European Child & Adolescent Psychiatry最新文献

Childhood adversities profoundly affect mental and physical well-being. Effective psychosocial interventions in schools are crucial for mitigating adversities' impacts. Despite availability, many children lack access to those interventions in low-income countries. This study evaluates a universal school-based intervention in Lebanon for children, including refugees, aimed at improving personal competence and reducing mental health symptoms including anxiety, depression, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder. The study involved 1,920 Lebanese and Syrian children in grades 4 to 7, attending public schools in Lebanon. The program comprised 13 sessions administered in classrooms by teachers supervised by fieldworkers. Data collection included pre- and post-intervention assessments using standardized measures to evaluate outcomes. We used linear mixed models to test for intervention effect. Moderators such as childhood adversity, positive home environment, and environmental sensitivity were also tested using three-way interaction. Our intervention led to significant improvements in personal competence and secondary outcomes such as depression, anxiety, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder symptoms. Childhood adversity and environmental sensitivity influenced intervention effects on some secondary outcomes. However, personal competence improvements were consistent across all student subgroups, highlighting the intervention's broad efficacy, even among students with various risk or protective factors. Our study emphasizes the significance of school-based interventions for addressing childhood personal competence and mental health symptoms, especially in low-income countries with limited access to mental health services.

The COVID-19 pandemic negatively affected child and adolescent mental health, but it is unclear which subgroups were affected most. We investigated to what extent severity and type of mental health problems during and after the pandemic were related to preexisting mental disorders in children in care at child and adolescent mental health services. We employed a repeated cross-sectional design involving data collection at seven time points (April 2020 to April 2023) in a total sample of 2,545 children (age 8-18 years). We grouped diagnostic classifications in four categories: Autism, ADHD, Anxious/Depressive disorders, and 'Other'. Mental health was assessed with parent-reported data on internalizing and externalizing problems and with self-reported data from the standardized PROMIS questionnaires 'Anxiety', 'Depressive symptoms', 'Sleep-related impairments', 'Anger', 'Global health', and 'Peer relations'. We tested for main effects between diagnostic categories and for different trajectories over time. We found that mental health outcomes varied substantially between diagnostic categories, with internalizing problems being largest in children with Anxious/Depressive disorders, and externalizing problems being largest in children with Autism and ADHD. However, we found no evidence for differences between diagnostic categories in trajectories in mental health outcomes during and after the COVID-19 pandemic. The results show that during the pandemic mental health outcomes worsened over time in children and adolescents in care, and that this negative effect on mental health did not differ between children with different diagnostic classifications. Regular high-quality monitoring is vital to recognize changing trajectories of youth mental health and to adapt to crisis situations.

Paediatric emergency department (ED) presentations for self-harm and suicidality have significantly increased worldwide in the past decade, making paediatric EDs a key point of contact for young people experiencing suicidal ideation. Since 2022, four systematic reviews have been conducted on interventions for self-harm/suicidality in paediatric EDs, but findings were limited by small sample sizes and high heterogeneity. This meta-review provides recommendations to guide clinical practice and future research to enhance the quality of interventions in paediatric EDs for addressing self-harm and suicide related behaviours. Of 286 studies identified, five reviews synthesising 14 individual studies on ED-based interventions published up to May 2022 were included. Key themes and conclusions were synthesised. Three main themes emerged including: lack of informative trials, low levels of intervention effectiveness and common intervention elements. Informativeness of prior trials was limited by small sample sizes, lack of globally relevant research and limited stakeholder perspectives. Common intervention elements included: follow-up contact post-ED discharge, family involvement and psychoeducation with safety planning. Limited progress has been made in this field, likely due to challenges in conducting rigorous trials in paediatric EDs. Research has failed to incorporate voices of young people and their families, crucial for meeting their needs. Future research must prioritise co-design with youth, parents, and stakeholders as a critical next step in developing more effective paediatric ED interventions. Digital tools may offer promise for delivering interventions in the ED but should complement face-to-face professional contact.

Young people who self-harm are at an increased risk of suicide. Furthering our understanding of the risk factors for self-harm is essential for identifying high-risk groups, which can be used to inform the design of preventative interventions. This study used the Avon Longitudinal Study of Parents and Children (ALSPAC) and applied latent class analysis to the risk factors for self-harm at ages 13 and 17. Longitudinal associations between the latent classes and self-harm at ages 17 and 20 were examined. Cross-cohort comparisons were conducted between this study and a previous study using Irish data. At age 13 there was a low risk group, a peer problems group, and substance use group, similar for the two cohort studies, and a family conflict group, which was the least similar group to its matching group in the Irish study. All of these age 13 high-risk groups had approximately twice the relative risk (between 1.3 and 2.5) for self-harm at age 17 compared to the low risk group. The age 17 models were very similar across the two cohorts, each with a low risk group, a depression and high substance use group, a depression and low substance use group, and a substance use group. The relative risk of self-harm at age 20 for these high-risk groups compared the low risk group ranged from 3.6 to 8.0. These groups could help identify those at risk of self-harm and inform the design of prevention programmes to reduce self-harm behaviour in young people.

Non-suicidal self-injury (NSSI) in adolescent depression is a prevalent and clinically significant behavior linked to dysregulated peripheral inflammation and corticostriatal circuitry dysfunction. However, the neuroimmune mechanisms bridging these systems remain poorly understood. Here, we combined peripheral cytokine profiling with static/dynamic functional connectivity (sFC/dFC) analysis to investigate the potential influence of inflammaton on corticostriatal circuit related to NSSI. A set of peripheral blood inflammatory markers and resting-state functional magnetic resonance imaging (rs-fMRI) were collected in depression with NSSI (NSSI+), depression without NSSI (NSSI-), and healthy controls (HC). We first ascertain group differences in level of pro- and anti-inflammatory cytokines. And using ventral/dorsal striatal seeds, we compared whole-brain, voxel-wise sFC and dFC differences across three groups. Further, we tested the mediation effects of connectivity in the association between inflammatory markers and NSSI frequency. NSSI+ group exhibited elevated pro-inflammatory cytokines (C-reactive protein (CRP), interleukin (IL)-1, and IL-6) whereas reduced anti-inflammatory cytokines (IL-10), compared to NSSI- and HC. Neuroimaging analysis revealed corticostriatal dysconnectivity mainly characterized by static hyperconnectivity between dorsal striatum and thalamus, dynamic instability in dorsal striatum-lingual pathways, and dynamic rigidity in ventral striatum-prefrontal/temporal/occipital gyrus circuits. Critically, sFC of dorsal striatum-thalamus and dFC of dorsal striatum-lingual gyrus mediated the prospective association between altered CRP and NSSI frequency, establishing corticostriatal circuits as conduits for inflammatory effects on NSSI. By bridging molecular psychiatry with circuit neuroscience, this work advances precision management of NSSI in adolescent depression, prioritizing biomarker-driven strategies to disrupt neuroimmune maladaptation.

Compassion and compassionate care for children and young people (CYP) encompass a variety of emotions, including sympathy, empathy, and sadness for their suffering, alongside actions intended to alleviate their distress. While compassion is a well-recognised concept in health and social care, literature has identified various barriers and facilitators that affect the delivery of compassionate care. These include compassion fatigue, time limitations, organisational and clinical culture, insufficient resources or support, technological advancements, and burdensome administrative tasks. Despite being viewed as essential in health care, the concept of compassionate care remains poorly defined and expressed, particularly in the context of mental health services for CYP. This review explored the perspectives of CYPs, their parents, and staff regarding the compassionate care provided in community services. Additionally, it aimed to identify factors that facilitate or obstruct compassionate care for CYPs in both mental health and community settings services. From June to August 2024, a search was carried out for peer-reviewed articles and grey literature, with additional searches conducted in October 2024. The initial search produced 7,461 articles, with 23 selected for this review. A thematic synthesis organised the studies based on the main themes identified: 'Compassionate care is all about humanity' and 'the complex interplay of facilitators and barriers to compassionate care'. The identified articles highlighted the increasing need for compassionate care in community-based services for CYP, along with the range of facilitators and barriers to providing this care. Lastly, we propose an alternative definition of compassionate care tailored to these services.

This study investigates the patterns of antipsychotic drug dispensations among children and adolescents from 2015 to 2023, with a focus on the impact of introducing national health reform (2015) and the COVID-19 pandemic. Data from Maccabi Healthcare Services, encompassing 1,105,439 individuals aged 6-18 years, were analyzed using a retrospective cohort study. We investigated the incidence rates of antipsychotic prescriptions by age, sex, socioeconomic status, and geographical region. During the study period, there was a 15% overall increase in antipsychotics prescriptions. Higher prescription rates were observed among boys aged 6-11 years and girls aged 14-18 years. Significant increases in prescriptions were observed in the year immediately following the mental health reform and the COVID-19 pandemic. Low socioeconomic status and peripheral regions exhibited higher and increasing prescription rates. Seasonal patterns revealed peaks in the fourth quarter of each year. The study highlights an overall increase in antipsychotic prescriptions, influenced by policy changes and the pandemic. Inequality in prescription rates by socioeconomic status and geographical location underscores the need for targeted mental health interventions. The findings also suggest enduring changes in the utilization of antipsychotic medications among youth, which may reflect broader impacts of the COVID-19 pandemic on mental health care needs.

Childhood maltreatment (CM) is a pivotal risk factor for depression, yet its potential contribution to major depressive disorder (MDD) in adolescents requires further investigation. This study aims to scrutinize the specific impact of CM on neurovascular coupling (NVC) in adolescents with MDD. A cohort of 189 adolescents, comprising 54 MDD with CM, 45 MDD without CM, 33 healthy controls (HC) with CM, and 57 HC without CM, underwent multimodal MRI scans. Cerebral blood flow (CBF) was computed to evaluate vascular responses, while functional connectivity strength (FCS) and amplitude of low-frequency fluctuation (ALFF) were measured to assess neuronal activity. NVC was calculated using whole gray matter CBF-neuronal activity correlation coefficients and regional CBF/neuronal activity ratios. MDD×CM interactions on NVC, CBF, and neuronal activity were analyzed, with further exploration of the associations between these abnormal NVC ratios and CM experience. Support vector machine classifiers were employed to differentiate MDD adolescents. Results revealed a significant MDD×CM interactive effect on CBF-FCS coefficients at whole gray matter level. Regionally, these interactions on NVC ratios primarily occurred in the reward systems, including bilateral anterior cingulate/orbitofrontal cortex, thalamus/mesial temporal lobe, and left occipitotemporal lobe, correlating with CM measurements. Notably, the integration of NVC ratio, CBF, and neuronal activity yielded robust classification performance in distinguishing MDD adolescents. These findings reinforce the importance of reward system for MDD adolescents related to CM, proposing a novel neuroimaging biomarker for early recognition of adolescent depression.