Journal of Clinical Psychology最新文献

Objectives

Adolescents transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) may face challenges in accurately identifying and reporting their mental health symptoms, often leading to discrepancies between clinician and patient evaluations. Using data from the MILESTONE project, this study aims to assess clinician-adolescent concordance over 24 months and identify domains of psychopathology with the highest disparities.

Methods

Participants were assessed at baseline, 9, 15, and 24 months using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scale and were categorized in four diagnostic groups. Hierarchical cluster analysis identified symptom-based subgroups of patients based on clinician and patient-rated HoNOSCA scores. Concordance was evaluated through multilevel linear regression models, while Bland–Altman plots examined agreement between scores across time points.

Results

Two clusters of patients were identified: one characterized by lower severity and greater prevalence, the other by higher complexity and fewer individuals. Clinician–patient concordance increased over time, rising from 77% to 83% by the second time point and stabilizing. Concordance varied across diagnostic categories, with anxiety showing the highest agreement and ADHD the lowest.

Conclusions

Improved communication, psychoeducation, and tailored interventions may facilitate greater patient–clinician alignment, thereby supporting more favorable outcomes during this critical developmental period.

Trial Registration: ISRCTN83240263; NCT03013595

Objective

The DSM-5 Alternative Model for Personality Disorders (AMPD) includes two main criteria, impairments in personality functioning (Criterion A) and the presence of maladaptive personality traits (Criterion B). The Personality Inventory for DSM-5 (PID-5) is the primary operationalization of the maladaptive trait framework characterized in Criterion B. This study sought to examine the temporal stability of the PID-5 across 1-year, as well as its concurrent and longitudinal associations with clinically relevant external criteria. We hypothesized the PID-5 would exhibit a high degree of rank-order stability over time, as well as positive associations with putatively negative clinical processes and negative associations with adaptive processes. Negative affectivity was expected to display a markedly consistent pattern of associations, and antagonism was expected to exhibit a more attenuated pattern.

Methods

Participants with heightened borderline personality features completed the PID-5 and measures of emotional, cognitive, and behavioral processes, as well as psychiatric symptomology, at baseline (N = 107; M = 30.94, SD = 7.33; 51% women) and 1-year follow-up (N = 72). Rank-order stability (Pearson's r) and mean-level changes (Cohen's d) for the PID-5 domains and facets were calculated, along with bivariate correlations with outcomes.

Results

Results suggest high stability in terms of rank-order (median Pearson's r correlation of 0.74 for domains and 0.70 for facets), but small to moderate mean-level Cohen's d changes were common (Mdn = −0.56 for domains). Prospective associations with clinical criteria suggest domains and facets are predictive of important therapeutic change processes and outcomes in theoretically expected ways. Negative affectivity exhibited a consistent pattern of associations with outcomes (14/19 correlations > 0.30), and antagonism demonstrated the most attenuated pattern of associations (5/19 correlations > 0.30).

Conclusion

Findings generally support the stability of AMPD maladaptive traits and provide further evidence for the model's clinical utility.

Objective

Early on the morning of September 27, 2024, Hurricane Helene roared through the Southeastern United States, leaving a trail of devastation to be followed by a recovery period that will last months, and, in some places, even years. The purpose of the current study was to analyze the extent to which online posts in response to a well-being prompt yielded positive affective responses despite the magnitude of the crisis.

Method and Results

One week and 2 weeks after the hurricane, a local news agency prompted followers on Facebook to respond with how they were coping. BERTopic modeling conducted on 1941 Facebook comments in response to the first prompt resulted in 25 non-noise topics. In the first sample (1 week after the Hurricane), the largest topic, centering around lack of power, contained 277 comments. The smallest topic, centering around the lack of Internet access, contained 11 relevant comments. Three categories generated from these topics were labeled “Outages” (702 comments), “Gratitude” (352 comments), and “Physical Recovery and Response” (257 comments). In the second sample (2 weeks after the Hurricane), the largest topic centered around gratitude and contained 30 comments. Outages again represented the largest category, with 67 comments, followed by gratitude with 57 comments. Sentiment analysis showed that gratitude had the highest sentiment with sentiment ratings increasing with the second sample. Significant differences by gender were not observed.

Conclusion

These results show that people can experience significant life upheaval and potentially catastrophic loss and still find joy and gratitude. Focusing on factors where people still hold power, such as gratitude for being alive and for community support, allows people to reframe tragedy into an opportunity for growth.

Background

Depression and anxiety are increasingly common among children and adolescents. While school-based cognitive behavioral therapy (CBT) is a promising intervention, most research has focused on its effects in high-risk or symptomatic populations. This leaves a critical gap in our understanding of its effectiveness as a universal prevention strategy for the general, low-risk student population. Establishing whether CBT can benefit low-risk students is crucial for developing proactive, school-wide mental health systems aimed at preventing future problems before they emerge. This study aimed to fill this gap by evaluating the short- and long-term effects of universal school-based CBT on low-risk children and young people, providing insights for optimizing intervention programs.

Methods

Systematic searches of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo were conducted from inception to January 15, 2025 to identify randomized controlled trials (RCTs) of school-based CBT for depression and anxiety in low-risk populations. Paired and regression meta-analyses of these results were conducted using Bayesian hierarchical models.

Results

The 31 RCTs included a total of 19,865 children and young people. Compared to the control group, school-based CBT produced a statistically significant but very small improvement in depressive symptoms (SMD: −0.06, 95% CrI: −0.08 to −0.04) and a small reduction in anxiety symptoms (SMD: −0.19, 95% CrI: −0.22 to −0.17). These effects appeared to be maintained for up to 1 year. Exploratory analyses suggested that males may benefit more from anxiety interventions.

Conclusion

This study provides the first meta-analytic evidence that universal school-based CBT can produce small but durable, long-term preventive effects in low-risk youth. Although the very low quality of the underlying evidence means the findings are not robust enough to support widespread implementation at this time, they establish a crucial signal of effectiveness. The primary implication is that universal CBT is a promising strategy that warrants significant investment in future high-quality, large-scale trials to confirm its real-world value.