Journal of Child and Adolescent Mental Health最新文献

Background: Parenting programmes are recommended for conduct disorders in 5-11 year olds, but ineffective for 25-33%. A feasibility trial was needed to determine whether a confirmatory trial of second-line, manualised short-term psychoanalytic child psychotherapy (mPCP) versus treatment as usual (TaU) is practicable.

Method: This was a two-arm, pragmatic, parallel-group, multi-centre, individually-randomised controlled feasibility trial with blinded outcome assessment. Child-primary carer dyads were recruited from National Health Service Child and Adolescent Mental Health Services and mPCP delivered by routine child psychotherapists.

Results: Thirty-two dyads (50% of eligible, 95% CI 37 to 63%) were recruited, with 16 randomised to each arm. Eleven (69%) completed ≥50% of 12 week mPCP and 13 (81%) . Follow-up was obtained for 24 (75%) at 4 months and 14/16 (88%) at 8 months. Teacher follow-up was 16 (50%) ≥1 session. Manual adherence was good. Baseline candidate primary outcomes were 37.4 (SD 11.4) and 18.1 (SD 15.7) on the Child Behaviour Checklist/Teacher Report Form externalising scale and 102.8 (SD 28.4) and 58.8 (SD 38.9) on the total score. Health economics data collection was feasible and the trial acceptable to participants.

Conclusion: Recruitment, teacher follow-up and the manual need some refinement. A confirmatory trial is feasible, subject to funding of research child psychotherapists.

Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.

Adolescence is a period of significant identity development and particular vulnerability to depression associated with negative self-evaluation. We investigated if increased depressive symptom severity was also associated with positive self-evaluation. We also considered pubertal developmental differences in positive and negative self-evaluation, and if these could reflect dissociated facets of the self. This cross-sectional sample consisted of healthy male and female adolescents (N = 109) aged 12-17 from the United States. Participants completed a self-referential encoding task, which required them to indicate if a single-word adjective was self-descriptive. We administered the Children's Depression Inventory, the Pubertal Development Scale, and the Child Narcissism Scale. Negative-word endorsement was significantly predicted by pubertal maturation level and depressive symptoms, but not by narcissism. Positive-word endorsement was significantly predicted by narcissism and negatively predicted by depressive symptoms, but not by pubertal maturation. In this typically developing sample, positive self-judgment does not vary across the pubertal range and is positively associated with narcissistic traits, and negatively associated with depressive symptom severity. Negative self-judgements are positively correlated with puberty and are associated with depressive symptom severity only. Our findings suggest that negative and positive aspects of the self are partially dissociable.

The objective of this study was to explore the five most frequently reported fears in a sample of university students, and investigate the origins of these fears. The study employed a cross-sectional design with convenience sampling. Data were collected using a self-report questionnaire and analysed using a combination of descriptive statistics and content analysis. Participants consisted of 544 first-year psychology students. This study identified academic failure, animals, general failure, losing loved ones to death, and violence/crime as the top five fears among a sample of university students. 'Conditioning experiences' was one of the most prominent pathways in the acquisition of all these fears. 'Negative information transmission' was also a dominant pathway relating to the origin of fear such as academic failure and violence/crime. However, 'modelling experiences' was not identified as a prominent pathway in the present study. These findings contribute to identifying the origins of first-year students' self-reported fears by using the three pathways theory. These findings may contribute meaningfully to the development and implementation of prevention and intervention programmes at higher education institutions.

Objective: This paper reports on the process followed in developing the "TEAM" (an acronym for the proposed intervention) model for the promotion of mental health among school-going adolescents.

Methods: A sequential explanatory mixed method combining both quantitative and qualitative approaches was used to gain in-depth understanding of the experiences of adolescents, school health nurses and teachers in dealing with emotional and social problems in high schools. Data collection was conducted in 4 phases from 2012 to 2015 and included a desk review of literature, qualitative interviews with 12 school teachers; qualitative interviews with 10 school health nurses and quantitative interviews with 347 adolescents. The quantitative tool that was used for the study was based on the Social and Emotional Learning Model.

Results: Key findings from the study revealed inappropriate handling of emotions by adolescents, leading them to form destructive groups (gangs); involvement in alcohol and substance abuse; disrespect; and adolescent pregnancy.

Conclusion: A universal team-oriented collaborative model that will assist adolescents to shift negative energy and attitudes to positive and productive lifestyles is required. The TEAM model centres all the activities of a collaborative and focused team on the facilitation of a sense of belonging, ownership and complete engagement of pupils in schools that will contribute positively to social and emotional well-being.

This research examined the development of anxiety across adolescence and early adulthood among a sample of juvenile offenders comprising males and females. In addition, despite the understanding of maternal substance abuse and maternal unemployment as risk factors predicting development of anxiety, this research examined the interaction between these two characteristics for doing so. Analyses used group-based trajectory modelling to provide descriptive representation of general developmental patterns of anxiety. Next, a series of multinomial logistic regression models were estimated to examine the effects of baseline covariates on the relative risk of assignment to the elucidated trajectory groups. A three-group model best fit the data, comprising low, moderate, and high anxiety trajectory groups. Results from the regression models indicate that the interaction between maternal unemployment and maternal substance abuse history significantly increased the risk of assignment to the high anxiety group.

Objective: This study represents an initial attempt to contrast behavioural and mental health correlates of shame as a result of physical abuse (PA) and sexual abuse (SA). Because they are distinctive forms of injury, it is possible that corollary shame from these injuries follows unique trajectories and ultimately results in different health challenges.

Method: Self-report data from a survey on the health of youth receiving protective services for reasons of PA and SA was used. It included standardised measures, such as the Childhood Trauma Questionnaire, Trauma Symptoms Checklist for Children, the Brief Symptoms Inventory, the Rutgers Alcohol Problem Index, and the South Oaks Gambling Screen. New measures of abuse-related shame, maltreatment, and substance use were also employed. Linear regression analyses were performed to determine whether level of shame was linked to mental health and behaviour issues, after controlling for level of abuse.

Results: Results were similar for shame as a result of PA and SA victimisation. After accounting for shared variance with abuse severity, both measures were linked to a full spectrum of mental health issues, such as depression (SA r² = 0.30, PA r² = 0.28), anxiety (SA r² = 0.27, PA r² = 0.20), post-traumatic stress (SA r² = 0.26, PA r² = 0.19), interpersonal sensitivity (SA r² = 0.17, PA r² = 0.22), and psychoticism (SA r² = 0.19, PA r² = 0.20), but not to gambling or substance use problems. PA-related shame was associated with suicidality (r² = 0.05).

Conclusions: Keeping in mind that this was largely a cross-sectional study and that causality cannot be inferred, the results seem to indicate that youth suffering from abuse-related shame are particularly vulnerable to mental health problems, but not to efforts to numb their problematic thoughts and feelings through gambling and substance use. Shame could serve as an early indicator of which child protection recipients are most in need of preventive efforts.

Objective: A case study describing the association between vagal tone and social-emotional adaptation in two distressed adolescent-parent (A-P) pairs during a Positive Cognitive Behaviour Therapy Programme (P-CBTP).

Methods: Two A-P pairs completed a P-CBTP with pre- and post-intervention biosocial-emotional assessments; weekly training sessions over 7 weeks to develop individual strengths, new adaptive cognitions, positive discipline skills, optimism and knowledge on age-appropriate developmental expressions; augmented by moderate physical activity. Resting vagal tone and vagal reactivity were assessed by time-domain measures of vagal activity (RMSSD).

Results: Social-emotional adjustment improved in all A-P pairs. Resting vagal tone increased over the intervention period, from low-to-low-normal towards average-for-normal in three subjects. The fourth individual had excessive pre-intervention resting vagal tone that declined in the direction of normal over the intervention period. Vagal reactivity in response to orthostatic stress remained the same pre- to post-intervention.

Conclusions: Changes in resting vagal tone demonstrated improvements in psychological functioning in all four subjects over the period of intervention. Results supported the view of the association between vagal tone and mental health not being an absolute positive relationship, but that low, as well as excessive, vagal tone may be maladaptive. Indications are that the same may apply to vagal reactivity to psychological stress. More studies need to examine the association between resting vagal tone and emotion regulation in A-P relationships during P-CBTP, keeping in mind that a linear relationship cannot summarily be expected in population studies.

Objective: The aim of this study was to systematically review available literature pertaining to the psychological effects of multimedia-induced sexualisation of girls in middle childhood (between the ages of 6 and 12 years old).

Method: A systematic review was conducted through a comprehensive electronic search. Nineteen studies were included in the review and the data was analysed by means of qualitative content analysis.

Results: Two themes were identified, namely: 1) detrimental psychological effects of sexualisation; and 2) beneficial psychological effects of sexualisation. Findings appeared to indicate that the psychological effects on girls in middle childhood resulting from sexualisation, such as internalisation, mental health problems, objectification and gender stereotyping, were more likely to be detrimental than beneficial to their well-being. The review also found a paucity of research on the topic within developing countries. Consequently, the authors recommended a precautionary approach pertaining to sexualisation of girls in middle childhood.

Conclusion: A thorough understanding of the topic is valuable as it can inform a preventative and proactive management approach. It can especially assist in informing policy as well as therapists by informing their developmental conceptualisation and treatment of girls in middle childhood.

Objective: The study aimed to investigate the prevalence of cannabis use among undergraduate medical students of the University of the Free State (UFS), and the extent of their knowledge about the substance.

Method: This cross-sectional study included five year groups of undergraduate medical students. A self-administered, anonymous questionnaire was used.

Results: Of the 643 medical students, 541 (84.1%) completed the questionnaire. In total, 161 (30.9%) students reported that they had ever used cannabis. The percentage of males who had ever used cannabis was twice that of females (relative risk 2.04; 95% CI 1.56; 2.67). Of the cannabis users, less than 12% used it monthly or more often. A fifth (19.5%) of all students stated that they did not know the side effects of cannabis use. Nearly half (45.4%) indicated that they could not name any medicinal (medical) uses. The median knowledge score of students who used cannabis tended to be higher than that of students who did not use cannabis; this was statistically significant only in the third-year group.

Conclusions: Medical students generally have a low level of knowledge about cannabis. The reported lifetime prevalence and pattern of cannabis use are similar to those reported in other South African studies published over the past 35 years.