European Child & Adolescent Psychiatry最新文献

This longitudinal, population-based cohort study examines the direct and indirect associations between adolescent Attention-Deficit/Hyperactivity Disorder (ADHD) and/or Oppositional Defiant Disorder (ODD) symptoms and adult incomes. Moving beyond a simple direct link, our model explores how ADHD and/or ODD symptoms indirectly affect the accumulation of human, social, and health capital, which in turn may affect productivity and income. The population was drawn from members of the Northern Finland Birth Cohort 1986 (NFBC1986) who had ADHD and ODD symptoms assessed at age 16 using the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviours (SWAN) scale. The results indicate a significant indirect negative effect of adolescent ADHD and ADHD + ODD symptoms on adult incomes. This effect was most pronounced in males with ADHD + ODD, who experienced a 25% income reduction via human capital (education) and an 18% reduction via health capital (presence of psychiatric disorders other than ADHD or ODD). Social capital did not mediate the association. The model was adjusted for work experience, white-collar status, marital status, parenthood, self-rated health, educational attainments of the participants' parents and family type during adolescence. Notably, no direct effect of adolescent ADHD and/or ODD symptoms on adult incomes was observed. These findings highlight the potential of educational and healthcare investments to reduce the income disparities associated with ADHD and ODD symptoms in the general population.

The 2025 ESCAP Research Academy Workshop in Strasbourg focused on the impact of psychological trauma on the brain, emphasising mechanistic insights and early intervention strategies. Prior to the ESCAP Congress, this event aims at supporting the next generation of clinician-scientists in child and adolescent mental health (CAMH). Under the guidance of coordinators Alexis Revet and Paul Klauser, nineteen fellows from 13 countries engaged in comprehensive discussions. Keynote speakers Andrea Danese, Isabelle Mansuy, Vera Clemens, and Eric Bui, offered critical insights into trauma mechanisms and interventions. Using the "world café" model, participants developed a European-wide trauma questionnaire, illustrating international collaboration. The workshop, which was supported by the ESCAP Academic division, successfully integrated academic and clinical insights with personal development. The next workshop is scheduled to take place in 2027 in Athens.

Ketamine and esketamine have been approved as an adjunctive therapy for treatment-resistant major depressive disorder with acute suicidal ideation and behavior in adults. The current paper aimed to systematically review the available data on their efficacy in children and adolescents. The MEDLINE was searched with the keyword 'esketamine' on July 5th, 2024 (by following the PRISMA statement). The review has been registered in PROSPERO for ketamine and esketamine separately (CRD42024552011 and CRD42024516053). Out of 5131 articles originally identified, 29 were included for analysis and discussion. There is only one double-blind RCT with ketamine and another one with esketamine. The ketamine trial tested the effects at 24 h of a single dose with a crossover design and reported that the therapeutic effect lasted for at least two weeks. No effect on suicidality was reported. The esketamine trial reported that mood and suicidality improved after the three infusions were completed. The improvement in depressive symptoms persisted until the end of the study, but the improvement in suicidality did not. ketamine attenuated the negativity bias and reduced depressive cognitive style. Esketamine did not harm cognition, but instead, it improved processing speed. The current systematic review found only positive reports in the literature, but the scarcity of data suggests there is no definitively convincing evidence concerning the usefulness of ketamine and esketamine in the treatment of paediatric resistant depression. More research is needed, both in light of the problematic data in adults as well as in the light of the problems this kind of substance could cause in brain development and maturation.

It is well-established in previous research that maternal psychological distress may have adverse effects on child social and emotional development. However, less is known about the environmental protective factors on child outcomes. This study aimed to explore the moderating role of Early Childhood Education and Care (ECEC) participation on the associations between maternal long-term prenatal, postnatal or current psychological distress and child social and emotional problems and competence. A total of 1,191 children (M_age = 24.54 months, SD = 0.59; 47.4% girls) were drawn from the FinnBrain Birth Cohort Study in Finland. Children participated either in center-based or family-based ECEC or they were cared for at home. Mothers had filled in self-reports of their long-term psychological distress during pregnancy, and postpartum, and the evaluation of their child social and emotional problems and competence at the child age of 2 years. The results showed that the ECEC participation played a protective role in the relation between current maternal psychological distress and child social and emotional problems. Associations between maternal symptoms and children's social and emotional problems was attenuated for children who participated in center-based ECEC (β = -0.37, [-0.64, -0.09], p = 0.008), or family-based ECEC (β = -0.75, [-1.11, -0.40], p < 0.001) when compared to children who were cared for at home. This study reinforces our understanding of the ECEC's potential buffering role in at-risk families and in particular in Nordic countries characterized by high-quality of ECEC and high enrollment rates during early childhood.

Background: While household dysfunction (HD) is associated with negative health outcomes, it remains unclear whether the duration or timing of exposure contribute to aggression. The underlying mechanisms in the HD-aggression relationship are also understudied. This study examined the effects of HD duration and timing on aggression while investigating potential mediating role of depressive symptoms. Sex differences were also explored.

Methods: Data were obtained from 7,800 participants in the Taiwan Birth Cohort Study (52.32% male, 47.68% female) followed to ages 17 or 18 years. HD were coded at five life stages: infancy, early childhood, middle childhood, late childhood, and early adolescence. A structured life course modeling approach was used to assess whether the accumulation of HD (duration), or the timing of exposure, including exposure during sensitive periods and more recent periods, exhibited the strongest association with aggression at age 17 or 18. Causal mediation analysis was conducted to evaluate the role of depressive symptoms in the pathway from HD to aggression.

Results: Among males, both HD accumulation (β = 0.04, 95% CI: 0.004-0.07) and middle childhood HD (β = 0.04, 95% CI: 0.01-0.07) were associated with increased adolescent aggression at age 17/18. Depressive symptoms at age 12 mediated the effects of both cumulative HD and middle childhood HD on aggression at ages 17/18, accounting for an estimated 33% and 20% of the total effects, respectively. No significant association between HD and aggression was observed among females.

Conclusions: Interventions should address HD early and sustain support throughout adolescence, while also targeting depressive symptoms, to effectively reduce aggression, particularly among males.

Background: Suicidality is a major public health concern worldwide. Evidence on the prevalence and risk factors of suicidality amongst unaccompanied young refugees (UYRs), a population already at risk for mental health disorders, is scarce.

Methods: Given the complexity of individual risk factor constellations influencing suicidality, machine learning (ML) methods offer a statistical approach that can detect complex relations within the data. Four ML classifiers, (logistic regression (LR), random forest (RF), support vector machines (SVM), and extreme gradient boosting (XGB)) were trained on a dataset of n = 623 UYRs (M_age=16.77, SD = 1.34, range: 12-21), retrieved from the large-scale randomized controlled trial Better Care to predict suicidal ideation. Features used in the classifiers were age, gender, asylum status, having contact with the family, and whether parents are alive as well as clinically elevated post-traumatic stress symptoms (PTSS), depressive symptoms and past suicide attempts. The classifiers were then tested on the independent dataset of n = 94 UYRs (M_age=16.31, SD = 2.03, range: 5-21) retrieved from the screening tool porta project to examine their predictive performance.

Results: The prevalence of past-week suicidal ideation in the combined sample of N = 717 was 18.13%. All classifiers yielded good predictive performance (accuracy 0.734-0.840, sensitivity 0.857, AUC 0.853-0.880). The most relevant features were past suicide attempts, PTSS and depressive symptoms as risk factors, and having a living mother as protective factor.

Conclusions: Suicidal ideation is prevalent amongst UYRs, and using ML approaches, the classifiers were able to classify roughly 85% of the cases with suicidal ideation in the past week correctly as suicidal. Building on the findings of this study, screening for suicidality could be further improved by implementing ML classifiers in the assessment to highlight potential at risk cases early, and suitable interventions be developed.