Child Psychiatry & Human Development最新文献

Given the ongoing youth mental health crisis amid limited resources, young people and their families need sustainable, low-cost school-based interventions to support their wellbeing and connect them to vital services. As a first developmental phase of a clinical trial to integrate innovative digital mental health intervention into high schools, we first sought to understand the lived experience of students and parents. This study used qualitative methods to analyze diverse high school student, young adult, and parent reports of accessing in-person school-based mental health supports and use of health-related apps. Two-thirds of young people reported using health-related apps with common use related to entertainment, fitness, and mental health. Further qualitative analysis regarding access identified themes around availability, experience with services, and normalizing mental health vs. stigma in schools. Findings suggest opportunities for digital interventions to increase mental health literacy and address stigma through psychoeducation. Digital health tools may support schools as an adjunct to in-person services in reaching under-resourced students in need.

This study investigates the association between maternal trauma history (lifetime exposure to physical and sexual violence), maternal mental health and child behavior. Pregnant women attending the Instituto Nacional Materno Perinatal (INMP) in Lima, Peru, were recruited to join the study beginning in February 2012. Maternal trauma history and prenatal mental health were assessed at 16-weeks gestation and mothers completed the Child Behavior Checklist when children were four years old. We used causal mediation analysis to examine the association between maternal trauma history and child behavior. This study population included 631 mother-child dyads; 74% of mothers reported one or more lifetime episodes of intimate partner violence (IPV). We found that 32% of the association between maternal lifetime exposure to IPV and child internalizing behavior was mediated by prenatal anxiety. Our findings suggest that prevention and treatment of perinatal IPV and mental health disorders should be prioritized.

Trichotillomania (TTM), skin-picking disorder (SPD), and nail-biting (NB) are classified as Body-Focused Repetitive Disorders (BFRBDs), which share characteristics with both obsessive-compulsive and impulse control disorders. This study aimed to compare impulsivity, metacognitions, and clinical characteristics across BFRBDs. Ninety adolescents (aged 10-18 years) with BFRBDs and 40 healthy controls (HC) completed the Revised Children's Anxiety and Depression Scale-Child Version (RCADS-CV), the Metacognitions Questionnaire for Children and Adolescents (MCQ-CA), the Barratt Impulsiveness Scale-Brief (BIS-Brief), and the Pediatric Quality of Life Inventory (PedsQL). Symptom severity was assessed using disorder-specific measures. There were no significant age differences between the BFRBDs and HC groups. However, within the BFRBDs subgroups, adolescents with TTM and SPD were significantly older than those with NB (p = .028). Notably, despite being younger, the NB group exhibited the longest duration of BFRBDs symptoms (p < .001). The TTM group showed higher MCQ-CA total, positive beliefs about worry, and cognitive monitoring. In contrast, the SPD group had higher poor self-regulation scores (all p < .05). Symptom severity across BFRBDs was negatively associated with PedsQL total scores and positively associated with MCQ-CA total and RCADS-CV total scores (all p < .05). These findings suggest that while metacognitions are more prominent in TTM, impulsivity plays a greater role in SPD. Understanding the distinct contributions of impulsivity and metacognitions in BFRBDs may facilitate the development of targeted treatment approaches tailored to each behavior.

Suicide is among the leading causes of death among individuals ages 10-24, making suicidal thoughts and behaviors (STBs) a serious public health crisis among youth. Suicide risk screening and assessment are vital to addressing this public health crisis. In fact, many youths that screen positive for suicidal ideation do not have known mental health concerns and would have been missed if not asked directly. Medical settings are an optimal setting to detect suicidality early and provide appropriate follow-up monitoring and care as needed. To support effective and efficient screening and assessment of suicidal thoughts and behaviors, providers must choose measures with both strong psychometric properties and clinical utility. While measurement of STBs can vary across health settings, suicide risk screening and assessment typically involves gathering information about current suicidal ideation, suicidal behaviors, and suicidal plans via self-report questionnaires, clinical interviews, and/or computerized adaptive screens. In alignment with measurement-based care efforts, the current manuscript will provide a scoping review of measures of youth suicidal ideation, behavior, plans, and their risk factors. Specifically, the psychometric properties, clinical utility, and other key considerations for screening and assessment of adolescent suicide risk are discussed.

Adverse Childhood Experiences (ACEs) include various childhood stressors that can negatively impact the health and well-being of children. ACEs are associated with poor academic achievement. Attention is strongly associated with academic achievement, and there is a graded relationship between ACEs exposure and subsequent development of parent-reported ADHD; however, it is unclear whether ADHD symptoms mediate the relationship between ACEs and academic achievement. This study tested a model of mediation by ADHD symptoms between ACEs and academic achievement (measured by reading score). This retrospective cohort analysis utilized data from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN), a data consortium exploring the impact of child maltreatment (n = 494). There were relatively even numbers of male and female child participants, and the majority of caregivers were either non-Hispanic White or Black. Path analyses were modeled for ACEs as a sum score and separately for individual ACE exposures, with number of symptoms of Inattention (IN) and Hyperactivity/Impulsivity (H/I) as mediators, and academic achievement as the outcome, adjusting for covariates. ACEs were highly prevalent in this sample (M = 5.10, SD = 1.90). After retaining significant covariates, significant direct associations (P < .05) were seen between ACE sum score and IN (β = .14) and H/I (β = .21), and between H/I and reading score (β=-.14). A higher ACE score was associated with lower reading scores through variation in H/I, but not IN. H/I mediated the relationship between ACEs and reading score in this high-risk population, providing new insight into relationships between ACEs and academic achievement, which can inform interventions.

Although there are an increasing number of studies that have explored the mental health consequences of COVID-19 focusing on revealing risk factors, the longitudinal research examining the potential mechanism of the co-occurrence of posttraumatic stress symptoms (PTSS) and depression symptoms among adolescents were scarce. The present study identified the important comorbidity symptoms and explored longitudinal relationship of PTSS and depression symptoms from the network perspective. A two-wave investigation (4 months interval; T1 and T2) was conducted with a sample of 1225 Chinese adolescents. Cross-sectional network and cross-lagged panel network (CLPN) analyses were adopted. Results showed that comorbidity symptoms consisted of both overlapping and non-overlapping symptoms, including "Future foreshortening" at T1 and T2 from PTSS, and "Hard to get started" at T1 and "Not sleep well" at T2 from depression symptoms. Strong longitudinal pathways appeared from all PTSS to depression symptoms, among which the pathway from "Difficulty concentrating" to "Hard to get started" was the strongest. These findings suggest that the possible comorbidity between PTSS and depression symptoms is caused by their independent and related structures, and their longitudinal association. Clinical intervention for these symptoms may alleviate adolescents' psychological problems in the aftermath of traumatic events.

This study aimed to examine the independent influences of academic stress, insecure attachment, and sense of community on suicidal ideation among adolescents. In particular, the independent influence of the sense of community on adolescent suicide was verified by controlling for other variables. For this purpose, youth data (7324 persons) from the panel data of the 4th to 6th Korean Education Longitudinal Studies of the Korea Educational Development Institute were used. Statistical analyses were performed using a generalized estimation equation (GEE). The analysis revealed that gender, academic stress, insecure attachment, and sense of community significantly influenced suicidal ideation. Female students had higher suicidal ideation than male students, and the higher the academic stress and degree of insecure attachment, the higher the suicidal ideation. In particular, the independent influence of a sense of community on suicidal ideation was significant; the higher the sense of community, the lower the suicide ideation score. The implication of this study is to comprehensively consider the factors related to adolescent suicidal ideation in various systems based on Bronfenbrenner's ecological theory. This research suggests that helping schools and communities to increase their sense of community, which is a macrosystem factor, is important in preventing adolescent suicide.

Herein we introduce the Collection "Measurement Based Care in Youth Depression and Suicidality." Measurement-based care (MBC), or the systematic use of measurement tools to inform treatment decisions, has been identified as a key component of providing evidence-based psychiatric care. However, the implementation of MBC at the clinic or health system level is not trivial; barriers to successful implementation are widespread but can be overcome. This Collection presents five manuscripts that cover a range of topics related to the implementation of MBC. The first two articles provide guidance to clinicians and researchers in careful selection of validated measurement tools for depression and suicidality. Next, our authors describe an effort to assess the fidelity of MBC use across the Texas Youth Depression and Suicide Research Network registry study, a statewide longitudinal cohort of depressed and suicidal youth. The following article outlines the benefits, barriers, and implementations strategies to implementing MBC at the health system level. Our final article details the implementation of MBC into a health system and provides data on screening outcomes and related clinical associations.