relates to clinical and psychosocial factors in patients with idiopathic scoliosis

OBJECTIVE

A pain intensity of 3 can reliably distinguish idiopathic scoliosis (IS) patients with acceptable pain or not. This research aims to analyze psychosocial, family and quality of life differences in patients according to their pain status.

MATERIAL AND METHODS

Patients with IS, without previous surgery, Cobb ≥ 30° and age (12-40) were included in the study. They completed the questionnaires Numerical Rate Scale (NRS), Tampa Scale for Kinesiophobia (TSK)-11, SRS22r, Hospital Anxiety-Depression Scale (HADS), COMI item 7 (work/school absenteeism) and family APGAR. Comorbidities and family health history were collected. Analysis of covariance was performed to compare means between the PAIN (NRS > 3), (NRS <  = 3) groups controlling for the effect of age and the magnitude of the curve.

RESULTS

In total, 272 patients were included. 37.1% belonged to the PAIN group (PG). The PG showed a significantly higher Cobb grade and age than the NO-PAIN group. After controlling for these variables, the PG had worse pain, mental health and SRS22-subtotal values. However, they did not differ in function or self-image. PG showed higher levels of kinesiophobia, anxiety, depression, absenteeism from work/school and impact on social/family environment. PG patients reported a higher prevalence of comorbidities and family history of nonspecific spinal pain.

CONCLUSIONS

Patients with IS and unacceptable pain constitute a group with a different incidence of psychological, social, family and comorbidities factors than those with acceptable pain. In contrast, the severity of IS was not substantially different between the groups. This profile is similar to that observed in patients with nonspecific spinal pain.

[Asthma and suicidal behavior in adolescents: a literature review]

INTRODUCTION

Adolescence is a difficult time in life and asthma has major psychological consequences for adolescents.

OBJECTIVES

This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population.

METHOD

Research on Medline for the 1980-2021 period. Objectives This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population.

RESULTS

An overwhelming majority of the studies taken into consideration demonstrated a significant positive association between asthma and suicidal behaviors. Among the 10 studies assessing SI (with or without SP), 9 of them found a significant positive association between asthma and SI. Eight studies assessed SA; five cross-sectional studies and one prospective study demonstrated a significant positive association between asthma and SA. Only one case-control study did not find a significant positive association between asthma and SA after hospitalization for asthma. The two cross-sectional studies assessing suicidal risk taken as a whole (SI, SP and SA) demonstrated a significant positive association between asthma and at least one suicidal behavior. (OR=1.71; P<0.001). However, several studies did not include depression as an adjustment factor.

CONCLUSION

It is important that healthcare professionals assess suicide risk in adolescent suffering from asthma, the objective being to avoid SA or death from SA.

Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS

Purpose of Review

To discuss emerging understandings of adolescent long COVID or post-COVID-19 conditions, including proposed clinical definitions, common symptoms, epidemiology, overlaps with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and orthostatic intolerance, and preliminary guidance on management.

Recent Findings

The recent World Health Organization clinical case definition of post-COVID-19 condition requires a history of probable or confirmed SARS-CoV-2 infection, with symptoms starting within 3 months of the onset of COVID-19. Symptoms must last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms of the post-COVID-19 condition include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction. These symptoms generally have an impact on everyday functioning. The incidence of prolonged symptoms following SARS-CoV-2 infection has proven challenging to define, but it is now clear that those with relatively mild initial infections, without severe initial respiratory disease or end-organ injury, can still develop chronic impairments, with symptoms that overlap with conditions like ME/CFS (profound fatigue, unrefreshing sleep, post-exertional malaise, cognitive dysfunction, and orthostatic intolerance).

Summary

We do not yet have a clear understanding of the mechanisms by which individuals develop post-COVID-19 conditions. There may be several distinct types of long COVID that require different treatments. At this point, there is no single pharmacologic agent to effectively treat all symptoms. Because some presentations of post-COVID-19 conditions mimic disorders such as ME/CFS, treatment guidelines for this and related conditions can be helpful for managing post-COVID-19 symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40124-022-00261-4.

What treatments work for anxiety and depression in children and adolescents with chronic fatigue syndrome? An updated systematic review

OBJECTIVES

Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings.

DESIGN

A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis.

PARTICIPANTS

Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety.

INTERVENTIONS

Observational studies or randomised controlled trials.

COMPARISON

Any or none.

OUTCOMES

Studies with outcome measures of anxiety, depression or fatigue.

RESULTS

The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated.

CONCLUSION

Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME.

PROSPERO REGISTRATION NUMBERS

CRD42016043488 and CRD42015016813.

Creation and validation of the pictorial ecological momentary well-being instrument (EMOWI) for adolescents

PURPOSE

Adolescence is characterized by the ongoing maturation of emotion-regulation skills and increased emotional reactivity. There is a need for a measurement tool suitable to the Ecological Momentary Assessment methodology, to better capture within-day variations in well-being, and provide fine-grained data that can help understand how environments, behaviors, and health intersect. This paper presents the development and evaluation of the Ecological MOmentary Well-Being Instrument for adolescents, designed for use in EMA.

METHODS

A mixed-methods study was conducted, using both qualitative and quantitative approaches, to develop and assess the EMOWI. A literature review, pictorial production by graphic designers, and qualitative interviews with French and Canadian professionals and adolescents helped design and evaluate the scale face validity. Quantitative evaluation of dimensionality, reliability, and validity was conducted in two samples of French 8th graders.

RESULTS

The resulting 8-item EMOWI showed excellent face validity. Confirmatory factor analysis supported a single factor hypothesis (RMSEA = 0.072). Internal consistency (Cronbach's alpha = 0.85) and intraday test-retest reliability (ICC = 0.83) were high. Correlations with existing scales were consistent with preset hypotheses. Ceiling effects were evidenced for all items, yet not on the global score. Quantitative estimations were similar for the verbal and pictorial versions, but qualitative findings argued in favor of the pictorial version.

CONCLUSION

The 8-item pictorial EMOWI is a short and innovative instrument to measure momentary well-being in adolescents aged 12 to 17 years. Its strong psychometric properties and its acceptability among adolescents make it an excellent candidate instrument for the Ecological Momentary Assessment of well-being in this population.

Validity of the Hospital Anxiety and Depression Scale (HADS) in primary care patients in Colombia

OBJECTIVE

To assess the validity of the Hospital Anxiety and Depression Scale (HADS) for depression and anxiety screening in primary care patients in Colombia.

METHODS

A criterion validity study was conducted with 243 adults that had completed the HADS and were later assessed using the MINI as a gold standard. Cronbach's alpha, McDonald's omega and factor structure were applied through confirmatory factor analysis (CFA). ROC curve analysis and Youden's statistic were used to determine the cut-off point.

RESULTS

Cronbach's α was reported to be 0.85 and 0.82 for McDonalds' ω. CFA supported a two-factor solution demonstrating satisfactory fit. Root mean square error of approximation = 0.04, Comparative Fix Index (CFI) and Tucker-Lewis Index (TLI) = 0.97. For HADS-A, the cut-off point was determined as 6 associated with a sensitivity of 0.76, a specificity of 0.72 and Youden's index of 0.50. The ABC was 0.81. For HADS-D, the cut-off point was determined as 4 associated with a sensitivity of 0.78, a specificity of 0.74 and Youden's index of 0.53. The ABC was 0.82.

CONCLUSION

The HADS is a valid and reliable instrument for anxiety and depression screening in adult patients of primary healthcare services in Colombia.

Evaluation of a structured skills training group for adolescents with attention-deficit/hyperactivity disorder: a randomised controlled trial

Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SSTG) for adolescents with ADHD. Adolescents (n = 184, ages 15-18 years) with a diagnosis of ADHD were randomly assigned to either the SSTG, which is based on dialectical behavioural therapy, or an active control group based on psychoeducation. Symptoms of ADHD, behavioural and emotional problems, functional impairment, and health-related outcomes were assessed with self-ratings and parental ratings two weeks before, two weeks after, and six months after treatment. All participants who completed the pre-treatment measurements (n = 164) were included in the main analyses, which were conducted using a linear mixed model. Our results demonstrated no significant group differences in favour of the SSTG for any of the study outcomes. A majority of the participants in both groups reported that they had increased their knowledge about ADHD, improved their ability to manage problems related to the diagnosis, and would recommend the treatment to others. We conclude that the SSTG seems to be acceptable for adolescents with ADHD in a clinical context. However, the treatment was not proved to be more effective or more acceptable than the psychoeducational control intervention.Trial registration: http://www.isrctn.com/ISRCTN17366720,11/05/2016 , retrospectively registered.

Mental Health among Higher Education Students during the COVID-19 Pandemic: A Cross-Sectional Survey from Lithuania

Mental health issues—anxiety, depression, suicidal ideation and behavior—are prevalent among students of higher education. The COVID-19 pandemic further affected students’ daily life through academic and socioeconomic disturbances. We set out to investigate students’ mental health amidst the COVID-19 pandemic and conducted a cross-sectional online survey at higher education institutions in Lithuania in 2021. The questionnaire consisted of the Hospital Anxiety and Depression scale (HADS) and the Sense of Coherence scale (SOC-3) questionnaires, evaluation of suicidal risk, experiences during the COVID-19 pandemic and self-rated health status (SRHS). Among 1001 students who completed the survey, the prevalence of clinically relevant anxiety was high (46.6%) and contrasted with the lower prevalence of depression (11.1%). 37.5% of all students admitted that they had thought about suicide at least once during their lifetime and a similar number of students thought about suicide during the previous year. High levels of anxiety and depression were statistically significant predictors of suicidal ideation and planning during the past year in binary regression models. High SRHS (higher score refers to more positive health status) was the only significant independent variable associated with less frequent suicidal attempts in the past year (p < 0.01, OR = 0.29, 95% CI = 0.12 to 0.66). Our study highlights anxiety and suicidality to be burdensome mental health issues among higher education students in Lithuania during the COVID-19 pandemic.