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

Avoidant/restrictive food intake disorder (ARFID) first entered the psychiatric nosology with the 2013 publication of DSM-5. Unlike binge eating disorder (BED), which was also new to DSM-5 but which had first been described by Stunkard in 1959,^1,2 ARFID had never been described in the psychiatric literature as a single diagnostic entity. The new diagnosis encompassed clinical constructs that were previously proposed and studied but not described in DSM (ie, causes of "non-organic failure to thrive" including infantile anorexia and post-traumatic feeding disorder,³ and extreme food selectivity in children with autism spectrum disorder⁴) and the DSM-IV Feeding Disorder of Infancy and Early Childhood (FDIEC).⁵ The ARFID diagnosis supplanted FDIEC and incorporated earlier descriptions of pediatric feeding problems into a lifespan diagnosis for patients with restrictive eating characterized by food selectivity, poor appetite/lack of interest in eating, or fear of aversive consequences of eating that led to significant weight loss or failure to grow, nutritional deficiency, supplement dependence, and/or psychosocial impairment.

Discrimination and structural factors that promote discrimination and sociocultural inequities are social determinants of health that contribute to poorer health outcomes among minoritized youth. Discrimination consists of institutional or individual-level biases leading to disparate and unequitable access to resources. If individuals are aware of these experiences and their impact on one's own ability to access resources or opportunities, individuals may self-report these occurrences. Experiences of discrimination, and one's personal experience of discrimination at individual, social, and/or institutional levels have been shown to contribute to worse psychiatric outcomes through the emergence of and increased severity of psychopathology, reduced access to treatment, decreased likelihood of active treatment seeking, and poorer treatment retention.^1,2 For youth, early and repeated exposures to discrimination, and perception of discrimination, may contribute to health disparities in psychopathology in adolescence, young adulthood, and beyond. Our understanding of protective factors and primary and secondary prevention strategies is limited, given the lack of systematic research on early and persistent exposure to discrimination on developmental outcomes in minoritized youth. Large longitudinal research studies with representative heterogeneous samples may allow for the study of these relationships.

In her presidential initiative, AACAP President Dr. Tami Benton outlined her vision for the dynamic role of child and adolescent psychiatrists and their respective communities, encouraging them to transcend traditional clinical roles and become public health advocates by "Bringing the Village to the Children." This message emphasizes the capacity of child and adolescent psychiatrists to reach beyond clinical silos and identify partnerships across a variety of disciplines to improve child mental health. This commentary summarizes concrete opportunities for child and adolescent psychiatrists and trainees to advocate for social media safety that protects the rights of racially minoritized children and adolescents by aligning with the presidential initiative.

The above case study is fictional, but Oliver's difficulties are representative of the experiences of many young people with a language disorder. Unfortunately, integrated mental health and speech-language therapy services are rare, and available research to inform evidence-based mental health intervention for this population is lacking. Children and adolescents with DLD have a 1.8- to 2.3-fold increased risk of mental health conditions compared with peers,¹ and 45% to 64% of adolescents referred to mental health services have diagnosed or undiagnosed language disorder.² Mental health assessments and psychological treatments are verbally mediated, making them difficult for youth such as Oliver to access.³ To address this inequality in mental health provision, we need increased understanding and awareness of language disorders and how they can affect mental health, novel language interventions aimed to prevent mental health problems in youth with language disorders, and adaptations to existing mental health treatments to make them suitable for youth with language disorders.

Objective: To systematically evaluate the measurement properties of 12 patient-reported outcome measures (PROMs) used to measure depression symptom severity in adolescents with depression. Depression symptom severity was chosen as the outcome of focus given its importance as an outcome to measure in adolescents with depression across clinical trials and/or care.

Method: MEDLINE, PsycInfo, Scopus, CINAHL, and Web of Science were searched from year of inception up to December 7^th, 2023. Study appraisal (i.e., risk of bias), evaluation of measurement properties, and evidence synthesis followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Included studies evaluated at least one of nine measurement properties as detailed in the COSMIN taxonomy within a reported sample or subgroup of youth 12-24 years, with at least 40% meeting criteria for any depressive disorder.

Results: Of the 15,560 records identified, 31 studies for seven PROMs were included in the COSMIN appraisal. Although several PROMs have the potential to accurately measure depression symptom severity in adolescents with depression, at this time none of the PROMs can be recommended for use without further evaluative work. High-quality evidence was generally lacking, largely due to few or inconsistent findings, small sample sizes, and other methodological concerns.

Conclusion: This systematic review of the measurement properties of 12 PROMs used to measure depression symptom severity in adolescents with depression found that none of the PROMs can be recommended for use until further evaluative work is conducted. Clinicians and researchers should proceed with caution when using these PROMs.

Objective: To examine individual and contextual characteristics associated with receipt of mental health treatment prior to youth suicide.

Method: Data from the US National Violent Death Reporting System, Area Health Resource File, and Social Vulnerability Index were used to examine characteristics associated with receipt of mental health treatment within 2 months before death among youth suicide decedents aged 5 to 17 years from 2013 to 2020 (N = 6,229). The association between individual (demographic, precipitating circumstances, and clinical characteristics) and contextual-level variables (county health resources, Social Vulnerability Index) and mental health service use was modeled using logistic regression.

Results: Mental health treatment was received by 31.6% of youth suicide decedents (n = 1,967) in the 2 months before suicide. Male individuals and youth from all racial and ethnic minority groups were less likely to receive mental health treatment in the 2 months prior to suicide, as were youth residing in non-metropolitan counties and living in counties characterized by high compared to low levels of social vulnerability. A history of family problems, a recent crisis, criminal/legal problems, and suicidal thoughts and attempts were associated with increased odds of receiving mental health services.

Conclusion: Youth suicide decedents who were male, members of a racial or ethnic minority group, and residing in counties that are non-metropolitan and/or socially disadvantaged were less likely to have received mental health services in the months prior to death. Suicide prevention efforts that focus on improving access to care are essential for these vulnerable populations at risk for suicide.

Objective: The aim of the current study was to identify the age at which sexual orientation disparity in mental health diagnoses can be first identified, as well as gender and sexual identity subgroup differences in such treatment, in a population-based sample.

Method: Young people aged 16 to 25 (N = 10,406) participating in the probability-based Swedish National Public Health Survey in 2018 were included. This sample was linked to physician-assessed mental health care treatment history data starting when all participants were 8 years old using national health care registries.

Results: Participants reporting a sexual minority identity in adolescence and young adulthood were more than 3 times as likely to have been treated for an internalizing disorder diagnosis (eg, depression, anxiety) and more than twice as likely to have been treated for a neurodevelopmental disorder diagnosis during childhood than participants reporting a heterosexual identity. Sexual minority participants overall and women in particular were more likely to have been treated for an internalizing disorder diagnosis at an early age compared with heterosexual participants, with this disparity starting at age 13. The sexual orientation disparity in likelihood of treatment for a neurodevelopmental disorder diagnosis was particularly elevated among bisexual/pansexual women with this disparity starting in early/middle adolescence.

Conclusion: This population-based study linked to physician-assessed mental health diagnoses during childhood and adolescence identifies the age at which sexual orientation differences in treatment for common mental disorders emerge. The early emergence of this disparity suggests a potential benefit of interventions that facilitate social belonging for all youth.

We currently face a national crisis¹ in youth mental health and well-being and significant child behavioral health inequities. There is a growing recognition among health care institutions, policymakers, researchers, and communities that major health problems of our time, including this crisis, must be confronted by addressing the underlying "causes of the causes,"² or social determinants of health. Social determinants of health³ are defined by the US Centers for Disease Control and Prevention as the conditions in which people live, learn, work, play, worship, and age and highlight the role that power and privilege occupy in shaping societal access to these resources. Social determinants of mental health (SDoMH) encompass the same conditions of social determinants of health, with the addition of the stigma often associated with mental health and substance use disorders. SDoMH focus on the social/environmental factors that place certain groups at increased risk for mental health concerns and worsening outcomes for individuals who already have mental health concerns.⁴ Addressing SDoMH is a key strategy to toward Healthy People 2030⁵ goals and "the attainment of the highest level of health for all people."