Clinical Research Updates

Abstract

Lucy Snelson

South London and Maudsley NHS Foundation Trust

Bullying is considered one of the most robust, preventable risk factors for the development of psychiatric disorders. It is recognised by the World Health Organisation as a major public health concern. Those with neurodevelopmental and psychiatric conditions may be at increased risk of being involved in bullying due to being perceived as different by their peers.

Abregú-Crespo et al. (2024) conducted a systematic review and meta-analysis to explore the overall prevalence of bullying in those with neurodevelopmental and psychiatric conditions. The authors identified 212 studies which reported bullying in children and adolescents (N = 126,717; 37.6% female) aged 4–17 (mean age: 12.3 years) with a neurodevelopmental or psychiatric condition. They distinguished between traditional bullying, which included physical, verbal and relational bullying (actions which intend to harm an individuals' reputation), and cyber bullying, defined as repeated harm inflicted online (for example on social media). They noted that this was the first meta-analysis in this population to differentiate between different types of bullying, including the relatively recent phenomenon of cyberbullying.

The authors found that 42.2% of young people with neurodevelopmental or psychiatric conditions were victims, 24.4% were perpetrators and 14% were both victims and perpetrators of traditional bullying. Those with conduct disorders, autism and ADHD showed the highest prevalence rates for involvement in traditional bullying. Prevalence rates were lower for involvement in cyber bullying, with 21.8% of the population being victims and 19.6% perpetrators. Interestingly, the rate of those who were both victims and perpetrators were higher for cyberbullying (20.7%) than traditional bullying. Furthermore, when compared with controls (N = 504,806; 47.5% female; mean age 12.5 years), this population experienced increased bullying victimisation (2.85-fold), perpetration (2.45-fold) and perpetration–victimisation (3.66-fold). The authors suggested that difficulties in social communication, behaviour and emotional regulation may lead young people in this population to be perceived as being different to their peers and, therefore, more vulnerable to being involved in bullying. Lastly, they found that victims of traditional bullying with neurodevelopmental or psychiatric conditions scored higher on mental health measures including internalising, externalising, general psychopathology and suicidality compared to controls.

A key strength of the study is that the authors used a thorough screening method to minimise risk of bias and to increase the validity of the results. All articles were screened twice across three screening phases with five researchers reviewing articles independently. They performed additional sensitivity analyses removing cases with conduct disorders to avoid skewing their results, in recognition of their finding that there is a higher prevalence of bullying involvement in this population. A limitation is that most of their reported results did not distinguish between neurodevelopmental and psychiatric conditions. Experiences and symptomatology of different psychiatric conditions vary significantly and particularly from neurodevelopmental disorders where differences in social communication is a defining feature. This may make it difficult for healthcare professionals to identify practical implications when supporting young people with different conditions. The authors also acknowledged that many of the studies included in the analysis were poorly described and lacking in detail.

Abregú-Crespo, R., Garriz-Luis, A., Ayora, M., Martín-Martínez, N., Cavone, V., Carrasco, M. Á., … & Díaz-Caneja, C. M. (2024). School bullying in children and adolescents with neurodevelopmental and psychiatric conditions: a systematic review and meta-analysis. The Lancet Child & Adolescent Health, 8, 122–134.

Charvi Saraswat

South London and Maudsley NHS Foundation Trust

Psychotic experiences (PEs) are population-level indicators of psychosis vulnerability, and their aetiologies have been linked to a variety of genetic, neurobiological, substance-related, infection-related and societal factors. The COVID-19 pandemic, and restrictions during this period evidently led to social isolation and, in turn, increase in mental health symptoms.

DeVylder et al. (2024) explored the presence of self-reported PEs in youth followed up since age 10 years as part of the Tokyo Teen Cohort study (TTC), an ongoing longitudinal study in metropolitan Tokyo. In TTC, adolescents born between September 1, 2002, and August 31, 2004, were randomly selected and data were collected around the ages of 10 years (T1), 12 years (T2), 14 years (T3) and 16 years (T4). Out of 3171 adolescent-parent pairs participating at T1, 2616 continued to be followed up by age 16 years with a follow up rate of 82.5%. PEs were assessed through a series of self-reported questions derived from the Diagnostic Interview Schedule for Children with an added question on visual hallucinations scoring on a three-point scale (no; maybe; yes, definitely). The participants included in the statistical analysis if they had responses on PEs both at T4 and at least one of previous stage. Multilinear regression models were used to test the association between phases of the COVID-19 pandemic and self-reported PEs. Of 1935 participants included in the analysis, 49.1% took the T4 survey before the pandemic and 50.9% during the pandemic. No adolescents were using recreational drugs including cannabis. Attrition bias was examined by comparing those included in the analysis with those excluded. The study identified a rapid increase in PEs at the onset of the COVID-19 pandemic, following approximately 6 years of steady decline across prior stages, which was more pronounced in boys than girls. This was also more pronounced at the later stages of the pandemic when social restrictions were put in place in Tokyo, including school closures, emergency status being announced and social distancing guidance.

The authors hypothesised about potential mechanisms for the increase in PEs. These included the contribution of social isolation to subjective feelings of loneliness, possible child maltreatment increasing and expectations related to college and employment prospects being affected. Adolescent boys may have been more impacted due higher expectations for their future associated with notable gender divides in Japan and due to the nature of their interpersonal interactions involving more shared social activities to conceptualise friendship compared to girls.

The authors recognised the potential limitation of the study's inability to rule out COVID-19 infection being a biological cause for increased PEs, albeit unlikely considering the low infection rate among this age group in Japan during this time. Other limitations include attrition, the lack of testing of possible mechanisms and the reliance on self-reported measures for PEs.

In conclusion, the study used the natural experiment of the COVID-19 pandemic and provided evidence that PEs may be increased due to social isolation and social restrictions, affecting differentially boys and girls.

DeVylder, J., Yamaguchi, S., Hosozawa, M., Yamasaki, S., Ando, S., Miyashita, M., … & Nishida, A. (2024). Adolescent psychotic experiences before and during the COVID-19 pandemic: A prospective cohort study. Journal of Child Psychology and Psychiatry, 65, 776–784.

Marios Stathopoulos

National and Kapodistrian University of Athens

Energy drinks (ED), characterised by high caffeine and sugar content, have seen a rapid increase in consumption since their introduction in 1987, with the global market estimated at $45.80 billion in 2020. There had been concerns in relation to the effects of these drinks on children and young people.

Ajibo and colleagues (2023) explored, through a systematic review, the effects of ED consumption on children and young people in relation to various health, behavioural and educational outcomes. The review employed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach and included 57 studies from diverse geographical regions, with 1,287,682 participants aged 9 to 21 years. Notably, 48 studies were excluded due to being evaluated as ‘weak’ following a quality assessment. ED consumption was found to be positively linked to smoking, alcohol use, binge drinking, substance use and risky behaviours. Additionally, ED consumers compared to nonconsumers more frequently exhibited sensation-seeking tendencies, engaged in delinquent behaviours and adopted less healthy lifestyles such as unhealthy dietary habits. Higher ED consumption also correlated with lower academic performance, short sleep duration and poor sleep quality, increased arterial stiffness, elevated blood pressure, heart rhythm irregularities and insulin resistance. Novel findings, compared to a previous systematic review by the same group, included associations of ED consumption with dental issues, asthma, allergic rhinitis, atopic dermatitis, frequent urination and unhealthy weight control behaviours. In relation to mental health adverse outcomes, ED intake was associated with increased anxiety, higher risk of suicidality, stress, depressive and panic symptoms, emotional difficulties, attention-deficit hyperactivity disorder symptoms and conduct disorder.

Limitations of this systematic review include study design issues, as most identified studies were cross-sectional, age range heterogeneity and inability to conduct a qualitative data synthesis. The lack of longitudinal studies did not allow the evaluation of the trajectory of health and behavioural effects over time which would help establish causal relationships. However, experimental studies to ascertain causality face ethical and feasibility challenges, particularly when investigating the impact of ED on children and young people.

In conclusion, this review strengthens the existing evidence on the adverse effects of ED consumption on children and youth. It recommended regulatory measures, including potential sales bans and advertising restrictions to younger age groups, to mitigate health risks associated with ED consumption in this population.

Ajibo, C., Van Griethuysen, A., Visram, S., Lake, A.A. (2024). Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes. Public Health, 227, 274–281.

No ethical approval was required for these updates.