Journal of the American Academy of Child and Adolescent Psychiatry最新文献

Objective: To investigate the impact of the SARS-CoV-2 infection on the rates of mental disorders in youth.

Method: The study involved 7,519,465 children and 5,338,496 adolescents from the TriNetX Research Network, all without prior mental disorder histories. Among them, 290,145 children and 223,667 adolescents had SARS-CoV-2-positive tests or confirmed COVID-19 diagnoses. Kaplan-Meier survival analysis was used to evaluate the probability of developing new mental disorders (any codes in International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) F01-F99 category and suicidal behaviors) within 2 years post infection, compared to the propensity score-matched youth who were never infected.

Results: Within 2 years post SARS-CoV-2 infection, children had a probability of 0.15 in acquiring new psychiatric diagnoses, compared to 0.026 for matched non-infected children; adolescents had a 0.19 probability against 0.05 for their non-infected counterparts. The hazard ratio (HR) was 6.0 (95% CI = 5.8-6.3) for children and 4.2 for adolescents (95% CI = 4.1-4.4), with children vs adolescents HR of 1.4 (95% CI = 1.36-1.51). Elevated HRs were observed for almost all subcategories of mental disorders and suicidal behaviors, with variations based on sex, severity of SARS-CoV-2 infection, and viral variants. COVID-19 was similar to other respiratory infections and was associated with a similarly increased rate of mental disorders in adolescents, but had a significantly higher effect on children (HR = 1.57, 95% CI =1.53-1.61).

Conclusion: This study revealed significant mental health distress following SARS-CoV-2 infection in youth, which was more pronounced in children than in adolescents. These findings underscore the urgent need to support at-risk youth, particularly those who contracted SARS-CoV-2 at younger ages and had more severe infections. CLINICAL GUIDANCE.

As the coronavirus disease of 2019 (COVID-19) pandemic continues, a body of emerging evidence suggests that individuals who had been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suffered from lingering adverse health consequences. Such long-term conditions, also known as "long COVID" or "post-acute COVID syndrome," are reported to bring both pulmonary and extrapulmonary manifestations.¹ The most common features of long COVID include fatigue and headache, which frequently occur with neuropsychiatric impairments. Given that the onset of mental disorders occurs primarily in late childhood and adolescence, it is essential to focus on the pediatric population to determine the risk of mental disorder diagnosis following SARS-CoV-2 infection.

Inscribed on the Statue of Liberty, Emma Lazarus's poem, The New Colossus,¹ helped shape the image of the United States as a country compassionate toward the needs of those who emigrated to its shores. The United States has more immigrants than any other country in the world, estimated at more than 40 million people.² Roughly 18 million children in the United States have at least 1 immigrant parent.² Most immigrants in the United States arrive with the hope of better educational and economic opportunities.³ Although moving to a new country can offer new opportunities, stability, and safety, there are also challenges. Immigrants experience unique stressors that lead to potentially negative mental health outcomes. After being pushed out of their home country because of stressful circumstances such as violence, severe poverty, and armed conflicts, many individuals then encounter additional stressors after migrating-including discrimination.³.

Objective: Suicide is a leading cause of death in adolescents and young adults and has increased substantially in the past 15 years. Accurate suicide risk stratification based on rapid screening can help reverse these trends. This study aimed to assess the ability of the Kiddie Computerized Adaptive Test Suicide Scale (K-CAT-SS), a brief computerized adaptive test of suicidality, to predict suicide attempts (SAs) in high-risk youth.

Method: A total of 652 participants (age range, 12-24 years), 78% of whom presented with suicidal ideation or behavior, were recruited within 1 month of mental health care contact. The K-CAT-SS, scaled from 0 to 100, was administered at baseline, and participants were assessed at about 1, 3, and 6 months after intake. Weekly incidence of SAs was assessed using the Adolescent Longitudinal Interval Follow-up Evaluation and Columbia-Suicide Severity Rating Scale. A secondary outcome was suicidal behavior, including aborted, interrupted, and actual SAs.

Results: The K-CAT-SS showed a 4.91-fold increase in SAs for every 25-point increase in the baseline score (95% CI 2.83-8.52) and a 3.51-fold increase in suicidal behaviors (95% CI 2.32-5.30). These relations persisted following adjustment for prior attempts; demographic variables including age, sex, gender identity, sexual orientation, and race/ethnicity; and other measures of psychopathology. No moderating effects were identified. At 3 months, area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) for 1 or more SAs.

Conclusion: The K-CAT-SS is an excellent tool for suicide risk stratification, particularly in higher-risk populations where other measures have shown lower predictive validity.

Depression is a major public health problem among adolescents and preadolescents in the United States. Clinical scientists have spent considerable resources designing and testing depression interventions. Some programs can prevent and reduce depression to a modest degree,¹ while others show null or potentially adverse impacts on youth mental health.² However, due to low access to treatment for depression (more than 50% of adolescents with depression symptoms never access treatment at all³) and the heterogeneity of depressive symptoms, no interventions have led to meaningful declines in the overall burdens of depression for adolescents.⁴ In high school students, rates of self-reported persistent feelings of sadness or hopelessness and suicidal thoughts and behaviors increased between 2011 and 2021 in the United States.⁵ Status quo approaches are unlikely to sustainably improve adolescent depression. We propose that a critical and often overlooked contributor to this shortfall is youth autonomy-a key, developmentally aligned need for adolescents-to reduce rates of depression at the population level. During adolescence, individuals begin to separate from their parents, guardians, and caregivers (hereafter caregivers) and make decisions independently. This process is critical for healthy identity formation, self-efficacy, and mental health, including prevention and reduction of depression.⁶ Youth autonomy is among myriad multilevel factors (eg, social connectedness, food and housing insecurity, adversity exposure) relevant to depression trajectories. However, in contrast to many social and structural contributors to depression, perceived autonomy of youths is relatively modifiable through individual-level intervention, making it a promising intervention target. The psychosocial importance of youth autonomy stands in sharp contrast to modern policies and structures that undermine youth independence and control-including within many existing depression interventions.

Despite decades-long interest in sleep in individuals with attention-deficit/hyperactivity disorder (ADHD)-"restless sleep" was a symptom for diagnosing attention deficit disorder in the Third Edition of the DSM-our understanding of its role in the pathophysiology, trajectories, and functional outcomes of ADHD remains far from complete. This is perhaps no more so the case than in the developmental period of adolescence. The oft-described "perfect storm" of short and ill-timed sleep coinciding with bioregulatory maturation during adolescence¹ may be further intensified for adolescents with ADHD, who often experience wide-ranging and intensifying functional impairments.² Almost a decade ago, Lunsford-Avery and colleagues³ provided a systematic review and research roadmap to guide future research on sleep in adolescents with ADHD, casting a much-needed spotlight on this understudied topic.

The negative effects of the COVID-19 pandemic on youth mental health have been significant.^1,2 The impact of the pandemic on eating disorders has been particularly notable, given the numerous risk factors exacerbated during the pandemic, such as increased social isolation and body image concerns associated with amplified virtual and social media exposure.³ Although the rise of eating disorder presentations have been documented by increased pediatric hospital admissions⁴ at an earlier ages of onset,⁵ there has, until this time, not been a meta-analytical approach to understanding the full scope of this impact on health care use. In our ever-burdened pediatric mental health care systems, it is crucial for the field to understand how health care use for eating disorders has been affected. As such, we read with keen interest the article by Madigan et al.⁶ This meta-analysis fills a gap in the field, analyzing the health care visits of close to 150,000 children and adolescents across more than 300 sites. This study highlights an important theme that has been observed across our mental health systems: there has been a significant increase in severe eating disorder symptom expression since the start of the pandemic. This article provides the empirical evidence to support what has been anecdotally and qualitatively observed across sites-namely, an increased use of higher levels of care, such as emergency rooms and inpatient units, in addition to outpatient care. This increase in service use for eating disorders has been particularly sharp among girls, adolescents, and those presenting with restricting presentations such as anorexia nervosa.⁶.

In this issue of the Journal, Krebs et al.¹ report on the prevalence of body dysmorphic disorder (BDD) in young people at the population level, addressing several important gaps in the literature. Previous attempts to estimate the prevalence of BDD in young people primarily relied on samples of students or twins, potentially lacking representativeness, and used self-administered instruments for estimation. While these studies employed validated cutoffs, ensuring reasonable sensitivity and specificity, they were unable to fully exclude alternative explanations for symptoms, such as concerns regarding body weight. Krebs et al.¹ break new ground by estimating the prevalence of diagnosed BDD in a large general population-based sample, employing a validated diagnostic instrument.

Bipolar disorder (BD) is a complex, heterogeneous illness, with 60% to 85% of its variance attributed to genetic factors.¹ Adolescence marks the first peak period of risk for the onset of BD, with the initial (hypo)manic episode often preceded by childhood psychopathology, including anxiety and sleep disorders, as well as internalizing symptoms.² Given the non-specific nature of childhood antecedents, combined with the prominence of depressive episodes in the early illness course, accurate diagnosis is often delayed by 8 to 10 years from onset.³ Yet, the early course of BD in youth is already associated with significant morbidity and mortality. Therefore, more accurate and timely diagnosis is a priority. One way forward could be to combine biomarkers with clinical variables to help validate diagnoses, improve individual risk prediction and treatment, and advance discovery research into pathogenesis.