Epidemiology of mental disorders in children and adolescents

Inequalities in the utilisation of mental health services amongst different clusters of Australian children and adolescents

AIMS

To investigate the inequalities in mental health service utilisation amongst socio-demographic classes of Australian children and adolescents diagnosed with major mental and/or behavioural disorders, and suicidality.

METHODS

A nationally representative sample of Australian children and adolescents was assessed, comprising 2898 parent and 1736 child participants. The Bolck, Croon, and Hagenaars (BCH) method was applied to pre-identified latent classes to determine adjusted class membership. Logistic regressions and predictive marginal analysis examined associations between these classes and mental health service utilisation in three scenarios: overall, with mental and/or behavioural disorders, and with suicidality.

RESULTS

Children and adolescents in Class 1 (Underprivileged) characterised by low socio-economic status and non-intact families showed the highest prevalence of mental and/or behavioural disorders and suicidality and the highest utilisation of mental health services. Classes 2 (Low-Skilled but Cohesive) and 4 (Affluent Single Parent) had higher prevalence rates of disorders and suicidality than Classes 3 (Stable Middle Class) and 5 (Privileged). However, Class 4 utilised services less than Classes 3 and 5, while Class 2 had the lowest utilisation amongst all classes, despite higher disorder prevalence.

CONCLUSIONS

The study highlights significant disparities in mental health service utilisation across socio-demographic classes. Children and adolescents from underprivileged and non-intact family backgrounds face the highest burden of mental health issues but also utilise services more frequently. In contrast, Classes 2 and 4, despite higher disorder prevalence, underutilise services, indicating barriers to access. Government initiatives should focus on improving parental awareness, family structures, and socio-economic conditions to enhance service utilisation and reduce mental health disparities.

Actigraphy-derived circadian rhythms, sleep-wake patterns, and physical activity across clinical stages and pathophysiological subgroups in young people presenting for mental health care

Staging models for youth mental health aim to locate clinical presentations on a spectrum from at-risk states to persistent disorder and predict future illness trajectories. Our previous publications on trans-diagnostic staging proposed three pathophysiological subgroups of major mood or psychotic disorders in youth ('hyperarousal-anxious depression', 'circadian-bipolar spectrum', 'neurodevelopmental-psychosis'). This study aims to investigate differences in objective measures of 24hr sleep-wake patterns, circadian rhythms, and physical activity across clinical stages and pathophysiological subgroups. Actigraphy data (median: 13 days) was collected from 497 youth presenting for mental health care (21.6 ± 4.7 years, 37% male) and 88 controls (24.1 ± 3.8 years, 44% male). Actigraphy estimates were compared across groups using analysis of covariance adjusting for age and sex. Compared with controls or earlier clinical stages, later clinical stages were significantly associated with longer sleep duration(η2 = 0.04), later sleep midpoint(η2 = 0.02), lower sleep regularity(η2 = 0.02), lower relative amplitude of the rest-activity cycle(η2 = 0.05), higher interdaily stability(η2 = 0.03), lower total activity(η2 = 0.08) and less moderate-vigorous physical activity(η2 = 0.06). Compared to controls, the 'circadian-bipolar spectrum' subgroup had later sleep midpoint(η2 = 0.02), and higher interdaily stability(η2 = 0.03); the 'neurodevelopmental-psychosis' subgroup had longer sleep duration(η2 = 0.02), and lower total activity(η2 = 0.03); and the 'hyperarousal-anxious depression' subtype had later sleep midpoint(η2 = 0.02), and lower sleep regularity(η2 = 0.02). The findings suggest differences in sleep-wake and rest-activity patterns according to clinical stage and proposed illness trajectory subtypes. The cross-sectional associations of sleep regularity and physical activity with clinical stage highlight a need for longitudinal explorations of how sleep-wake patterns and circadian rhythms interact with treatment factors and progression of both mental and physical illness.

The effects of physical activity on the mental health of typically developing children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical activity has gained attention in recent years as a promising intervention for improving the mental health of children and adolescents. However, evidence supporting the effectiveness of physical activity interventions for the mental health of typically developing children and adolescents remains limited.

METHODS

This study conducted a comprehensive search across five electronic databases up to July 2024. Studies were eligible for inclusion if they involved an intervention with a control group that examined the effects of physical activity on the mental health of typically developing children and adolescents. Articles focusing on participants with developmental, behavioral, or psychiatric disorders were excluded. A random-effects meta-analysis was conducted using Stata 18.0. The quality of evidence and risk of bias were assessed using the GRADE framework and the PEDro scale.

RESULTS

The initial search yielded 27,527 articles, of which 30 met the inclusion criteria. Meta-regression analysis indicated that country and intervention frequency were significant sources of heterogeneity. Physical activity interventions were significantly more effective than the control group in improving mental health (SMD = 0.37, 95% CI: 0.20 to 0.53). These interventions showed particularly strong effects on stress reduction (SMD = 0.86, 95% CI: 0.15 to 1.56) and social competence enhancement (SMD = 0.56, 95% CI: 0.07 to 1.06). Moreover, physical activity interventions were notably more effective for male adolescents (SMD = 1.11, 95% CI: 0.34 to 1.88) and those at the secondary school level (SMD = 0.45, 95% CI: 0.23 to 1.69).

CONCLUSIONS

Physical activity is beneficial in improving various aspects of mental health, including anxiety, depression, stress, self-esteem, and social competence in typically developing children and adolescents. However, the quality of evidence in this study is low due to methodological limitations of the studies included in this review. More high-quality randomized controlled trials are needed to validate these findings. Teachers and community workers can leverage physical activity as a preventive strategy to promote the mental health of children and adolescents. Future research should also investigate how factors like socioeconomic status and the sporting environment impact the effectiveness of these interventions.

TRIAL REGISTRATION

PROSPERO, CRD42024567153.

Heterogeneity of early-onset conduct problems: assessing different profiles, predictors and outcomes across childhood

BACKGROUND

Among early-onset conduct problems (CP), associated with more disruptive behaviors of greater intensity and stability, several domains have been proposed from a variable-centered perspective to capture their heterogeneity: oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional traits (CU). Using a person-centered approach, the present study aims to identify distinct profiles of child CP, examining different predictors and developmental outcomes.

METHODS

Data included parent- and teacher-reported questionnaires from an ongoing longitudinal study (ELISA). Latent profiles were identified first in a community sample (n = 2,103; age 4-8 years; 50.9% boys) and replicated in a high-CP subsample (n = 168; 70.24% boys).

RESULTS

Four profiles emerged in the community sample (Normative Development, Daring/Impulsive, Low prosociality + Fear; Low prosociality + Psychopathic Traits [PP]), and three in the high-CP sample (same except the normative). The identified CP profiles aligned with the ADHD and CU domains, but not the ODD domain. Differences in activity, punitive and inconsistent parenting emerge as the most significant predictors. Regarding the outcomes, the Low prosociality + PP profile stands out as the group with the most severe emotional, social and behavioral maladjustment.

CONCLUSIONS

These findings highlight the heterogeneity within CP, and the importance of designing specific and tailored interventions for each identified profile.

Clinical effectiveness of drop-in mental health services in paediatric healthcare settings: a non-randomised multi-site study for children, young people and their families

BACKGROUND

Despite the high prevalence of mental health disorders in children and young people with long-term health conditions, access to timely and effective treatment is often difficult. This study aimed to evaluate the clinical effectiveness of drop-in mental health services for young people with long-term health conditions and their families at six paediatric healthcare settings in England.

METHODS

This was a prospective non-randomised single-arm multi-centre interventional study. Young people up to 25 years old with a long-term health condition, and their families were eligible. The primary outcome was the change in the total difficulties score on the Strengths and Difficulties Questionnaire between baseline and 6 months. Interventions provided were standard evidence-based low intensity cognitive-behaviour therapy, onward referral or signposting. Secondary outcomes included quality of life, depression, anxiety, satisfaction with services and cost.

RESULTS

Accessing the drop-in services led to significant reductions in emotional and behavioural symptoms (p < 0.01; Cohen's d = 0.39) and improved quality of life (p < 0.01; Cohen's d = 0.44). Parental depression and anxiety significantly improved (p < 0.01; Cohen's d = 0.30 and d = 0.34). The average waiting time for an initial assessment was 13.42 days. High levels of satisfaction were reported. The cost per patient was approximately half the estimated cost of a typical course of psychological therapy.

CONCLUSIONS

Drop-in mental health services are effective and acceptable and can be delivered at low cost per patient for young people with long term conditions. This model of care is a feasible approach for increasing access to evidence-based mental health treatment in paediatric healthcare settings.

TRIAL REGISTRATION

ISRCTN15063954, Registered on 9 December 2022.

Study protocol for assessing the effectiveness, implementation fidelity and uptake of attachment & child health (ATTACH™) Online: helping children vulnerable to early adversity

BACKGROUND

Exposure to early childhood adversities, such as family violence, parental depression, or low-income, undermine parent-child relationship quality and attachment leading to developmental and mental health problems in children. Addressing impacts of early childhood adversity can promote children's development, giving them the best start in life. Parental reflective function (RF), or parents' ability to understand their own and children's mental states, can strengthen parent-child relationships and attachment and buffer the negative effects of early adversity. We developed and tested ATTACH™ (Attachment and Child Health), an effective RF intervention program for parents and their preschool-aged children at-risk from early adversity. Pilot studies revealed significantly positive impacts of ATTACH™ from in-person (n = 91 observations of 64 dyads) and online (n = 10 dyads) implementation. The two objectives of this study are to evaluate: (1) effectiveness, and (2) implementation fidelity and uptake of ATTACH™ Online in community agencies serving at-risk families in Alberta, Canada. Our primary hypothesis is ATTACH™ Online improves children's development. Secondary hypotheses examine whether ATTACH™ Online improves children's mental health, parent-child relationships, and parental RF.

METHODS

We will conduct an effectiveness-implementation hybrid (EIH) type 2 study. Effectiveness will be examined with a quasi-experimental design while implementation will be examined via descriptive quantitative and qualitative methods informed by Normalization Process Theory (NPT). Effectiveness outcomes examine children's development and mental health, parent-child relationships, and RF, measured before, after, and 3 months post-intervention. Implementation outcomes include fidelity and uptake of ATTACH™ Online, assessed via tailored tools and qualitative interviews using NPT, with parents, health care professionals, and administrators from agencies. Power analysis revealed recruitment of 100 families with newborn to 36-month-old children are sufficient to test the primary hypothesis on 80 complete data sets. Data saturation will be employed to determine final sample size for the qualitative component, with an anticipated maximum of 20 interviews per group (parents, heath care professionals, administrators).

DISCUSSION

This study will: (1) determine effectiveness of ATTACH™ Online and (2) understand mechanisms that promote implementation fidelity and uptake of ATTACH™ Online. Findings will be useful for planning spread and scale of an effective online program poised to reduce health and social inequities affecting vulnerable families.

TRIAL REGISTRATION

Name of registry: https://clinicaltrials.gov/ .

REGISTRATION NUMBER

NCT05994027. Date of registration: July 22, 2023.

PROTOCOL VERSION

Version 1.

Prenatal Antidepressant Exposure and Risk of Depression and Anxiety Disorders: An Electronic Health Records-Based Cohort Study

OBJECTIVE

To examine the associations of serotonergic antidepressant exposure during pregnancy with the risk of depression and anxiety disorders in offspring.

METHOD

The Mayo Clinic Rochester Epidemiology Project medical records-linkage system was used to study offspring born to mothers who were prescribed a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor (S/NRI users, n = 837) during pregnancy (1997-2010). Cox regression models were used to calculate hazard ratios to examine associations of S/NRIs with diagnosed depression and anxiety, defined based on a review of medical records by 2 board-certified psychiatrists, vs no maternal antidepressant use during pregnancy (nonusers, n = 863) and maternal antidepressant use in the year prior to pregnancy (former users, n = 399) as control groups.

RESULTS

After all adjustments for covariates, children born to S/NRI users during pregnancy did not differ in onset of depression or anxiety from the children of nonusers (adjusted hazard ratio = 1.00, 95% CI [0.74, 1.85]) or former users (adjusted hazard ratio = 0.94, 95% CI [0.69, 1.27]). These associations were similar when exposure was limited only to selective serotonin reuptake inhibitors.

CONCLUSION

The results suggest that higher rates of childhood and adolescent depression or anxiety conditioned on maternal S/NRI use in pregnancy are more likely to be driven by maternal depression or underlying propensity for depression rather than direct pharmacological effects of in utero S/NRI exposure.

Psychiatric comorbidity in children and adolescents with ADHD: A systematic review and meta-analysis

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with estimated worldwide prevalence of 7.2 % in children and adolescents. Comorbidity of psychiatric disorders is considered common in ADHD and has been found to contribute to poorer prognosis. Despite decades of research, the actual prevalence of comorbid psychiatric disorders in children and adolescents with ADHD is unclear. The purpose of this systematic review and meta-analysis was to investigate the prevalence of comorbid disorders in children and adolescents with ADHD. Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to February 2025. In total 121 studies involving 39,894 children and adolescents with ADHD diagnosis were included. The most common comorbid disorders were Oppositional Defiant Disorder (34.7 %), Behavior Disorders (30.7 %), Anxiety Disorders (18.4 %), Specific phobias (11.0 %), Enuresis (10.8 %), and Conduct Disorder (CD) (10.7 %). All individual disorders studied had a higher prevalence among children and adolescents with ADHD than in the general population. Few gender differences were found; higher prevalence of CD among boys and higher of OCD in girls. The findings indicate that comorbid psychiatric disorders are highly prevalent in children and adolescents with ADHD and must be considered in both assessment and treatment of ADHD. PROSPERO registration: ID CRD42022359965.

Racial discrimination and adverse childhood experiences predicting depressive symptoms and developmental assets: Testing cultural socialization and preparation for bias as moderators among Black adolescents and caregivers

The current study examined whether adverse childhood experiences and racial discrimination predicted adolescents' internal developmental assets, external developmental assets, and depressive symptoms. We also tested whether these relations were buffered by aspects of caregivers' reports of ethnic-racial socialization efforts (i.e., cultural socialization and preparation for bias). Participants were Black adolescents 12 to 17 years of age (Mage = 15.09, SD = 1.36) and their caregivers. Findings indicated that adolescents' racial discrimination experiences and adverse childhood experiences were associated with less internal assets, less external assets, and greater depressive symptoms. Preparation for bias was a protective moderator in two associations, such that at low levels of preparation for bias, racial discrimination predicted less external assets, but this relation became non-significant at high levels of preparation for bias. Similarly, at low levels of preparation for bias, adverse childhood experiences predicted greater depressive symptoms, but this relation became non-significant at high levels of preparation for bias. Caregivers' cultural socialization was also protective in that at low levels of cultural socialization, adverse childhood experiences predicted less internal developmental assets, but this relation became non-significant at high levels of cultural socialization. Adverse childhood experiences and racial discrimination contribute to poorer outcomes, but caregivers' efforts to teach their children about their race, ethnicity, and culture are protective in some of these associations. Findings highlight that it is important to focus on both risk factors and protective family cultural processes to promote Black adolescents' positive developmental and mental health.

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

Background

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

Methods

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

Results

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

Conclusion

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

Startle potentiation to unpredictable threat predicts adolescent development of generalized anxiety disorder

BACKGROUND

An elevated startle reflex in anticipation of unpredictable threat has been associated with concurrent anxiety disorders. However, only one study to date has examined whether startle potentiation in anticipation of unpredictable threat predicts the development of anxiety disorders.

METHOD

In a community sample of 309 adolescents, we examined whether the startle reflex in anticipation of predictable or unpredictable threat at age 15 predicted onset of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) at age 18. To evaluate the specificity of these relationships, we also examined the development of depressive disorders. Startle reflex was measured using the no, predictable, and unpredictable threat task at age 15. Semi-structured diagnostic interviews were administered at both waves to assess lifetime anxiety disorders and depression.

RESULTS

Average startle reflex and startle potentiation to unpredictable, but not predictable, threat at age 15 predicted GAD at age 18, independent of lifetime GAD through age 15 and lifetime depression through age 18. Startle responses at age 15 did not predict SAD or depression at age 18.

CONCLUSIONS

The present study suggests that elevated startle potentiation in anticipation of unpredictable threat is a risk factor for the development of GAD in adolescence.

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

CONTEXT

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021276316.

Global burden of diseases attributable to intimate partner violence: findings from the Global Burden of Disease Study 2019

PURPOSE

Our study aims to evaluate the global burden of disease attributable to IPV from 1990 to 2019 at global, regional, national, and socio-demographic index (SDI) levels. Our research question is: What is the global burden of disease attributable to intimate partner violence (IPV) from 1990 to 2019, and how does it vary at global, regional, national, and socio-demographic index (SDI) levels?

METHODS

Data parameters for the number of deaths, disability-adjusted life years (DALYs), and age-standardized rate were obtained from the Global Burden of Disease Study 2019. We calculated the percentage change and population attributable fraction with 95% uncertainty intervals.

RESULTS

IPV directly accounted for 0.14% [95% UI 0.09%, 0.21%] and 0.32% [95% UI 0.17%, 0.49%] of global all-cause deaths and DALYs in 2019, respectively. The age-standardized deaths and DALYs rates of IPV increased by 12.83% and 4.00% respectively from 1990 to 2019. Women aged 35-39 and 30-34 had the highest deaths and DALYs rate respectively. The highest age-standardized rates of IPV-related deaths and DALYs were observed in Southern Sub-Saharan. Both of deaths and DALYs were high in low-socio-demographic Index (SDI) quintile in 2019.

CONCLUSIONS

A higher level of deaths and DALYs attributable to IPV were reported in younger women, in the early 2000s, in Southern Sub-Saharan regions and in low SDI regions. Our study provides policymakers with up-to-date and comprehensive information.

Do coping strategies mediate the effects of childhood adversities and traumata on clinical high-risk of psychosis, depression, and social phobia? A cross-sectional study on patients of an early detection service

BACKGROUND

Childhood adversities and traumata (CAT) increase the risk for various mental disorders, including the clinical high-risk of psychosis (CHR-P) state and its main comorbidities, i.e., depression, and social phobia. However, these relations are likely mediated by personal coping behaviors. This cross-sectional study investigates the relationships between the main CAT domains, coping, CHR-P, depression, and social phobia.

METHODS

Using path analyses, we analyzed data of 736 patients (mean age 24 years, 67% male) who presented at an early detection service between 2002 and 2013, answered questionnaires on CAT, coping, depressiveness, and social phobia, and underwent clinical examination for CHR-P according to the recommendations of the Guidance project of the European Psychiatric Association.

RESULTS

All path models (total sample, males and females) showed good to excellent fit to the data. In all models, higher scores on maladaptive coping mediated the negative effect of emotional abuse on mental health outcomes. Additionally, in the total sample and males, lower scores on adaptive coping mediated the negative effect of emotional abuse and neglect, and physical neglect was associated with lower scores on adaptive coping that, in turn, were linked to depression and social phobia but not CHR-P. Overall, effects of maladaptive coping were higher than those of adaptive coping, although adaptive coping was more diversely associated with CAT. Furthermore, the interrelated depression and social phobia were more widely explained by the models than CHR-P, which was not significantly associated with them.

CONCLUSIONS

Our findings underscore the complex interplay of the CAT domains and their relevant mediators with mental health outcomes that likely reflect underlying sex-specific psychological, social, cultural and neurobiological mechanisms. Supporting a broader view on CAT than the traditional focus on sexual abuse, results indicate an important role of emotional abuse that, descriptively, is most strongly mediated by maladaptive coping strategies on mental health outcomes. A detailed understanding of the effects of CAT will in future help to develop a multi-dimensional, holistic and sex-specific approach to the treatment of patients who have experienced CAT.

TRIAL REGISTRATION

The study was registered in the German Clinical Trial Register ( https://drks.de/ ) as DRKS00024469 at 02/24/2021.

Differential gray matter correlates and machine learning prediction of abuse and internalizing psychopathology in adolescent females

Childhood abuse represents one of the most potent risk factors for the development of psychopathology during childhood, accounting for 30-60% of the risk for onset. While previous studies have separately associated reductions in gray matter volume (GMV) with childhood abuse and internalizing psychopathology (IP), it is unclear whether abuse and IP differ in their structural abnormalities, and which GMV features are related to abuse and IP at the individual level. In a pooled multisite, multi-investigator sample, 246 child and adolescent females between the ages of 8-18 were recruited into studies of interpersonal violence (IPV) and/or IP (i.e. posttraumatic stress disorder (PTSD), depression, and/or anxiety). Youth completed assessments for IP, childhood abuse history, and underwent high resolution T1 structural MRI. First, we characterized how differences in GMV associated with childhood abuse exposure depend on the presence or absence of IP using voxel-based morphometry (VBM). Next, we trained convolutional neural networks to predict individual psychopathology and abuse experience and estimated the strength and direction of importance of each structural feature in making individual-level predictions using Shapley values. Shapley values were aggregated across the entire cohort, and the top 1% of feature clusters with the highest importance are reported. At a group-level, VBM analyses identified widespread decreases in GMV across the prefrontal cortex, insula, and hippocampus in youth with IP, while abuse experience was specifically associated with increased GMV in the cingulate cortex and supramarginal gyrus. Further, interactions between IP and severity of abuse were identified in the ventral and dorsal prefrontal cortex, anterior cingulate cortex, and thalamus. After extensive training, model tuning, and model evaluation, the neural networks performed above chance when predicting IP (63% accuracy) and abuse experiences (71% accuracy) at the level of the individual. Interestingly, structural regions with the highest importance in making individual IP predictions had a high degree of overlap with group-level patterns. We have identified unique structural correlates of childhood abuse and IP on both the group and individual level with a high degree of overlap, providing evidence that IP and trauma exposure may uniquely and jointly impact child and adolescent structural neurodevelopment. Feature learning may offer power and novelty above and beyond traditional group-level approaches to the identification of biomarkers and a movement towards individualized diagnosis and treatment.

Predictors and Moderators Two Treatments of Oppositional Defiant Disorder in Children

OBJECTIVE

The aim of this study was to examine predictors and moderators of behavioral improvement in children with Oppositional Defiant Disorder (ODD) following treatment with Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills were examined.

METHOD

One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms. Using an intent-to-treat sample in this secondary analysis (Murrihy et al., 2022), linear regressions and PROCESS (Hayes, 2017) were used to examine these predictors and possible moderators of treatment.

RESULTS

Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions - mothers who were more likely to attribute their child's problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.

CONCLUSIONS

CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD. While tentative, this provides promising insights as to how treatment outcomes for children with ODD may be improved.

Implementing Task-Shared Child and Adolescent Psychological Interventions in Low- and Middle-Income Countries: A Scoping Review

OBJECTIVE

Effective "task shared," or nonspecialist delivered, psychological interventions for children and adolescents have been developed or adapted in low- and middle-income countries with the aim of closing the global treatment gap for youth mental health care. Yet, delivery remains limited, in part due to the lack of knowledge of associated implementation, or process, outcomes. This scoping review aims to describe, examine the quality of, and synthesize findings on implementation outcomes of child and adolescent psychological interventions in low-and middle-income countries.

METHODS

PubMed, Web of Science, and PsycInfo were searched for studies on child and adolescent psychological interventions in low- and middle-income countries reporting on implementation outcomes. After abstract and full-text review, data were extracted and summarized on implementation outcomes and quality of implementation outcomes reporting. Implementation barriers and recommendations for addressing barriers were also charted and narratively synthesized.

RESULTS

Out of 5,207 manuscripts, 86 met inclusion criteria. Younger children were underrepresented. Studies largely reported feasibility and acceptability and did not state hypotheses or use conceptual models. Barriers primarily related to interventions being too complex, not an acceptable fit with participant cultures, and facilitators lacking time for or experiencing distress delivering interventions. Recommendations focused on increasing intervention fit and flexibility, training and support for facilitators, and linkages with existing systems.

CONCLUSIONS

Rigorous, broader implementation outcomes research is needed within child and adolescent psychological intervention research in low-and middle-income countries. Current evidence suggests the importance of the further developing strategies to increase acceptability to participants and better support facilitators.

Differential Associations Between Device-Assessed and Parent-Reported Physical Activity With Indicators of Mental Health in Children and Youth With Disabilities

PURPOSE

We examined associations between device-assessed and parent-reported physical activity with mental health indicators among children and youth with disabilities.

METHOD

Physical activity and mental health data were collected from a larger national surveillance study of physical activity in children and youth with disabilities in Canada. A total of 122 children and youth with disabilities (mean age = 10 y; 80% boys, 57% with developmental disability) wore a Fitbit for 28 days to measure their daily steps. Parents reported the frequency and duration of their child's leisure-time physical activity during the previous 7 days. Parents also completed the Strengths and Difficulties Questionnaire (ie, total difficulties score, internalizing problems, externalizing problems, and prosocial behavior) as a measure of mental health symptoms.

RESULTS

Significant relationships were observed between parent-reported physical activity and total difficulties as well as internalizing problems but not externalizing problems. Nonsignificant relationships were observed between median daily step counts and mental health indicators.

CONCLUSION

Differential relationships between physical activity and mental health indicators may exist among children and youth with disabilities depending on how physical activity is operationalized (ie, steps vs active minutes) and measured (ie, proxy report vs device assessed). Interventionists seeking to improve mental health outcomes among children and youth with disabilities through physical activity promotion should consider these findings when deciding upon methods to assess physical activity behaviors.

Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population

BACKGROUND

Subthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation.

METHODS

We conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals.

RESULTS

Our analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%).

CONCLUSIONS

Anxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.

Prevalence, Patterns and Correlates of Child and Adolescent Mental Disorders in Kumasi, Ghana: An Urban Community-Based Survey

This study examined the prevalence and correlates of mental disorders among youth in Kumasi, Ghana, through a community-based cross-sectional survey. 672 urban participants aged 6-17 years were surveyed. Mental disorders were screened using Rutter's A2 Scale for Parent Assessment of Child Behaviour, with diagnoses confirmed by the Kiddie-Schedule for Affective Disorders and Schizophrenia. The Double Sampling method was used for weighted prevalence estimates, and correlates analysed using chi-square and logistic regression. Lifetime weighted prevalence of CAMH disorders was 30.4% (95% CI: 26.9-33.9), predominantly anxiety-related disorders, with current weighted prevalence 18.6% (95% CI: 15.7-21.5). Notably, lacking an active reading habit was associated with nearly three times the odds of mental illness. Children in the 3rd and 4th wealth quintiles had significantly higher odds of mental disorder (12- and 9-times increased odds, respectively), as did lack of caregiver homework supervision among children under 11 years. This study provides the first community-based prevalence figures for childhood mental disorders in Ghana, highlighting the link between poverty-related factors and mental health, and suggesting potential policy interventions to inform policy.

Examining the mental health trajectories of children and adolescents: a cross-cohort analysis

BACKGROUND

Epidemiological samples provide opportunity to understand the development of mental health trajectories to better understand whether such epidemiological data can help to plan and modify service delivery for youth mental health. Variation between countries is not well understood and thus applying evidence from other countries to national strategies limits support service policy and planning. We therefore examine developmental patterns of youth mental health across different countries using the Growing Up in Ireland (GUI) Cohorts, with comparison to existing UK longitudinal cohort data (Millennium Cohort Study, MCS; Growing up in Scotland, GUS).

METHODS

Youth mental health problems within each cohort across development (5-17/18 years) were assessed using parent reported Strengths and Difficulties Questionnaire (SDQ) scores. Using latent growth curve analyses, we examined trajectories of emotional, conduct, and hyperactivity problems for boys and girls, separately for each cohort.

RESULTS

Across cohorts, we observed similar developmental patterns for emotional, conduct, and hyperactivity problems. However, the GUI emotional problems in Ireland emerged earlier than in the UK. By adolescence, GUI emotional scores were similar to the UK, suggesting that the differences in emotional problems between the ROI and UK had narrowed by adolescence. Covariates also had different associations with youth mental health trajectories across cohorts.

CONCLUSIONS

Utilizing multiple nationally representative cohort longitudinal datasets can help inform clinically meaningful conclusions and potential recommendations on population level multi-tiered service needs and development in the area of child and adolescent mental health support and future provision.

Association and interaction between overweight/obesity and suicide attempts in young first-episode and drug-naïve patients with major depressive disorder

Aims

This research's objective was to explore the correlation of overweight/obesity and suicide attempts in young patients with major depressive disorder (MDD) and the related factors of suicide attempts in patients with/without overweight/obesity.

Methods

This study included 520 young patients with MDD who were first-episode and drug-naïve (FEDN), with an average age of 20.50 ± 2.36 years. Height and weight of each subject were measured, and overweight was classified as 24≤BMI<28, and obesity as BMI≥28.Biochemical indicators were detected including blood glucose, lipid, and thyroid function indicators. Depressive symptoms, anxiety symptoms, and psychotic symptoms were evaluated using Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale (HAMA) and Positive and Negative Syndrome Scale (PANSS) positive subscale, respectively.

Results

Overweight/obesity was a separate factor influencing suicide attempts in subjects(p < 0.05, OR = 0.57, 95%CI: 0.34-0.95). Higher HAMD, HAMA scores, levels of total cholesterol (TC), thyroid stimulating hormone (TSH), and prevalence of thyroid peroxidase antibody abnormalities were seen in overweight/obese individuals who attempted suicide(all p values < 0.01).While in patients without overweight/obesity, those who attempted suicide had higher HAMD, HAMA, PANSS positive subscale scores, levels of TSH, fasting blood glucose, TC, blood pressure, prevalence of TSH abnormalities, and lower levels of high-density lipoprotein cholesterol(all p values < 0.01).

Conclusions

In young FEDN patients with MDD, overweight/obesity might influence the incidence of suicide attempts and related influences.

Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need. We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators. The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence. Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Coming of age in war: Early life adversity, age at menarche, and mental health

Armed conflict and forced migration (ACFM) represent a set of extreme environments that are increasingly common for children and adolescents to experience. Adolescence may constitute a sensitive period (puberty and psychoneurological maturation) through which ACFM adversity leaves a lasting mark. Adolescence has become a focal point for analysis and intervention as it relates to the effects of early life adversity on puberty, linear growth, and mental health. Research in public health and psychological science suggests early life adversity (ELA) may accelerate puberty, heightening risks for mental health disorders. However, it is not well substantiated whether ACFM-derived adversities accelerate or delay relative pubertal timing. Secondly, ACFM provides salient context through which to probe the relationships between nutritional, psychosocial, and demographic changes and their respective impact on puberty and mental health. We conducted a narrative review which 1) examined constructions of early life adversity and their proposed influence on puberty 2) reviewed empirical findings (n = 29 studies, n = 36 samples) concerning effects of ACFM ELA on age at menarche and 3) discussed proposed relationships between early life adversity, puberty, and mental ill-health. Contrary to prior research, we found war-derived early life adversity was more consistently associated with pubertal delay than acceleration and may exert counterintuitive effects on mental health. We show that ELA cannot be operationalized in the same way across contexts and populations, especially in the presence of extreme forms of human stress and resilience. We further discuss the ethics of puberty research among conflict-affected youth.

The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis

OBJECTIVE

Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children?

SOURCES

This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034.

SUMMARY OF THE FINDINGS

Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %).

CONCLUSIONS

These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress.

Secular trends in risk factors for adolescent anxiety and depression symptoms: the Young-HUNT studies 1995-2019, Norway

In recent decades, increases in mental health problems in adolescents have been reported from several large population-based surveys. This raises questions about changes in underlying risk and protective factors that can inform future intervention strategies. Population data were collected from 1995 to 2019 in three waves of the Young-HUNT studies in Norway to map decennial trends in the prevalence of established risk factors for, and their associations with, adolescent mental health problems. All adolescents (aged 13-19 years) attending lower and upper secondary school in the county of Trøndelag were invited, representing three historical cohorts of 25,245 unique adolescents. Mental health problems (HSCL-5) and established mental health risk factors were self-reported. Using a generalized linear model and linear regression, we calculated changes in relative and absolute differences between risk factors and mental health problems. Overall, the prevalence of established risk factors for mental health problems in adolescence increased markedly between 1995 and 2019, especially in girls. Prominent increases were observed for fatigue, bullying, musculoskeletal pain and migraine, loneliness, and overweight. Furthermore, with the exception of excess alcohol use and family economy, associations between each risk factor and adolescent mental health problems strengthened over the same time span in girls, but less among boys. Our findings suggest that several modifiable risk factors for poor mental health in adolescence are increasing, especially among girls, and should be targeted in community, school, and in clinical settings.

Prevalence and risk of psychiatric disorders in young people: prospective cohort study exploring the role of childhood trauma (the HUNT study)

BACKGROUND

Better knowledge about childhood trauma as a risk factor for psychiatric disorders in young people could help strengthen the timeliness and effectiveness of prevention and treatment efforts.

AIMS

To estimate the prevalence and risk of psychiatric disorders in young people following exposure to childhood trauma, including interpersonal violence.

METHOD

This prospective cohort study followed 8199 adolescents (age range 12-20 years) over 13-15 years, into young adulthood (age range 25-35 years). Data about childhood trauma exposure from adolescents participating in the Trøndelag Health Study (HUNT, 2006-2008) were linked to data about subsequent development of psychiatric disorders from the Norwegian Patient Registry (2008-2021).

RESULTS

One in four (24.3%) adolescents were diagnosed with a psychiatric disorder by young adulthood. Regression analyses showed consistent and significant relationships between childhood exposure to both interpersonal violence and other potentially traumatic events, and subsequent psychiatric disorders and psychiatric comorbidity. The highest estimates were observed for childhood exposure to two or more types of interpersonal violence (polyvictimisation), and development of psychotic disorders (odds ratio 3.41, 95% CI 1.93-5.72), stress and adjustment disorders (odds ratio 4.20, 95% CI 3.05-5.71), personality disorders (odds ratio 3.98, 95% CI 2.70-5.76), alcohol-related disorders (odds ratio 3.28, 95% CI 2.06-5.04) and drug-related disorders (odds ratio 4.67, 95% CI 2.87-7.33).

CONCLUSIONS

These findings emphasise the importance of integrating knowledge about childhood trauma as a potent risk factor for psychopathology into the planning and implementation of services for children, adolescents and young adults.

Telehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability

BACKGROUND

There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability.

METHODS

Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training.

RESULTS

Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement.

CONCLUSIONS

The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations.

Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study

BACKGROUND

Despite the ubiquity of adolescent screen use, there are limited longitudinal studies that examine the prospective relationships between screen time and child behavioral problems in a large, diverse nationwide sample of adolescents in the United States, which was the objective of the current study.

METHODS

We analyzed cohort data of 9,538 adolescents (9-10 years at baseline in 2016-2018) with two years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We used mixed-effects models to analyze associations between baseline self-reported screen time and parent-reported mental health symptoms using the Child Behavior Checklist, with random effects adjusted for age, sex, race/ethnicity, household income, parent education, and study site. We tested for effect modification by sex and race/ethnicity.

RESULTS

The sample was 48.8% female and racially/ethnically diverse (47.6% racial/ethnic minority). Higher total screen time was associated with all mental health symptoms in adjusted models, and the association was strongest for depressive (B = 0.10, 95% CI 0.06, 0.13, p < 0.001), conduct (B = 0.07, 95% CI 0.03, 0.10, p < 0.001), somatic (B = 0.06, 95% CI 0.01, 0.11, p = 0.026), and attention-deficit/hyperactivity symptoms (B = 0.06, 95% CI 0.01, 0.10, p = 0.013). The specific screen types with the greatest associations with depressive symptoms included video chat, texting, videos, and video games. The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents. The association between screen time and depressive symptoms was stronger among White compared to Asian adolescents.

CONCLUSIONS

Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small. Video chat, texting, videos, and video games were the screen types with the greatest associations with depressive symptoms. Future research should examine potential mechanisms linking screen use with child behavior problems.

The reflective function questionnaire for youth: Hungarian adaptation and evaluation of associations with quality of life and psychopathology

An important correlate of mental health problems is mentalizing capacity, which appears to be particularly influential during adolescence. However, quality of life has not been studied in relation to mentalizing capacity among adolescents. This study aimed to translate the Reflective Function Questionnaire for Youth (RFQY) into Hungarian, present its psychometric properties, and assess its relationship with demographic characteristics, psychopathology and quality of life. A community sample of 384 youths aged 12-18 years completed the RFQY, the Measure of Quality of Life for Children and Adolescents, and the Strengths and Difficulties Questionnaire. First, we conducted an exploratory factor analysis with direct oblimin rotation on the RFQY items. Next, we assessed the associations between the RFQY and demographics, quality of life, and psychopathology. The EFA resulted in four factors: Internal-self, Internal-other, Self-other, and Strong emotions. The Cronbach's alpha coefficients of the scales were .81, .82, .67, and .80, respectively. The subscales were uniquely associated with psychopathology and quality of life. Our study provides the first psychometric support for the Hungarian version of the RFQY and indicates that adolescents suffering from internalizing, externalizing symptoms or lower levels of quality of life could benefit from interventions aimed at enhancing mentalizing capacity.

Mental health among school children and adolescents in China: A comparison of one-child and multiple-children families from a nationwide survey

The influence of China's "one-child" policy on the mental health of children and adolescents is still unclear. This study examined the associations between number of children and children's mental health using data from the national school children and adolescents survey of China. Mental health was measured using the Achenbach's Child Behavior Checklist (CBCL). Linear regression models were used to explore the relationship between number of children per family and children's mental health. A total of 64,017 students were enrolled, with 68.60 % from one-child families. Compared with children from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales (all P<0.001). Analyses suggested children from multiple-child families have a higher risk of mental health problems (total problems on the CBCL: adjusted B=2.217, 95 %CI=1.883-2.550, P<0.001). Regular mental health assessments should be implemented and effective interventions should be developed for those in need.

Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health

OBJECTIVE

Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of mental health treatment in youth when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics.

METHOD

In a cluster randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation strategy plus training and technical assistance in MBC (k = 11, n = 117) or training and technical assistance only (k = 10, n = 117). Primary outcomes of MBC fidelity (assessed via electronic metadata) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youths (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Outcomes of each youth were assessed for 6 months following baseline.

RESULTS

A total of 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition in clinic, clinician, or youth characteristics. Youths in clinics using the Leadership and Organizational Change for Implementation strategy experienced significantly higher MBC fidelity compared with youths in control clinics (23.1% vs 3.4%, p = .014), and exhibited significantly greater reductions in symptoms from baseline to 6 months (d = 0.31, 95% CI: 0.04-0.58, p = .023).

CONCLUSION

Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services.

PLAIN LANGUAGE SUMMARY

Measurement-based care is an evidence-based intervention that has been shown to improve the outcomes of mental health services in dozens of randomized trials; however, it is not widely used in routine practice. In this randomized controlled trial of 21 outpatient mental health clinics and 234 youth, the authors found an organizational intervention which trained clinic leaders in skills to support the use of measurement-based care increased the extent to which patients received measurement-based care compared to control clinics where clinic leaders did not receive this training (23% vs. 3%). Youth receiving services in the clinics that received the organizational intervention also had greater reductions in mental health symptoms.

CLINICAL TRIAL REGISTRATION INFORMATION

Working to Implement and Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/; NCT04096274.

Mechanisms Linking Physical Activity With Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review

INTRODUCTION

Physical activity (PA) is a promising way to improve mental health in children and adolescents with neurodevelopmental disorders (NDDs). However, the underlying mechanisms remain unclear. The current review aimed to explore the potential neurobiological, psychosocial, and behavioral mechanisms between PA interventions and mental health in children and adolescents with NDDs.

METHODS

Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC were searched from inception to June 2023. Randomized controlled trials/quasi-experimental designs applying PA interventions and reporting at least one mental health outcome and at least one potential mechanism in children and adolescents with NDDs were included. The best evidence synthesis rating system was adopted to determine the strength and consistency of potential mechanisms and was performed in 2024.

RESULTS

In total, 45 studies were included, 29 of which were randomized controlled trials and 16 were quasi-experimental, with a total of 1,751 participants. According to the best evidence synthesis rating system, neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms were the frequently examined and consistent mechanisms through which PA affected mental health in children and adolescents with NDDs. However, evidence regarding P3 latency, beta activity, and physical self-concept was insufficient.

DISCUSSION

Future PA interventions could consider neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms. Alternatively, PA can be developed as an adjunctive approach with interventions that specifically focus on these mechanisms to enhance mental health in children and adolescents with NDDs.

Rural-urban differences in common mental disorders among Indonesian youth: a cross-sectional national survey

BACKGROUND

The onset of common mental disorders (CMDs) is most prevalent among youth; thus, mental health management is crucial. We examined differences in risk and risk factor determinants regarding CMDs prevalence among youth in rural and urban Indonesia.

METHODS

This cross-sectional study utilized data from the 2018 Indonesia National Health Survey. The population comprised 122,114 respondents, aged 15 to 24 years, who had completed the 20-item Self-Report Questionnaire along with providing demographic and health behavior data. Chi-square testing and logistic regression were employed for analysis.

RESULTS

The CMDs risk was higher among urban than rural youth. Risk factors impacting both populations included being female, having a lower education level, consuming fewer than 7 portions of vegetables weekly, smoking, and drinking alcohol (p<0.05). Consuming under 7 portions of fruit weekly and being in the highest or lowest wealth quintile were significant risk factors only in urban youth, while unemployment and divorce were significant only among rural respondents (p<0.05). Marriage was protective against CMDs among rural participants.

CONCLUSION

Being male, possessing a college degree, consuming at least 7 portions of vegetables weekly, not smoking, and not consuming alcohol were associated with reduced CMDs risk in urban and rural youth. Among rural youth, marriage and employment were linked to decreased risk, whereas divorce displayed the opposite relationship. In urban populations, consuming at least 7 portions of fruit weekly and belonging to neither the highest nor the lowest economic quintile were protective factors. Management strategies for CMDs in young people must address these considerations.

Prevalence of depressive symptoms among young adults in Brazil: Results of the 2013 and 2019 editions of the National Health Survey

OBJECTIVE

To estimate the prevalence of depressive symptoms in the population aged 18 to 24, according to socioeconomic and demographic aspects in Brazil, comparing its evolution between 2013 and 2019.

METHODS

Cross-sectional study carried out with secondary data obtained from National Health Survey 2013 and 2019. It were included 7,823 young adulthood (aged 18 to 24) from 2013 and 8,047 from 2019. The instrument used to assess depression was the Patient Health Questionnaire-9 (PHQ-9). All estimates included population weights and complex sampling.

RESULTS

The prevalence of depression almost doubled: 10.9% (95%CI 9.6-12.2) in 2019, compared to 5.6% (95%CI 4.8-6.4) in 2013, an absolute difference of 5.3% (4.5-6.0) greater. Women were the most affected in both surveys, with an increase between 2013 (8.3%; 95%CI 6.9-9.6) and 2019 (15.6%; 95%CI 13.5-17.6) higher than that of men (2013: 2.9%; 95%CI 2.0-3.8 and 2019: 6.2%; 95%CI 4.7-7.7). In both sexes, the pattern of increase was greater for the groups aged 18 to 20, not participating in religious activities, who were at the lowest levels of education and income, who lived with two or three or more people, who lived in the Northeast, Southeast, capitals and metropolitan areas of the country.

CONCLUSION

There was a significant increase in the prevalence of depressive symptoms over the six years between the two surveys. However, this increase did not occur homogeneously among the characteristics analyzed, indicating population groups and locations in Brazil where the presence of these symptoms increased most in the period.

Assessment of Children and Adolescents' Admissions to Pediatric Psychiatric Emergency Department

OBJECTIVE

Emergencies in child and adolescent psychiatry are prevalent, and pediatric psychiatric emergency departments play a crucial role in acute intervention during mental health-related crises. This retrospective cross-sectional study aimed to analyze the characteristics of children and adolescents who were admitted to a pediatric psychiatric emergency department.

METHOD

The data were collected from the records of 8803 patients (females 56.6%, Mage = 15.07 ± 2.6) admitted to our pediatric psychiatry emergency department between 2014 and 2021. Diagnoses were made using the International Statistical Classification of Diseases, 10th Revision. We used descriptive statistics to determine patient characteristics and conducted a regression analysis to compare the changes in the admissions numbers by the year.

RESULTS

It was found that depressive disorder was the highest psychiatric diagnosis, with a percentage of 21.4%. Depressive disorder, autism spectrum disorder, and obsessive-compulsive disorder have shown an increase over the years. In 2020, with the onset of the COVID-19 pandemic, psychiatric admissions reached their lowest level. The percentage of hospitalizations was 21.1% for the total of all years. No significant change was found in the total number of admissions, sex, and age.

CONCLUSIONS

The number of admissions for female adolescents who were diagnosed with depressive disorder to our pediatric psychiatry emergency department is shown to be high. The fact that these patients seek help more frequently should be taken into consideration during the planning of mental health services for outpatient and inpatient clinics as well as pediatric psychiatry emergency services.

A systematic review of suicide risk management strategies in primary care settings

Introduction and Objective

Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts.

Methodology

A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized.

Results

Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance.

Discussion

Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.

Parent-child emotion dynamics in families presenting for behavioral parent training: Is there a link with child behavior, parenting, and treatment outcome?

OBJECTIVE

Behavioral parent training (BPT) is the standard of care for early onset behavior disorders (BDs), however, not all families benefit. Emotion regulation (ER) is one potential mechanism underlying BPT outcomes, yet there are challenges in capturing intra- and interpersonal aspects of emotion regulation within parent-child interactions that are central to BPT. This study examined how vocally encoded emotional arousal unfolds during parent-child interactions and how parents and children influence each other's arousal (Aim 1), the links between these emotion dynamics, child behavior, and parenting at baseline (Aim 2), and BPT outcome (Aim 3).

METHOD

Families of children with BDs (N = 45) completed two interaction tasks and measures of parenting and child behavior. Parent-child dynamics of vocal fundamental frequency (f₀) were modeled using actor-partner interdependence models (APIMs) and coupled linear oscillators (CLOs).

RESULTS

When considering relative levels of f₀ from one talk turn to the next (APIMs), parents and children showed intrapersonal regulation and synchronizing reactivity to each other's f₀. When considering the shape of oscillations (CLOs), parents and children showed intrapersonal regulation but no reactivity. Intrapersonal regulation of f₀ during the interaction was slowed for parents with more maladaptive parenting and children with more behavior problems at baseline.

CONCLUSIONS

This preliminary characterization of f0 in families presenting for BPT provides insights into the emotion dynamics potentially underlying parenting behavior and child behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

The relationship between general psychopathology in young people with family functioning and engagement with psychotherapy

OBJECTIVE

to examine whether an underlying general psychopathology factor (p factor) existed in children and adolescents attending psychodynamic psychotherapy and whether this general psychopathology factor was associated with family functioning and engagement with psychotherapy.

METHOD

Participants were 1976 children and adolescents, and their families, who sought psychodynamic psychotherapy from a community-based clinic in Southern Brazil. The Child Behavior Checklist and the Family Adaptability and Cohesion Evaluation Scales for assessing symptoms and family functioning were used, with treatment engagement data available through linked records. Confirmatory factor analytic methods examined psychopathology and regression models were constructed to examine associations.

RESULTS

A general psychopathology factor and specific internalizing and externalizing factors were identified. Higher general psychopathology scores at assessment were associated with an increased likelihood of dropout and poorer attendance compared to completing treatment. Father's educational level, living with both parents, lack of family adaptability and cohesion, and maltreatment experience were related to increased p factor severity.

CONCLUSION

General psychopathology severity seems to contribute to child and adolescent psychotherapy outcomes, increasing the risk of non-adherence and dropout. Family difficulties and traumatic experiences may increase p factor severity. Identifying general psychopathology routinely can be crucial for developing effective treatment plans.

Measurement of adolescent psychological wellbeing: A test of factor structure and measurement invariance

Gains in holistic approaches to adult mental health have been associated with increasing interest in understanding psychological wellbeing (PWB) among adolescents. Empirical examination of measurement models for PWB in adolescence is lacking. Thus, the current study examined PWB in a longitudinal, diverse sample of 433 adolescents (non-Latinx Black: 37.6%; non-Latinx White: 25.9%; Latinx: 36.5%; Male adolescents: 50.1%). A one-factor, correlated six-factor and hierarchical models were examined across racial/ethnic (White, Black, and Hispanic) and gender (female, male) identities, after which the best fitting model was selected to undergo invariance testing. A one-factor structure was superior, and exhibited strict invariance across racial/ethnic and gender identities at each wave of the study, as well as longitudinal invariance within the entire sample.

Sociodemographic Predictors and Moderators of Treatment Outcomes of Psychotherapeutic Interventions for Young People with Mental Disorders: A Systematic Review

Despite the worrying prevalence of mental disorders among adolescents and young people, evidence on predictors of treatment outcome remains scarce. Systematic reviews have focused on specific disorders or treatment modalities and have not targeted this age group in particular. This systematic review presents an overview of the sociodemographic predictors and moderators on the outcome of psychotherapeutic interventions for adolescents and young people with mental disorders across treatment modalities. The search was conducted in PubMed and PsycINFO following the PICOS strategy. The included studies were clinical outcome studies on psychotherapeutic interventions, targeted for young people (aged 12–30 years) with specified mental disorders and published in peer-reviewed journals. During a four-step screening process, 17,359 articles were assessed, among which 114 met the inclusion criteria. Most included studies involved patients with mood, eating, or substance use disorders. Age, gender, and ethnicity were the most frequently reported predictors. For age and gender the findings were mixed, so it is not possible to state which age group or gender would benefit most from treatment across disorder groups. Ethnic minority status and history of traumatic events may predict poorer outcomes. However, the results mainly did not support the relevance of sociodemographic variables for predicting treatment outcome.

Development of Internalizing Mental Health Symptoms from Early Childhood to Late Adolescence

Children's mental health symptoms' development can be characterized by both continuity and discontinuity. However, existing studies ignore the potential discontinuity in children's internalizing symptoms' development. Hence, the current study examines continuous and discontinuous developmental trajectories using representative data from a sample of 2792 children (49.10% females) from the Growing Up in Australia cohort assessed seven times (ages 4, 6, 8, 10, 12, 14, 16). Longitudinal measurement invariance analyses revealed that internalizing symptoms were comparable over time. Linear, quadratic, and piecewise latent growth curve models were deployed to estimate the trajectory of internalizing symptoms from early childhood to late adolescence. The analyses showed that internalizing symptoms were characterized by a quadratic-quadratic piecewise growth curve comprising two distinct phases of upward concave growth. Internalizing scores reduced steadily between ages 4 and 8 years but exhibited a slight upward curvature between ages 8 and 10 years. By age 14 years, the trajectory remained relatively stable but spiked between age 14 and 16 years. The two phases of internalizing symptoms' development were largely unrelated. Overall, the study adds to the knowledge about the development of internalizing mental health from early childhood to late adolescence and highlights the need for additional support in late adolescence.

Hypomania-Checklist-33: risk stratification and factor structure in a mixed psychiatric adolescent sample

BACKGROUND

The 33-item Hypomania Checklist (HCL-33) has been shown to distinguish between adolescent bipolar disorder (BD) and unipolar depression. To investigate the utility of the HCL-33 as a screening tool in routine diagnostics, the frequency and psychopathological characteristics of detected individuals in a mixed psychiatric sample necessitate more examination.

METHODS

The HCL-33, Children's Depression Inventory, Beck's Anxiety Inventory, and Strengths and Difficulties Questionnaire were completed by 285 children and adolescents (12-18 years) in a mixed psychiatric sample. Applying the proposed HCL-33 cut-off score of ≥ 18, individuals with depressive symptoms were divided into at-risk or not at-risk for BD groups. The factorial structure, sum and factor score correlations with psychopathology, and impact on daily functioning were assessed.

RESULTS

20.6% of the sample met at-risk criteria for BD. These individuals (n = 55) were older, more anxious, and showed more conduct problems vs the not at-risk group (n = 107). A two- and a three-factor model were pursued with the same Factor 1 ("active-elated"). Factor 2 ("risk-taking/irritable") was separated into 2a ("irritable-erratic") and 2b ("outgoing-disinhibited") in the three-factor model. Whereas higher Factor 2 and 2a scores correlated with a broad range of more severe symptomatology (i.e., depression, anxiety, hyperactivity), higher Factor 1 and 2b scores correlated with more emotional and conduct problems, respectively. 51.7% of the sample reported a negative impact from hypomanic symptoms on daily functioning.

LIMITATIONS

Cross-sectional design and data collection in a single mental health service.

CONCLUSIONS

The HCL-33 may be a useful tool to improve diagnostics, especially in adolescents with depressive symptoms additionally presenting with anxious symptoms and conduct problems.

Sleep quality and the cortisol and alpha-amylase awakening responses in adolescents with depressive disorders

BACKGROUND

Depressive disorders in adolescents affect all aspects of life and impose a very large burden of disease. Sleep is frequently affected by depression and is crucial for facing challenges during development. One of the postulated reasons for depression-induced sleep disruption is dysregulation of the physiological stress system.

AIMS

To investigate the links of adolescent depressive disorders with subjective sleep quality, objective sleep quality, and the course of cortisol and alpha-amylase after awakening.

METHOD

We compared subjective sleep quality (via daily questionnaires) and objective sleep quality (via actigraphy measurement) of 35 adolescents with depressive disorders and 29 healthy controls over 7 consecutive days. In addition, saliva samples were collected on 3 days to examine cortisol and alpha-amylase patterns after awakening.

RESULTS

No significant differences in cortisol or alpha-amylase awakening responses were observed between participants with depressive disorders and healthy controls. We found severe reductions in subjective sleep quality in the depression group (Z = -5.19, P < 0.001, d = 1.80) and a prolonged actigraphy-measured sleep onset latency (Z = -2.42, P = 0.015, d = 0.64) compared with controls. Reductions in subjective sleep quality were partially correlated with objective sleep measures (sleep onset latency: r = -0.270, P = 0.004, sleep efficiency: r = 0.215, P = 0.017).

CONCLUSIONS

Sleep onset latency seems to aggravate depressive symptoms and to have an important role in perception of sleep quality. Adolescents with depressive disorders should be supported regarding the establishment of good sleep hygiene and avoiding activities that may impede falling asleep.

Within-person biological mechanisms of mood variability in childhood and adolescence

Mood variability, the day-to-day fluctuation in mood, differs between individuals and develops during adolescence. Because adolescents show higher mood variability and average mood than children and adults, puberty might be a potential biological mechanism underlying this increase. The goal of this preregistered developmental study was to examine the neural and hormonal underpinnings of adolescent-specific within-person changes in mood variability, with a specific focus on testosterone, cortisol, pubertal status, and resting-state functional brain connectivity. Data from two longitudinal cohorts were used: the L-CID twin study (aged 7-13, N at the first timepoint = 258) and the accelerated Leiden Self-Concept study (SC; aged 11-21, N at the first timepoint = 138). In both studies resting-state functional magnetic resonance imaging (rs-fMRI) data was collected, as well as daily mood. Additionally, in the SC study self-reported puberty testosterone and cortisol were collected. Random intercept cross-lagged panel models (RI-CLPM) were used to study the within-person relations between these biological measures and mood variability and average mood. Mood variability and average mood peaked in adolescence and testosterone levels and self-reported puberty also showed an increase. Connectivity between prefrontal cortex (dlPFC and vmPFC) and subcortical regions (caudate, amygdala) decreased across development. Moreover, higher testosterone predicted average negative mood at the next time point, but not vice versa. Further, stronger vmPFC-amygdala functional connectivity predicted decreases in mood variability. Here, we show that brain connectivity during development is an important within-person biological mechanism of the development of mood in adolescents. PRACTITIONER POINTS: Mood variability peaks in adolescence. Within-person changes in testosterone predict within-person changes in mood. Within-person changes in vmPFC-amygdala connectivity predict within-person changes in mood variability.

Development and psychometric properties of the Clinical Anxiety Scale for People with Intellectual Disabilities (ClASP-ID)

BACKGROUND

There is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure.

METHODS

A comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities.

RESULTS

Exploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores.

CONCLUSIONS

The findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.

AttentionCARE: replicability of a BCI for the clinical application of augmented reality-guided EEG-based attention modification for adolescents at high risk for depression

Affect-biased attention is the phenomenon of prioritizing attention to emotionally salient stimuli and away from goal-directed stimuli. It is thought that affect-biased attention to emotional stimuli is a driving factor in the development of depression. This effect has been well-studied in adults, but research shows that this is also true during adolescence, when the severity of depressive symptoms are correlated with the magnitude of affect-biased attention to negative emotional stimuli. Prior studies have shown that trainings to modify affect-biased attention may ameliorate depression in adults, but this research has also been stymied by concerns about reliability and replicability. This study describes a clinical application of augmented reality-guided EEG-based attention modification ("AttentionCARE") for adolescents who are at highest risk for future depressive disorders (i.e., daughters of depressed mothers). Our results (n = 10) indicated that the AttentionCARE protocol can reliably and accurately provide neurofeedback about adolescent attention to negative emotional distractors that detract from attention to a primary task. Through several within and cross-study replications, our work addresses concerns about the lack of reliability and reproducibility in brain-computer interface applications, offering insights for future interventions to modify affect-biased attention in high-risk adolescents.

Evaluating outcomes following adolescent and youth mental health inpatient admissions: A systematic review

AIM

Increasing rates of mental illness among young people, exacerbated by the negative impacts of COVID-19, has resulted in growing pressure on available psychiatric resources to meet increasing demand. Inpatient units provide specialist care for young people with the most severe and complex mental disorders but are one of the most expensive models of psychiatric care. The aim of this review is to provide an update on the effectiveness of adolescent and youth mental health inpatient units in improving outcomes to inform the most efficacious use of psychiatric resources.

METHODS

Systematic searches of PubMed, The Cochrane Library, PsycINFO, EMBASE, and Web of Science were conducted for studies published in English between January 2011 to May 2022. Criteria for selection included participants aged 12-25 years who had been admitted to amental health inpatient unit. Studies were excluded if set in substance abuse or disability specific units, outpatient or forensic settings, or assessed novel interventions.

RESULTS

23 studies were identified as meeting inclusion criteria, with most (n = 19) utilizing a pre-post observational design and reporting improvement across various domains following inpatient treatment. A total of 24 different outcome measures or methods were used meaning a meta-analysis of results was not possible. There was also a lack of consistency across models of care, lengths of stay, admission policies, and interventions provided.

CONCLUSION

Inpatient units provide positive outcomes for consumers however a clear understanding of clinical significance and comparison to other treatment settings is lacking.

Pediatric Pharmacology for the Primary Care Provider: Advances and Limitations

Despite >1 in 5 children taking prescription drugs in the United States, off-label drug use is common. To increase the study of drugs in children, regulatory bodies have enacted legislation to incentivize and require pediatric drug studies. As a result of this legislation, novel trial approaches, and an increase in personnel with pediatric expertise, there have been numerous advancements in pediatric drug development. With this review, we aim to highlight developments in pediatric pharmacology over the past 6 years for the most common disease processes that may be treated pharmacologically by the pediatric primary care provider. Using information extracted from label changes between 2018 and 2023, the published literature, and Clinicaltrials.gov, we discuss advances across multiple therapeutic areas relevant to the pediatric primary care provider, including asthma, obesity and related disorders, mental health disorders, infections, and dermatologic conditions. We highlight instances in which new drugs have been developed on the basis of a deeper mechanistic understanding of illness and instances in which labels have been expanded in older drugs on the basis of newly available data. We then consider additional factors that affect pediatric drug use, including cost and nonpharmacologic therapies. Although there is work to be done, efforts focused on pediatric-specific drug development will increase the availability of evidence-based, labeled guidance for commonly prescribed drugs and improve outcomes through the safe and effective use of drugs in children.