Social Media and Youth Mental Health

PURPOSE OF REVIEW

We review recent evidence regarding the relationship between the social media (SM) habits, experiences, and the mental health of youth. We examine effects of social media use (SMU) on specific diagnoses including depression and anxiety. The relationship between psychiatric illness, specific SM experiences, and the issue of SM mental health contagion is also explored.

RECENT FINDINGS

Youth engagement in SMU has increased dramatically in recent years, concurrent with increases in prevalence of depression and anxiety. The relationship between SMU and mental illness is complex and depends on characteristics of the user (e.g., social comparison and fear of missing out (FOMO) and their SM habits and experiences (e.g., cyberbullying, and sexting,). SM engagement has distinct impacts on anxiety, depression, and suicidality. Growing evidence documents how SM may be a medium for psychiatric contagion. Research findings are largely correlational and dependent on subjective report, limiting their interpretation. The mental health of youth is increasingly tied to their SMU, depending greatly on how youth engage with SM and resultant feedback. Future research must look to establish causality in relationships between SM and mental illness.

The Importance of Sibling Relationships for Children in Foster Care

There are approximately 500,000 children in the foster care system in the United States of America. With exposure to chronic and cumulative trauma, they constitute a population with an increased risk of developing mental health concerns and adverse outcomes in later life, including contact with the forensic system. Legislative frameworks that have been developed to facilitate improved outcomes are outlined, although these vary between states, and the focus is often on the parental relationship. Several studies have emphasized the importance of sibling relationships and that placing siblings in the same foster home is associated with higher rates of placement stability, reunification, adoption and guardianship, and fostering positive sibling relations. The multifaceted role of the clinician in promoting recovery from trauma, enhancing resiliency, and thoughtfully prescribing and advocating for familial relationships is discussed.

An exploratory study of clinical and physiological correlates of problematic social media use in adolescents

Prior validation studies of the Bergen Social Media Addiction Scale (BSMAS) demonstrate its utility for identifying problematic social media use in adolescents. There are knowledge gaps regarding the potential clinical and physiological underpinnings of problematic social media use in adolescents. This cross-sectional, single-visit study examined a sample of depressed (n = 30) and healthy (n = 30) adolescents who underwent clinical assessments of depressive symptom severity, bullying, cyberbullying, self-esteem, salivary measures of stress (cortisol and α-amylase) to identify correlates with adolescent and parental reports of the BSMAS. LASSO-penalized multiple linear regression models were implemented. With respect to the adolescent BSMAS scores in all subjects, the risk of problematic social media increased as depressive symptom severity increased. Depressed female adolescents appeared to have a greater risk. Based on parental BSMAS scores, depression status, depressive symptom severity, cyberbullying score, and salivary cortisol significantly predicted problematic social media use. For the depressed sample, the risk of problematic social media use increased as salivary cortisol increased. No significant predictors of problematic social media usage emerged in the healthy control sample. These preliminary results provide novel insights into clinical and physiological characteristics of problematic social media use in adolescents.

Altered markers of stress in depressed adolescents after acute social media use

Social media use (SMU) is an inherent element in the daily life and neurodevelopment of adolescents, but broad concerns exist regarding the untoward effects of social media on adolescents. We conducted a prospective, cross-sectional study that sought to examine the acute effects of SMU on clinical measures and biomarkers of stress in healthy and depressed adolescents. After at least 24 h of abstinence from social media, depressed adolescents (n = 30) and healthy control adolescents (n = 30) underwent baseline clinical assessment of their prior SMU, depressive symptom severity, self-esteem, and exposure to bullying. Participants provided salivary samples that were analyzed for α-amylase and cortisol levels. After 20 min of unsupervised SMU, saliva analyses and clinical assessments were repeated. After 20 min of SMU, salivary cortisol and α-amylase levels were significantly higher in adolescents with depression but not in healthy control adolescents. Furthermore, small but statistically significant changes in depressive symptom severity occurred in all participants. These changes in depressive symptoms were not clinically meaningful. SMU did not significantly change self-esteem measures among participants. Adolescents with depression appeared to have more physiological reactivity after SMU compared with healthy adolescents. Further research should characterize SMU as a clinical dimension and risk factor among adolescents with depression and other psychiatric disorders.

A Retrospective Evaluation of a Pilot Youth Community Assessment and Treatment Service

OBJECTIVE

Targeted, highly accessible early intervention for youths with emerging and complex psychiatric presentations is increasingly needed. The Youth Community Assessment and Treatment Team (YCATT) multidisciplinary service was established to provide intensive intervention for youths in Perth, Australia.

METHODS

The authors conducted a retrospective evaluation to examine YCATT's impact on emergency department (ED) visits, psychiatric inpatient admissions, and provision of care for youths in the transition period between adolescent and adult psychiatric services. Demographic, clinical, and service utilization data for all referrals over the pilot period (2016-2017) were collected and analyzed with descriptive statistics.

RESULTS

During the pilot period, 308 referrals were accepted. All referred youths had a trauma history and presented with acute or complex conditions, and most (66%) were between 16 and 18 years old. The admission rate to a psychiatric inpatient unit was <7%. Of 61 youths specifically referred to YCATT as an alternative to psychiatric admission, 90% were successfully diverted from psychiatric or ED admission. After discharge from YCATT, youths had improved scores on the Health of the Nations Outcome Scale and 10-item Kessler Psychological Distress Scale.

CONCLUSIONS

These findings suggest that YCATT is an accessible and effective service for the population of transition-age youths. It appears that YCATT, in collaboration with other community services, contributed to diverting psychiatric inpatient admissions, facilitated outpatient treatment, and enabled continuity of care for vulnerable youths. The results underscore the need for more accessible, individualized treatment approaches for youths who transition to adulthood.

Evidence Based Dyadic Therapies for 0- to 5-Year-Old Children With Emotional and Behavioral Difficulties

As many as one in four preschool-aged children are estimated to struggle with psychosocial stress and social-emotional issues; yet, interventions are often postponed until older ages when change is actually more difficult. Reasons for this include limited interventions, paucity of FDA approved medications for young children, as well as the dearth of clinicians adequately trained in psychotherapeutic approaches for young children. This commentary outlines indications of the four most commonly used evidence-based dyadic psychotherapies for young children: Child-Parent Psychotherapy (CPP) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), used primarily for young children with trauma, and Parent-Child Interaction Therapy (PCIT) and Child Parent Relationship Therapy (CPRT), used mostly for children with behavioral issues. Rooted in attachment theory and further supported by the premise that the quality of the child-caregiver dyad is paramount to psychological wellbeing, these therapies focus on strengthening this relationship. Literature indicates that insecure or disorganized early attachments adversely affect an individual's lifelong trajectory. These therapies have demonstrated efficacy leading to positive behavioral changes and improved parent-child interactions. The major challenges of clinical practice focused on young children and their families include proper diagnosis and determining the best therapeutic strategy, especially for families who have not benefited from prior interventions. At this time, it is still unclear which therapy is best indicated for which type of patients and it mostly has been driven by convenience and provider preference or training. Further research is required to tailor treatments more successfully to the child's needs.

Dementia Care at End of Life: Current Approaches

PURPOSE OF REVIEW

Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia.

RECENT FINDINGS

Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia. Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.

Parent-Child Interaction Therapy in a Case of Global Developmental Delay and Leukoencephalopathy

Parent-child interaction therapy (PCIT) is an evidence-based, behavioral dyadic treatment for caregivers and their children aged 2-7 years old with emotional and behavioral disorders. Here we present a treatment course of a 3-years-old girl with leukoencephalopathy, dysgenesis of the brainstem, and associated global developmental delay who was diagnosed with muscular dystrophy after PCIT completion. At the beginning of PCIT she had the developmental level of an 18 months old with language skills of a 12-18 months old; both her vocabulary and verbal expression were very limited. She had slow, unco-ordinated gait with limited fine motor skills. She was referred to Psychiatry with concerns regarding disruptive behaviors including severe self-injury. PCIT was started with a focus on PRIDE skills (Praise, Reflection, Imitation, behavioral Description and Enjoyment); particularly behavioral description and reflection with simple developmentally appropriate labeled praise. Modifications to treatment included using non-verbal actions (e.g., "high fives" as praises), sign language and using only one-step basic commands, which greatly improved compliance. In a matter of weeks, the patient demonstrated remarkable improvement in her disruptive behavior as evidenced by parent/daycare report and clinical observation. Surprisingly her vocabulary more than doubled and her ability of self-expression also increased; she was able to point to things and ask for them. This clinical experience suggests that PCIT principles are effective treatment interventions for other clinical presentations outside of the usual inclusion criteria. Implementation of targeted PCIT interventions greatly benefited the development of language skills and communication in a young child with global developmental delay.