Child and Adolescent Mental Health最新文献

We appreciate the commentary by Tiffin and Kelleher on our systematic review and meta-analysis. The CHR-P paradigm remains one of the most established preventive approaches in mental health. While concerns have been raised regarding the clinical utility of the CHR-P paradigm, its implementation in specialized services worldwide supports its relevance. These services provide evidence-based interventions, reducing unnecessary antipsychotic use and guiding treatment strategies. Tiffin and Kelleher's critique largely focuses on transition rates and age cutoffs. While we argue that transition rates in adolescents at CHR-P are significant, other outcomes need to be considered. Among others, negative symptoms are clinically significant in adolescents at CHR-P, impairing functioning and long-term outcomes. We think we should refine and improve the CHR-P paradigm rather than simply abandoning it. With advancements in precision medicine, we can improve risk stratification and tailor interventions to better serve individuals at risk. We can also expand the paradigm, so it supports other help-seeking adolescents at risk requiring transdiagnostic, developmentally sensitive interventions to prevent psychosis.

There has been much academic interest in ‘the clinical high risk for psychosis’ (CHR-P) concept. Indeed, as two child and adolescent psychiatrists interested in psychosis prediction and prevention, we enthusiastically embraced the paradigm in our clinical and academic work. However, despite more than two decades of research, there is no definition of CHR-P in adolescence that has proven to be able to usefully predict transition to psychosis. Indeed, research suggests that much, if not all, of the risk associated with CHR diagnoses in adolescents is captured by being help-seeking for mental health problems, rather than being associated with a CHR diagnosis itself. In this commentary, we critique the systematic review by Frearson et al. (2025). In particular, we challenge the conceptualisation around the CHR-P concept, as applied to under 18 s, and the assumptions underpinning it. We also highlight issues with the terminology used when describing the experiences of young people categorised as being at CHR-P. Rather, we make the case for understanding and supporting help-seeking young people with distressing perceptual and ideational disturbance employing a needs-based, person-centred approach.

Urban environments are related to higher prevalences of common mental disorders (addictions, anxieties and mood disorders) in adults. The mechanisms underlying this relationship are less clear. Cities function as a magnet, related to economic and educational opportunities, but are also related to urban stress and low well-being. Urban areas have larger inequalities, and people in deprived areas are at enhanced risk for mental health problems, which have been related both to environmental factors like pollution and to perceptions of the (social) environment, including perceived safety and social support. The interactions of vulnerability factors at different levels of description (e.g., within-person stress vulnerability vs. neighborhood stressors) can be considered a complex system. We here discuss what is known about growing up in an urban versus rural environment, with the aim to identify target points for mental health-related interventions in youth. We summarize this for three broad developmental periods: early life (first 1000 days), childhood, and adolescence into young adulthood, with implications for interventions.

While urban–rural gradients exist for common mental disorders (Wiers et al., 2025), observations from the Global North suggest these are strongest for psychotic disorders, which typically emerge during adolescence. Despite well-documented urban–rural variation in risk, recent research suggests a more nuanced relationship between place and these severe mental illnesses exists. Traditional urban–rural dichotomies cannot account for social gradients in psychosis globally for young people. Instead, a framework centred on social identity, inclusion and belonging may provide a more comprehensive approach to understanding psychosis risk as a result of the environments in which people are born, raised and live. Future research should integrate traditional epidemiological designs with causal inference methods and new technologies to capture momentary responses to diverse environmental stimuli that are both place-based and placeless. This approach could uncover novel avenues for prevention and intervention, tailored to the digital age, ultimately improving outcomes for young people and families affected by psychosis.