International Review of Psychiatry最新文献

The last quarter century has seen a clear move internationally towards greater integration between healthcare service types - including across mental and physical health - as well as with social care. The drivers include growing population complexity and clinical need, and a recognition that the broader evidence base supports better outcomes and cost effectiveness through tackling social determinants of health in a more joined-up and preventative manner. Challenges have included a lack of granularity about which approaches work best at a local level, which data might support learning from these, and how we might disseminate this between often very different systems and populations. The next 25 years will see renewed efforts towards greater integrated and preventative community approaches. However, we still lack a consensus about inpatient provision and need to optimise this through clinically led learning and care models. Technology is at a point where we can have digital infrastructure that pulls large-scale population-level clinical effectiveness data. The opportunity is to anchor this as our key tool to grow and refine better care models, augmenting more traditional process and governance data-sets, and therein also leverage research findings into measured novel implementation in practice.

Depressive disorders with onset during adolescence and young adulthood are common, disabling, and often difficult to diagnose due to their heterogeneous and developmentally specific presentation. Compared with adult depression, young people more frequently display irritability, somatic complaints, and behavioural problems, which can obscure recognition and delay treatment. This narrative review aims to synthesize current evidence on depressive disorders in young people, while highlighting implications for treatment and prevention. The keywords ("youth" OR "adolescent" OR "childhood" OR "child" OR "young") AND ("depression" OR "depressive symptoms" OR "mood disorder" OR "depressed mood") were entered in the main databases and combined through Boolean operators. Findings confirm that youth depression presents with distinct clinical features and strong sociocultural influences, is frequently comorbid with other psychiatric disorders, and follows a recurrent and impairing course. Psychotherapy remains the most effective intervention, with selective serotonin reuptake inhibitors indicated for moderate-to-severe cases. Preventive and school-based strategies show promising results but are unevenly implemented. In conclusion, depressive disorders in young people require early detection and developmentally sensitive, multimodal treatment strategies. Future work should prioritize scalable interventions that integrate psychosocial, pharmacological, and digital tools, with special attention to prevention and to the influence of cultural and contextual factors.

Youth mental health is crucial for academic success and civic engagement; when well-being declines, core cognitive functions suffer, undermining individual potential and broader societal progress. The present investigation explores the differences in coping strategies and psychological symptoms among N = 328 Paraguayan university students during (2020) and after (2024) the COVID-19 pandemic, using a non-experimental, quantitative, and longitudinal trend, partial replication design based on Vuyk et al. (2023). Two cohorts of students (n = 164 per group) were evaluated, using the DASS-21 and COPE-28. The results show a significant increase in the overall use of coping strategies. Stress and depression levels increased, and anxiety levels remained clinically elevated. These findings underscore the need for universities to implement inclusive and sustainable policies that promote adaptive strategies, reduce psychological symptoms, and strengthen students' resilience to future challenges.

Adolescent mental health remains an underexplored area in Paraguay despite its significant implications for public health. This study investigated the prevalence of self-injurious thoughts and behaviours as well as the associated psychosocial and demographic factors among Paraguayan adolescents. A cross-sectional study was conducted with 535 adolescents aged 12-18 years from Asunción and the Central Department, using validated instruments, including the PHQ-2 for depression, GAD-7 for anxiety, APCTSS for post-traumatic stress, and SDQ for emotional and behavioural issues. The findings revealed alarmingly high prevalence rates of anxiety (40.6%), depression (50.3%), and PTSD (64.5%), with females being disproportionately affected. Non-suicidal self-injury was reported by 30.5% of participants, with significantly higher rates among females. Factors such as bullying, loneliness, and food insecurity were strongly associated with self-harm and suicidal ideation. Logistic regression analysis identified female sex, depression, anxiety, and experiences of bullying as key predictors of self-injurious behaviours. These results highlight the urgent need for school-based mental health interventions, gender-sensitive policies, and trauma-informed care to mitigate the burden of adolescent mental-health disorders in Paraguay. Future studies should explore longitudinal trends and targeted prevention strategies to address this pressing public health concern.

Adolescents face a critical developmental stage marked by physical, psychological, and social changes, and may show increased vulnerability to difficulties in body comfort, self-perception, and eating behaviours, particularly under the influence of sociocultural appearance ideals. This study evaluated the effects of a structured psychoeducational intervention on 65 second-year secondary school students. Assessments targeted binge-eating behaviours, orthorexia nervosa, body image, body compassion, and alexithymia, with pre- (T0) and post-intervention (T1) comparisons. Post-intervention, Orthorexia Nervosa (TOS) scores, Body Uneasiness Test (BUT) Avoidance and Depersonalization significantly decreased by 14.8%, 34.5%, and 33.3% (all p ≤ 0.0045), respectively. Body Compassion Scale (BCS) total and Defusion scores increased by 6.36% and 6.35% (all p ≤ 0.0428), indicating enhanced self-compassion. Binge Eating Scale (BES) scores showed a downward trend (p = 0.0508). Overweight/obese adolescents had higher baseline Externally-Oriented Thinking and retained elevated BES, TOS, and BUT scores post-intervention. Underweight participants showed higher BCS scores. Finally, females exhibited higher baseline binge-eating severity, alexithymia, and body image disturbance, whereas males showed larger reductions in Weight Phobia and Avoidance after intervention. Psychoeducational interventions may reduce orthorexic tendencies, improve body-related emotional processing and body compassion in adolescents. These preliminary findings support the potential development of psychoeducational strategies within school settings.

Psychological trauma is a universal experience among humans; when suffered during developmental ages it might affect development and be at the base of psychopathology. Having a parent diagnosed with cancer is a highly distressing experience for a child and may influence the development of future psychopathology. This PRISMA-adhering systematic review focused on studies of children with a parent diagnosed with cancer and reporting psychiatric diagnoses or clinically significant symptoms assessed with validated instruments. The review included 25 studies spanning from 1994 to 2025. Studies found increased prevalence of anxiety, depressive, and posttraumatic stress disorder in children and adolescents with a parent affected by cancer compared to controls. Internalizing problems were higher than externalizing problems in children and adolescents, especially girls. There have been few implemented programs for children with a parent with cancer, despite recognition of higher psychopathological risk. The few psychotherapeutic trials yielded results with small effect sizes, while there is a dearth of pharmacological trials that does not allow drawing conclusions. There is need to prioritize programs that take care of children with parents with cancer so to reduce future psychopathology. Psychotherapeutic interventions must target the internalizing and externalizing symptoms and address the posttraumatic aspects of the child's suffering.

Sexual and gender minority youth (SGMY) face unique psychosocial stressors that increase vulnerability to substance use. However, evidence from low- and middle-income countries (LMICs) remains limited. Objective: To compare the lifetime prevalence and age of onset of substance use between LGBTQIAPN+ and cisgender heterosexual adolescents in Brazil. Data were drawn from the Brazilian High-Risk Cohort Study for Mental Health Conditions (BHRC), a longitudinal, community-based study. A total of 1,492 participants aged 9-18 at wave 1 and 12-21 at wave 2 provided complete data on sexual orientation, gender identity, and lifetime use of alcohol, tobacco, cannabis, and cocaine. LGBTQIAPN+ adolescents had higher lifetime prevalence of tobacco (OR = 1.66; 95% CI: 1.22-2.26; p = 0.001), cannabis (OR = 1.94; 95% CI: 1.42-2.64; p < 0.001), and cocaine use (OR = 2.28; 95% CI: 1.21-4.13; p = 0.008) than cisgender heterosexual peers. These differences were driven by participants assigned female at birth, with no significant differences among males. LGBTQIAPN+ females also reported earlier initiation of alcohol (p = 0.001), tobacco (p < 0.001), and cannabis (p < 0.001). Conclusions: Brazilian LGBTQIAPN+ youth, especially females, show elevated substance use and earlier initiation, underscoring the need for targeted, gender-sensitive prevention strategies.

This study explored whether structural magnetic resonance imaging (MRI) data from the Brazilian High-Risk Cohort for Mental Conditions (BHRCS) could be used to predict anxiety disorders in youth through machine learning. The sample included 209 participants with any anxiety disorder and 232 healthy controls, aged 6 to 14 years at baseline, followed across three waves from 2010 to 2019. Youth in the anxiety group had a diagnosis at any timepoint and valid MRI scans, while controls had no psychiatric diagnoses. Structural brain features extracted via FreeSurfer were used to train a random forest classifier to differentiate the two groups. The model incorporated feature selection, ComBat harmonization to address site effects, and 5-fold cross-validation. Performance was evaluated on a test sample and on a hold-out validation sample comprising 20% of the total dataset (n = 88). The model achieved an accuracy of 64% and an area under the curve (AUC) of 0.70 in the test set. However, performance in the validation sample was near chance, with an AUC of 0.51. These findings suggest that while structural MRI may capture some neurobiological differences in youth with anxiety, its predictive value for clinical classification remains limited in this context.

Adolescence is a critical period of biopsychosocial development often marked by engagement in risk behaviors, including psychoactive substance use and early sexual initiation. Emerging evidence suggests a robust association between these behaviors, particularly early sexual debut (i.e. before age 15). This cross-sectional analytical study draws on data from the 2019 National School Health Survey (PeNSE) to examine the relationship between recent psychoactive substance use and early sexual initiation among Brazilian adolescents aged 15-17 years (n = 72,679). Substance use in the past 30 days was assessed for nine substances: alcohol, conventional cigarettes, hookah, electronic cigarettes, clove cigarettes, hand-rolled cigarettes, marijuana, crack and other illicit drugs. Early sexual initiation was reported by 33.3% of participants. Use of all substances was significantly associated with early sexual debut, with the strongest associations observed for crack (adjusted OR = 1.91; 95% CI = 1.56-2.33), marijuana (OR = 1.58; 95% CI = 1.43-1.75), other illicit drugs (OR = 1.50; 95% CI = 1.37-1.64) and alcohol (OR = 1.47; 95% CI = 1.35-1.59). These findings highlight a strong association between recent substance use and early sexual initiation in Brazilian adolescents, underscoring the need for comprehensive, multisectoral public policies that integrate substance use prevention and sexual health education within school, family and healthcare contexts.

Major depressive disorder (MDD) significantly impairs adolescents' development, with increasing rates of treatment resistance and suicide risk. Ketamine has emerged as a promising, rapid-acting antidepressant in adults, but its efficacy and safety in adolescents remain unclear. This systematic review and meta-analysis aimed to evaluate short-term outcomes of ketamine administration in youth with mood disorders. Following PRISMA guidelines and PROSPERO registration (CRD42024568658), four studies were included, comprising 272 adolescents aged 12-18 years. Three studies (n = 189) contributed data to the meta-analysis. At 24 hours post-administration, ketamine showed a small, non-significant effect on depressive symptoms compared to placebo (SMD = -0.19; 95% CI: -0.41 to 0.04). Clinical response and remission were not significantly different between groups, but ketamine was associated with a significantly higher rate of suicidal ideation remission (RR = 1.49; 95% CI: 1.06 to 2.08). Adverse events were generally mild, transient, and consistent with known pharmacological effects. While findings support ketamine's potential role in acute presentations, current evidence is preliminary. Larger randomized controlled trials with extended follow-up are needed to clarify the clinical utility, optimal protocols, and long-term safety of this approach in adolescent populations.