Children and young adults comprise a significant proportion of the world’s refugee population and are disproportionately negatively affected by the social determinants of health. This heterogeneous group faces high rates of poor mental health, yet research investigating within-group inequalities in mental health remains limited. We performed a latent profile analysis to explore classes of mental health based on posttraumatic stress symptoms (PTSS), general functioning, and well-being. This study aimed to improve the understanding of mental health differences, thereby providing better guidance for assessment and tailored interventions.
Method
This study involved 131 children and 127 young adults with refugee backgrounds (mean age 18.21 years, 44.6% female, 23.6% unaccompanied) recruited nationwide in Sweden (2019-2022). To examine classes and their predictors, latent profile analysis was conducted, followed by multinomial logistic regression analysis.
Results
Latent profile analysis identified four distinct classes: Good Mental Health (58.1%; low PTSS, good functioning and well-being); Severe Mental Distress (13.6%; high PTSS, low functioning and well-being); Moderate Mental Strain (12.4%; low PTSS, moderate functioning, low well-being); and Resilient (15.9%, high PTSS, good functioning, moderate well-being). Social determinants of health, such as being unaccompanied, asylum status, exposure to multiple types of violence, sexual victimization, and child maltreatment, distinguished the classes.
Conclusion
Children and young adults with refugee backgrounds can be categorized into classes based on clinically relevant mental health indicators. Focusing solely on those individuals at the highest risk for poor mental health may overlook many who are mentally healthy and those who need more targeted support. Future research should aim to replicate findings and to evaluate additional predictive factors at the family and societal levels.
Plain language summary
This study found that a Swedish community sample of children and young adults with refugee backgrounds could be grouped into four mental health profiles: good mental health, resilient, moderate mental strain, and severe mental distress. While most participants were doing well or coping despite challenges, others showed signs of moderate or severe mental health difficulties. Exposure to violence, being unaccompanied, and insecure asylum status were linked to poorer mental health. Focusing only on those in obvious distress may overlook both those in need of more targeted support and those who are doing well.
{"title":"Latent Profile Analysis of Mental Health Among Children and Young Adults With Refugee Backgrounds","authors":"Johan Andersson MSc , Hongru Zhai MSc , Reeta Kankaanpää MSc , Carolina Bråhn MSc , Erica Mattelin PhD , Kirsi Peltonen PhD , Ann-Charlotte Münger PhD , Laura Korhonen PhD","doi":"10.1016/j.jaacop.2025.06.003","DOIUrl":"10.1016/j.jaacop.2025.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>Children and young adults comprise a significant proportion of the world’s refugee population and are disproportionately negatively affected by the social determinants of health. This heterogeneous group faces high rates of poor mental health, yet research investigating within-group inequalities in mental health remains limited. We performed a latent profile analysis to explore classes of mental health based on posttraumatic stress symptoms (PTSS), general functioning, and well-being. This study aimed to improve the understanding of mental health differences, thereby providing better guidance for assessment and tailored interventions.</div></div><div><h3>Method</h3><div>This study involved 131 children and 127 young adults with refugee backgrounds (mean age 18.21 years, 44.6% female, 23.6% unaccompanied) recruited nationwide in Sweden (2019-2022). To examine classes and their predictors, latent profile analysis was conducted, followed by multinomial logistic regression analysis.</div></div><div><h3>Results</h3><div>Latent profile analysis identified four distinct classes: Good Mental Health (58.1%; low PTSS, good functioning and well-being); Severe Mental Distress (13.6%; high PTSS, low functioning and well-being); Moderate Mental Strain (12.4%; low PTSS, moderate functioning, low well-being); and Resilient (15.9%, high PTSS, good functioning, moderate well-being). Social determinants of health, such as being unaccompanied, asylum status, exposure to multiple types of violence, sexual victimization, and child maltreatment, distinguished the classes.</div></div><div><h3>Conclusion</h3><div>Children and young adults with refugee backgrounds can be categorized into classes based on clinically relevant mental health indicators. Focusing solely on those individuals at the highest risk for poor mental health may overlook many who are mentally healthy and those who need more targeted support. Future research should aim to replicate findings and to evaluate additional predictive factors at the family and societal levels.</div></div><div><h3>Plain language summary</h3><div>This study found that a Swedish community sample of children and young adults with refugee backgrounds could be grouped into four mental health profiles: good mental health, resilient, moderate mental strain, and severe mental distress. While most participants were doing well or coping despite challenges, others showed signs of moderate or severe mental health difficulties. Exposure to violence, being unaccompanied, and insecure asylum status were linked to poorer mental health. Focusing only on those in obvious distress may overlook both those in need of more targeted support and those who are doing well.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1188-1201"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-13DOI: 10.1016/j.jaacop.2025.06.002
Grace E. DiDomenico BA , Martins M. Gatavins BA , Nadine Michel MD, PhD , Paige Lombard MPH , Tami D. Benton MD , Ran Barzilay MD, PhD
{"title":"Engaging Voices, Shaping Futures: Lessons From a Youth Advisory Board on Black Youth Suicide Prevention","authors":"Grace E. DiDomenico BA , Martins M. Gatavins BA , Nadine Michel MD, PhD , Paige Lombard MPH , Tami D. Benton MD , Ran Barzilay MD, PhD","doi":"10.1016/j.jaacop.2025.06.002","DOIUrl":"10.1016/j.jaacop.2025.06.002","url":null,"abstract":"","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 817-821"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-09DOI: 10.1016/j.jaacop.2025.06.001
Sally I-Chun Kuo PhD , Vivia V. McCutcheon PhD , Kathleen K. Bucholz PhD , Danielle M. Dick PhD , Fazil Aliev PhD , Jacquelyn L. Meyers PhD , Sarah J. Brislin PhD , Grace Chan PhD , Howard J. Edenberg PhD , Chella Kamarajan PhD , John Kramer PhD , Samuel Kuperman MD , Dongbing Lai PhD , Martin H. Plawecki MD, PhD , Carolyn E. Sartor PhD , Marc A. Schuckit MD , Jessica E. Salvatore PhD
Objective
Parental separation and relationship discord are linked to alcohol use behaviors, but their influence on the longitudinal course of alcohol misuse and interactions with genetic predisposition remain unclear. This study examined how the longitudinal course of heavy episodic drinking (HED) from adolescence to young adulthood varies with polygenic risk, parental separation, and relationship discord.
Method
Participants were from the Collaborative Study on the Genetics of Alcoholism (COGA) Prospective Sample, and included individuals from 2 genetically inferred continental groups: European-like (EA; n = 1761) and African-like (AA; n = 894) who were reassessed biennially (mean age = 16.39 at first assessment; mean assessments = 4.65). Alcohol misuse was indexed by past-year HED frequency. Predictors included parental separation, parental relationship discord, and problematic alcohol use polygenic scores (PGSPAU). Data were analyzed using linear mixed-effects growth models.
Results
HED increased through young adulthood before declining. In European Americans (EA), parental separation was associated with HED intercepts, but not with linear slope or quadratic curvature. Higher PGSPAU was associated with a faster initial growth and slower decline. In African American (AA), parental relationship discord was not associated with HED intercepts but was associated with a faster initial growth and slower decline. PGSPAU were not associated the intercept or the course of HED. No interaction was found between PGSPAU and parental separation or discord to predict the longitudinal course of HED in either EA or AA samples.
Conclusion
Genetic risk and exposure to parental separation and discord are associated with the course of HED, with some differences across continental groups.
Plain language summary
This study utilized data from the Collaborative Study on the Genetics of Alcoholism (COGA) to examine how the course of heavy episodic drinking (HED) from adolescence to young adulthood varies with genetic risk, parental separation, and relationship discord. Parental separation and relationship discord were associated with initial levels of heavy episodic drinking and their course into young adulthood. In the European American sample, these family stressors were associated with higher initial levels of heavy episodic drinking, which were sustained over time with genetic factors amplifying this pattern. In the African American sample, parental relationship discord was associated with a rapid increase in heavy episodic drinking that declined slowly. These findings highlight the contributions of genetics and family adversity in shaping risk for harmful patterns of alcohol use across development.
目的：父母分离和关系不和谐与酒精使用行为有关，但它们对酒精滥用纵向过程的影响以及与遗传易感性的相互作用尚不清楚。本研究考察了从青春期到青年期重度发作性饮酒（HED）的纵向过程如何随多基因风险、父母分离和关系不和谐而变化。方法参与者来自酒精中毒遗传学合作研究（COGA）前瞻性样本，包括来自2个遗传推断的大陆组的个体：欧洲样（EA, n = 1761）和非洲样（AA, n = 894），每两年重新评估一次（首次评估时平均年龄= 16.39，平均评估= 4.65）。酒精滥用以过去一年的HED频率为索引。预测因子包括父母分离、父母关系不和和问题性酒精使用多基因评分（PGSPAU）。数据分析采用线性混合效应增长模型。结果：在成年早期，血流量增加，然后下降。在欧裔美国人（EA）中，亲代分离与HED截距有关，但与线性斜率或二次曲率无关。较高的PGSPAU与更快的初始生长和更慢的下降有关。在非裔美国人（AA）中，父母关系不和谐与HED拦截无关，但与早期快速增长和缓慢下降有关。PGSPAU与HED的截距和病程无关。在EA或AA样本中，PGSPAU与父母分离或不和谐之间没有相互作用，无法预测HED的纵向病程。结论遗传风险和父母分离不和谐暴露与HED病程相关，但各大洲人群存在一定差异。本研究利用酒精中毒遗传学合作研究（COGA）的数据，研究了从青春期到青年期重度间歇性饮酒（HED）的过程如何随遗传风险、父母分离和关系不和谐而变化。父母分离和关系不和谐与最初的严重间歇性饮酒水平及其进入青年期的过程有关。在欧洲裔美国人的样本中，这些家庭压力源与较高的初始重度间歇性饮酒水平有关，随着时间的推移，遗传因素会放大这种模式。在非裔美国人的样本中，父母关系的不和谐与间歇性酗酒的迅速增加有关，而酗酒的增加速度缓慢下降。这些发现强调了遗传和家庭逆境在形成整个发育过程中有害饮酒模式的风险方面的作用。
{"title":"The Impact of Polygenic Risk, Parental Separation, and Parental Relationship Discord on Heavy Episodic Drinking Across Adolescence and Young Adulthood in a High-Risk Sample","authors":"Sally I-Chun Kuo PhD , Vivia V. McCutcheon PhD , Kathleen K. Bucholz PhD , Danielle M. Dick PhD , Fazil Aliev PhD , Jacquelyn L. Meyers PhD , Sarah J. Brislin PhD , Grace Chan PhD , Howard J. Edenberg PhD , Chella Kamarajan PhD , John Kramer PhD , Samuel Kuperman MD , Dongbing Lai PhD , Martin H. Plawecki MD, PhD , Carolyn E. Sartor PhD , Marc A. Schuckit MD , Jessica E. Salvatore PhD","doi":"10.1016/j.jaacop.2025.06.001","DOIUrl":"10.1016/j.jaacop.2025.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>Parental separation and relationship discord are linked to alcohol use behaviors, but their influence on the longitudinal course of alcohol misuse and interactions with genetic predisposition remain unclear. This study examined how the longitudinal course of heavy episodic drinking (HED) from adolescence to young adulthood varies with polygenic risk, parental separation, and relationship discord.</div></div><div><h3>Method</h3><div>Participants were from the Collaborative Study on the Genetics of Alcoholism (COGA) Prospective Sample, and included individuals from 2 genetically inferred continental groups: European-like (EA; n = 1761) and African-like (AA; n = 894) who were reassessed biennially (mean age = 16.39 at first assessment; mean assessments = 4.65). Alcohol misuse was indexed by past-year HED frequency. Predictors included parental separation, parental relationship discord, and problematic alcohol use polygenic scores (PGS<sub>PAU</sub>). Data were analyzed using linear mixed-effects growth models.</div></div><div><h3>Results</h3><div>HED increased through young adulthood before declining. In European Americans (EA), parental separation was associated with HED intercepts, but not with linear slope or quadratic curvature. Higher PGS<sub>PAU</sub> was associated with a faster initial growth and slower decline. In African American (AA), parental relationship discord was not associated with HED intercepts but was associated with a faster initial growth and slower decline. PGS<sub>PAU</sub> were not associated the intercept or the course of HED. No interaction was found between PGS<sub>PAU</sub> and parental separation or discord to predict the longitudinal course of HED in either EA or AA samples.</div></div><div><h3>Conclusion</h3><div>Genetic risk and exposure to parental separation and discord are associated with the course of HED, with some differences across continental groups.</div></div><div><h3>Plain language summary</h3><div>This study utilized data from the Collaborative Study on the Genetics of Alcoholism (COGA) to examine how the course of heavy episodic drinking (HED) from adolescence to young adulthood varies with genetic risk, parental separation, and relationship discord. Parental separation and relationship discord were associated with initial levels of heavy episodic drinking and their course into young adulthood. In the European American sample, these family stressors were associated with higher initial levels of heavy episodic drinking, which were sustained over time with genetic factors amplifying this pattern. In the African American sample, parental relationship discord was associated with a rapid increase in heavy episodic drinking that declined slowly. These findings highlight the contributions of genetics and family adversity in shaping risk for harmful patterns of alcohol use across development.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1177-1187"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-28DOI: 10.1016/j.jaacop.2025.05.003
Carol A. Wygant MSW , Cassandra Hartman MA , Xueting Xia MS , Nichole L. Michaels PhD , Donna A. Ruch PhD
Objective
Youth suicide is a growing public health concern, and younger preteens have experienced notable increases in suicide rates. Suicide by firearm among preteens have increased more than all other suicide methods combined. The current study examined characteristics and precipitating circumstances associated with firearm suicides among preteens and teens ages 8 to 17 years.
Method
This cross-sectional study analyzed data from the National Violent Death Reporting System from 2012 to 2021 on youth firearm suicide decedents (N = 3,768). Comparisons between preteens (8-12 years old) and teens (13-17 years old) were analyzed using linear mixed models that adjusted for sex, race, and ethnicity.
Results
The sample included 229 preteen and 3,539 teen firearm suicide decedents (14.7% female; 9.4% Black; 8.1% other race; 82.5% White; 10.7% Hispanic). Preteens were more likely to be female (adjusted odds ratio [AOR] = 1.76; 95% CI, 1.26-2.46) and Black (AOR = 1.72; 95% CI, 1.14-2.58) compared with teens and more likely to experience family (AOR = 1.69; 95% CI, 1.27-2.23) and school (AOR = 2.04; 95% CI, 1.51-2.74) problems. Preteens were less likely than teens to have a current mental health problem (AOR = 0.47; 95% CI, 0.32-0.68), a depressed mood at time of death (AOR = 0.49; 95% CI, 0.33-0.72), and a history of suicidal thoughts (AOR = 0.60; 95% CI, 0.38-0.95) or attempts (AOR = 0.25; 95% CI, 0.08-0.81). Among cases with firearm-related information, most youth had access to a gun that was unlocked or loaded.
Conclusion
Findings suggest that universal suicide risk screening and assessment is warranted, especially for younger preteens, and advocating for safe firearm storage practices remains a key component of prevention for this population
Plain language summary
This study compared characteristics and precipitating circumstances of preteens (8-12) and teens (13-17) who died by firearm suicide using data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System. Preteen decedents were more likely to have been female or Black compared to teens and were more likely to have a diagnosis of attention deficit with hyperactivity. Preteens were approximately half as likely as their teen counterparts to have an identified mental health problem or a perceived depressed mood at the time of death. Findings suggest that preteens would benefit from intervention and prevention efforts tailored to their specific, age-dependent needs.
{"title":"Characteristics and Precipitating Circumstances of Preteen and Teen Suicide Decedents Who Died by Firearm in the United States, 2012-2021","authors":"Carol A. Wygant MSW , Cassandra Hartman MA , Xueting Xia MS , Nichole L. Michaels PhD , Donna A. Ruch PhD","doi":"10.1016/j.jaacop.2025.05.003","DOIUrl":"10.1016/j.jaacop.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>Youth suicide is a growing public health concern, and younger preteens have experienced notable increases in suicide rates. Suicide by firearm among preteens have increased more than all other suicide methods combined. The current study examined characteristics and precipitating circumstances associated with firearm suicides among preteens and teens ages 8 to 17 years.</div></div><div><h3>Method</h3><div>This cross-sectional study analyzed data from the National Violent Death Reporting System from 2012 to 2021 on youth firearm suicide decedents (N = 3,768). Comparisons between preteens (8-12 years old) and teens (13-17 years old) were analyzed using linear mixed models that adjusted for sex, race, and ethnicity.</div></div><div><h3>Results</h3><div>The sample included 229 preteen and 3,539 teen firearm suicide decedents (14.7% female; 9.4% Black; 8.1% other race; 82.5% White; 10.7% Hispanic). Preteens were more likely to be female (adjusted odds ratio [AOR] = 1.76; 95% CI, 1.26-2.46) and Black (AOR = 1.72; 95% CI, 1.14-2.58) compared with teens and more likely to experience family (AOR = 1.69; 95% CI, 1.27-2.23) and school (AOR = 2.04; 95% CI, 1.51-2.74) problems. Preteens were less likely than teens to have a current mental health problem (AOR = 0.47; 95% CI, 0.32-0.68), a depressed mood at time of death (AOR = 0.49; 95% CI, 0.33-0.72), and a history of suicidal thoughts (AOR = 0.60; 95% CI, 0.38-0.95) or attempts (AOR = 0.25; 95% CI, 0.08-0.81). Among cases with firearm-related information, most youth had access to a gun that was unlocked or loaded.</div></div><div><h3>Conclusion</h3><div>Findings suggest that universal suicide risk screening and assessment is warranted, especially for younger preteens, and advocating for safe firearm storage practices remains a key component of prevention for this population</div></div><div><h3>Plain language summary</h3><div>This study compared characteristics and precipitating circumstances of preteens (8-12) and teens (13-17) who died by firearm suicide using data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System. Preteen decedents were more likely to have been female or Black compared to teens and were more likely to have a diagnosis of attention deficit with hyperactivity. Preteens were approximately half as likely as their teen counterparts to have an identified mental health problem or a perceived depressed mood at the time of death. Findings suggest that preteens would benefit from intervention and prevention efforts tailored to their specific, age-dependent needs.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 655-662"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-21DOI: 10.1016/j.jaacop.2025.05.002
Jennifer Kramer MSc , Renée L. Roelofs PhD , Ellen Wingbermühle PhD , Sara Pieters PhD , Jos Egger PhD
Objective
The current study aims to examine executive and social functioning in children and adolescents with Noonan syndromes, which contributes to the understanding of the cognitive and behavioral profile of this population and possible treatment options.
Method
A total of 26 children and adolescents with Noonan syndromes (including Noonan syndrome, Noonan syndrome with multiple lentigines, and Noonan-like syndrome with loose anagen hair; mean age = 11.92 years, SD = 2.64) and 25 typically developing children and adolescents (mean age = 10.32 years, SD = 2.75) participated in this study. Cognitive and behavioral measures of executive and social functioning of children and adolescents in these groups were compared using multivariate analyses of variance. Moreover, the relationship between executive and social functioning was examined.
Results
Results showed significant group differences on working memory and attention, with controls outperforming children and adolescents with Noonan syndromes, even when controlling for crystallized intelligence. At a behavioral level, children and adolescents with Noonan syndromes experienced more executive function problems and more characteristics of attention-deficit/hyperactivity disorder and autism spectrum disorders in daily life than controls, even when controlling for crystallized intelligence. Positive relationships were found between behavioral measures of executive functions and characteristics of autism spectrum disorders.
Conclusion
Difficulties in working memory and attention seem to be key cognitive features in children and adolescents with Noonan syndromes. These difficulties occur alongside parental reports of executive function problems, characteristics of attention-deficit/hyperactivity disorder, and autism spectrum disorders.
Plain language summary
This Netherlands study examined executive and social functioning in 26 children and adolescents (7-17 years) with Noonan syndromes compared to 25 typically developing peers. Youth with Noonan syndromes showed relatively lower performance on working memory and attention, and in daily functioning. Parents reported more executive function problems, characteristics of attention deficit with hyperactivity, and autism spectrum disorders in the group with Noonan syndromes. These findings contribute new knowledge of cognitive and behavioral features of Noonan syndromes and underline the importance of individualized neuropsychological assessment in this population, especially in the context of functional impairments, such as learning and social problems.
{"title":"Executive and Social Functioning in Children and Adolescents With Noonan Syndromes: Cognition and Behavior","authors":"Jennifer Kramer MSc , Renée L. Roelofs PhD , Ellen Wingbermühle PhD , Sara Pieters PhD , Jos Egger PhD","doi":"10.1016/j.jaacop.2025.05.002","DOIUrl":"10.1016/j.jaacop.2025.05.002","url":null,"abstract":"<div><h3>Objective</h3><div>The current study aims to examine executive and social functioning in children and adolescents with Noonan syndromes, which contributes to the understanding of the cognitive and behavioral profile of this population and possible treatment options.</div></div><div><h3>Method</h3><div>A total of 26 children and adolescents with Noonan syndromes (including Noonan syndrome, Noonan syndrome with multiple lentigines, and Noonan-like syndrome with loose anagen hair; mean age = 11.92 years, SD = 2.64) and 25 typically developing children and adolescents (mean age = 10.32 years, SD = 2.75) participated in this study. Cognitive and behavioral measures of executive and social functioning of children and adolescents in these groups were compared using multivariate analyses of variance. Moreover, the relationship between executive and social functioning was examined.</div></div><div><h3>Results</h3><div>Results showed significant group differences on working memory and attention, with controls outperforming children and adolescents with Noonan syndromes, even when controlling for crystallized intelligence. At a behavioral level, children and adolescents with Noonan syndromes experienced more executive function problems and more characteristics of attention-deficit/hyperactivity disorder and autism spectrum disorders in daily life than controls, even when controlling for crystallized intelligence. Positive relationships were found between behavioral measures of executive functions and characteristics of autism spectrum disorders.</div></div><div><h3>Conclusion</h3><div>Difficulties in working memory and attention seem to be key cognitive features in children and adolescents with Noonan syndromes. These difficulties occur alongside parental reports of executive function problems, characteristics of attention-deficit/hyperactivity disorder, and autism spectrum disorders.</div></div><div><h3>Plain language summary</h3><div>This Netherlands study examined executive and social functioning in 26 children and adolescents (7-17 years) with Noonan syndromes compared to 25 typically developing peers. Youth with Noonan syndromes showed relatively lower performance on working memory and attention, and in daily functioning. Parents reported more executive function problems, characteristics of attention deficit with hyperactivity, and autism spectrum disorders in the group with Noonan syndromes. These findings contribute new knowledge of cognitive and behavioral features of Noonan syndromes and underline the importance of individualized neuropsychological assessment in this population, especially in the context of functional impairments, such as learning and social problems.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 645-654"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-09DOI: 10.1016/j.jaacop.2025.05.001
Layne Wetherbee MSW, LCSW , Jason Carbone PhD , Hannah S. Szlyk PhD, LCSW , Alexander Hayek DO , Nathaniel A. Dell PhD, LCSW
Objective
Among adolescents, maltreatment is an established risk factor for suicidal ideation (SI). This study tests the relationship between different forms of maltreatment and SI encountered in emergency department (ED) settings.
Method
We used cross-sectional data from a nationally representative sample of ED visits from 2016 to 2020 that involved adolescents 12 to 17 years of age. We sought to characterize the relationship between forms of maltreatment and SI, to explore the relationship between perpetrator type and SI, and to analyze patterns in SI by maltreatment type.
Results
SI was significantly higher among ED visits with maltreated adolescents (7.05%) relative to ED visits without confirmed maltreatment (2.92%; p < .001). SI was documented most in cases of psychological maltreatment (32.85%), followed by multiple forms of maltreatment (24.72%), neglect (6.73%), physical abuse (6.43%), and sexual abuse (5.20%) (p < .001). SI was associated with payer in cases of neglect (p = .038) and sexual abuse (p < .001), sex in cases of physical abuse (p = .022) and sexual abuse (p = .016), and urban–rural status in cases of physical abuse (p = .044). Perpetrator type was differentially associated with SI (p < .001). A significant trend in SI-related ED visits was found by year (odds ratio = 1.12, p = .003) when adjusting for maltreatment type and demographic characteristics.
Conclusion
Study findings present new evidence on the relationship between maltreatment and SI encountered in ED settings. Suicide risk assessment for adolescents with maltreatment histories presenting to the ED is important for supporting the psychological health of this vulnerable population.
Plain language summary
Using a national sample of emergency department visits from 2016–2020, this study evaluates the relation between abuse and suicidal ideation in adolescents presenting to the emergency department (ED). Suicidal ideation was higher in youth with psychological abuse who were seen in the ED relative to other forms of abuse or neglect. These findings draw attention to the need for suicide screening and appropriate intervention in youth with a history of maltreatment.
{"title":"Suicidal Ideation Among Adolescents With Confirmed Maltreatment: Insights From the 2016-2020 Nationwide Emergency Department Sample","authors":"Layne Wetherbee MSW, LCSW , Jason Carbone PhD , Hannah S. Szlyk PhD, LCSW , Alexander Hayek DO , Nathaniel A. Dell PhD, LCSW","doi":"10.1016/j.jaacop.2025.05.001","DOIUrl":"10.1016/j.jaacop.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>Among adolescents, maltreatment is an established risk factor for suicidal ideation (SI). This study tests the relationship between different forms of maltreatment and SI encountered in emergency department (ED) settings.</div></div><div><h3>Method</h3><div>We used cross-sectional data from a nationally representative sample of ED visits from 2016 to 2020 that involved adolescents 12 to 17 years of age. We sought to characterize the relationship between forms of maltreatment and SI, to explore the relationship between perpetrator type and SI, and to analyze patterns in SI by maltreatment type.</div></div><div><h3>Results</h3><div>SI was significantly higher among ED visits with maltreated adolescents (7.05%) relative to ED visits without confirmed maltreatment (2.92%; <em>p</em> < .001). SI was documented most in cases of psychological maltreatment (32.85%), followed by multiple forms of maltreatment (24.72%), neglect (6.73%), physical abuse (6.43%), and sexual abuse (5.20%) (<em>p</em> < .001). SI was associated with payer in cases of neglect (<em>p</em> = .038) and sexual abuse (<em>p</em> < .001), sex in cases of physical abuse (<em>p</em> = .022) and sexual abuse (<em>p</em> = .016), and urban–rural status in cases of physical abuse (<em>p</em> = .044). Perpetrator type was differentially associated with SI (<em>p</em> < .001). A significant trend in SI-related ED visits was found by year (odds ratio = 1.12, <em>p</em> = .003) when adjusting for maltreatment type and demographic characteristics.</div></div><div><h3>Conclusion</h3><div>Study findings present new evidence on the relationship between maltreatment and SI encountered in ED settings. Suicide risk assessment for adolescents with maltreatment histories presenting to the ED is important for supporting the psychological health of this vulnerable population.</div></div><div><h3>Plain language summary</h3><div>Using a national sample of emergency department visits from 2016–2020, this study evaluates the relation between abuse and suicidal ideation in adolescents presenting to the emergency department (ED). Suicidal ideation was higher in youth with psychological abuse who were seen in the ED relative to other forms of abuse or neglect. These findings draw attention to the need for suicide screening and appropriate intervention in youth with a history of maltreatment.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1087-1097"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-08DOI: 10.1016/j.jaacop.2025.04.009
Allison DeLetter MD , Lindsay Stafford DO , Adon F.G. Rosen PhD , David E. Bard PhD , Stephanie DeLeon MD
Objective
Suicide has been a leading cause death in adolescents nationally for years; the full effect of COVID-19 pandemic and social isolation on pediatric mental health and subsequent suicidality is not yet fully understood.
Method
This retrospective chart review describes trends in patients 4 to 17 years of age who presented to the emergency room or for hospital admission with suicidal thoughts or acts of self-harm from January 2012 to July 2022. Both change point and auto-regressive moving average (ARMA) models were fit to patient presentation numbers; expected change in presentation rates in pandemic months were compared to pre-pandemic time periods.
Results
There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period, with an average baseline increase of 0.015 patient presentations per week. Change point and ARMA models both demonstrated an increase in patient presentations around April 2020; ARMA modeling estimated 1.67 additional patient presentations per week above pre-pandemic model predictions.
Conclusion
In the pandemic time period, there were significantly more patient presentations for suicidal ideation and intentional self-harm than would have been expected based on pre-pandemic patterns. This volume has continued up to 2 years after the pandemic declaration and has both mental health access and resource implications.
Plain language summary
This retrospective chart review describes trends in patients 4 to 17 years of age who presented to a tertiary children’s hospital with suicidal thoughts or acts of self-harm from January 2012 to July 2022. There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period with a sharp increase in presentations in April 2020 coinciding with the onset of the COVID-19 pandemic. This increase lasted throughout the study period and represented an additional 2 patient presentations per week than predicted by pre-pandemic modeling.
Diversity & Inclusion Statement
One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group.
{"title":"Seeking Care for Suicidal Thoughts and Actions: How COVID Affected Our Pediatric Patients","authors":"Allison DeLetter MD , Lindsay Stafford DO , Adon F.G. Rosen PhD , David E. Bard PhD , Stephanie DeLeon MD","doi":"10.1016/j.jaacop.2025.04.009","DOIUrl":"10.1016/j.jaacop.2025.04.009","url":null,"abstract":"<div><h3>Objective</h3><div>Suicide has been a leading cause death in adolescents nationally for years; the full effect of COVID-19 pandemic and social isolation on pediatric mental health and subsequent suicidality is not yet fully understood.</div></div><div><h3>Method</h3><div>This retrospective chart review describes trends in patients 4 to 17 years of age who presented to the emergency room or for hospital admission with suicidal thoughts or acts of self-harm from January 2012 to July 2022. Both change point and auto-regressive moving average (ARMA) models were fit to patient presentation numbers; expected change in presentation rates in pandemic months were compared to pre-pandemic time periods.</div></div><div><h3>Results</h3><div>There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period, with an average baseline increase of 0.015 patient presentations per week. Change point and ARMA models both demonstrated an increase in patient presentations around April 2020; ARMA modeling estimated 1.67 additional patient presentations per week above pre-pandemic model predictions.</div></div><div><h3>Conclusion</h3><div>In the pandemic time period, there were significantly more patient presentations for suicidal ideation and intentional self-harm than would have been expected based on pre-pandemic patterns. This volume has continued up to 2 years after the pandemic declaration and has both mental health access and resource implications.</div></div><div><h3>Plain language summary</h3><div>This retrospective chart review describes trends in patients 4 to 17 years of age who presented to a tertiary children’s hospital with suicidal thoughts or acts of self-harm from January 2012 to July 2022. There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period with a sharp increase in presentations in April 2020 coinciding with the onset of the COVID-19 pandemic. This increase lasted throughout the study period and represented an additional 2 patient presentations per week than predicted by pre-pandemic modeling.</div></div><div><h3>Diversity & Inclusion Statement</h3><div>One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1069-1075"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-07DOI: 10.1016/j.jaacop.2025.04.008
Lindsay Dickey MEd , Griffin B. Murch BS , Samantha Pegg MS , Anh Dao BA , Lisa Venanzi MEd , Madison Politte-Corn MS , George Abitante MS , Autumn Kujawa PhD
Objective
Despite an increased focus on prevention, rates of suicidal thoughts and behaviors have failed to decline and robust predictors have yet to be identified, highlighting a critical need to integrate multiple risk processes across methodological approaches in predictive models.
Method
The current pilot study leveraged machine learning with multimethod data to predict concurrent and prospective suicidal ideation (SI) in a sample of adolescents 14 to 17 years of age (N = 165) oversampled for depression and depression risk. Predictors included clinical diagnoses and comorbidity load, interviewer-rated chronic stress, self-reported internalizing symptoms, daily experiences of positive and negative affect, and neural measures of emotion processing and reward responsiveness. The presence or absence of SI was measured at baseline using self-report and a clinician interview. SI was self-reported again at a 6-month follow-up and was reassessed via a clinician interview approximately 1 year after baseline. Random forest classification models with a synthetic minority oversampling technique were implemented and cross-validated.
Results
Random forest classification outperformed logistic regression, predicting SI with high precision and recall both concurrently and prospectively (F1s = 0.81-0.85). Predictor importance analyses showed that cognitive symptoms of depression and average positive affect were prominent predictors across models. Surprisingly, chronic stress and neural measures demonstrated limited predictive utility.
Conclusion
Findings from this pilot study support the potential of machine learning algorithms with multimethod data in the prediction of SI in adolescence, although replication and extension are needed.
Plain language summary
Despite an increased focus on prevention, rates of suicidal thoughts and behaviors have failed to decline. This pilot study applied machine learning to multimethod data including clinical diagnoses, demographic information, life stress, daily emotion fluctuations, and neural markers to predict current and future suicidal ideation in a sample of adolescents at varying risk for depression. The machine learning algorithm was able to identify those with suicidal ideation better than traditional statistical approaches. Findings from this study support the potential of machine learning algorithms with multimethod data in the detection of suicidal ideation in youth.
Diversity & Inclusion Statement
We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance, as well as race, ethnic, and/or other types of diversity in the recruitment of human participants. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our ref
{"title":"Concurrent and Prospective Prediction of Suicidal Ideation in Adolescents Using Multimethod Data and Machine Learning: A Pilot Study","authors":"Lindsay Dickey MEd , Griffin B. Murch BS , Samantha Pegg MS , Anh Dao BA , Lisa Venanzi MEd , Madison Politte-Corn MS , George Abitante MS , Autumn Kujawa PhD","doi":"10.1016/j.jaacop.2025.04.008","DOIUrl":"10.1016/j.jaacop.2025.04.008","url":null,"abstract":"<div><h3>Objective</h3><div>Despite an increased focus on prevention, rates of suicidal thoughts and behaviors have failed to decline and robust predictors have yet to be identified, highlighting a critical need to integrate multiple risk processes across methodological approaches in predictive models.</div></div><div><h3>Method</h3><div>The current pilot study leveraged machine learning with multimethod data to predict concurrent and prospective suicidal ideation (SI) in a sample of adolescents 14 to 17 years of age (N = 165) oversampled for depression and depression risk. Predictors included clinical diagnoses and comorbidity load, interviewer-rated chronic stress, self-reported internalizing symptoms, daily experiences of positive and negative affect, and neural measures of emotion processing and reward responsiveness. The presence or absence of SI was measured at baseline using self-report and a clinician interview. SI was self-reported again at a 6-month follow-up and was reassessed via a clinician interview approximately 1 year after baseline. Random forest classification models with a synthetic minority oversampling technique were implemented and cross-validated.</div></div><div><h3>Results</h3><div>Random forest classification outperformed logistic regression, predicting SI with high precision and recall both concurrently and prospectively (F1s = 0.81-0.85). Predictor importance analyses showed that cognitive symptoms of depression and average positive affect were prominent predictors across models. Surprisingly, chronic stress and neural measures demonstrated limited predictive utility.</div></div><div><h3>Conclusion</h3><div>Findings from this pilot study support the potential of machine learning algorithms with multimethod data in the prediction of SI in adolescence, although replication and extension are needed.</div></div><div><h3>Plain language summary</h3><div>Despite an increased focus on prevention, rates of suicidal thoughts and behaviors have failed to decline. This pilot study applied machine learning to multimethod data including clinical diagnoses, demographic information, life stress, daily emotion fluctuations, and neural markers to predict current and future suicidal ideation in a sample of adolescents at varying risk for depression. The machine learning algorithm was able to identify those with suicidal ideation better than traditional statistical approaches. Findings from this study support the potential of machine learning algorithms with multimethod data in the detection of suicidal ideation in youth.</div></div><div><h3>Diversity & Inclusion Statement</h3><div>We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance, as well as race, ethnic, and/or other types of diversity in the recruitment of human participants. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our ref","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1046-1059"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1016/j.jaacop.2025.04.007
Gregory R. Niklason BS , Andrea M. Maxwell BS , Leyla R. Brucar MSc , Caroline Ostrand MA , Erich Kummerfeld PhD , Monica Luciana PhD , Anna Zilverstand PhD
<div><h3>Objective</h3><div>Extant research has focused on the risk factors for alcohol use in adolescence, but little work has examined these in childhood. Early alcohol sipping, defined here as sipping alcohol by ages 9 to 10, may be a unique and informative developmental precursor to future problematic alcohol use. This study employed machine learning to rank risk factors linked to early alcohol sipping by importance.</div></div><div><h3>Method</h3><div>Data from a subset of the Adolescent Brain Cognitive Development℠ (ABCD) Study sample were used (n = 10,707 children ages 9-10 years old; 48.1% girls). Two state-of-the-art machine learning techniques, eXtreme Gradient Boosting (XGBoost) and Shapley Additive exPlanations (SHAP), were combined to rank 341 environmental, 359 health, and 127 psychological factors and 1,332 indicators of brain function by their importance in classifying children with early alcohol sipping.</div></div><div><h3>Results</h3><div>The environmental classification model yielded the highest classification performance (area under the curve = 0.76; 95% CI, 0.749-0.774). Factors related to family norms, socioeconomic status, parental stress, and maternal alcohol use were most important for identifying a child with early alcohol sipping. The health classification model had the second highest performance (area under the curve = 0.68; 95% CI, 0.662-0.690), with sleep patterns, early puberty onset, and mental health symptoms the most important for classifying early sipping. The psychological model yielded the third highest classification performance (area under the curve = 0.65; 95% CI, 0.638-0.667) and linked negative affect, sensation seeking, impulsivity, and impaired reward processing to sipping. Models that included brain indices performed only marginally better than chance.</div></div><div><h3>Conclusion</h3><div>Taken together, these results suggest that the factors underlying early alcohol sipping are similar to the factors underlying problematic alcohol use later in life and that interventions targeting these early in life may be effective at preventing future alcohol use.</div></div><div><h3>Plain language summary</h3><div>Utilizing machine learning approaches, data from 10,707 children from the Adolescent Brain and Cognitive Development℠ (ABCD) Study was used to identify risk factors linked to taking a sip of alcohol before 9 to 10 years of age. Family-related factors such as parenting style, parental stress, socioeconomic status, and family rules around alcohol use were the most important risk factors for alcohol sipping in childhood. Health and psychological factors were the second most important, with sleep disruptions, negative emotional state, mental health symptoms, and sensation seeking being the most significant risk factors for early experimental alcohol use. These findings draw attention to important family and lifestyle targets for early intervention.</div></div><div><h3>Diversity & Inclusion Statement<
{"title":"Environmental, Health, and Psychological Factors Predict Alcohol Sipping in Childhood: A Machine Learning Analysis of the ABCD Study","authors":"Gregory R. Niklason BS , Andrea M. Maxwell BS , Leyla R. Brucar MSc , Caroline Ostrand MA , Erich Kummerfeld PhD , Monica Luciana PhD , Anna Zilverstand PhD","doi":"10.1016/j.jaacop.2025.04.007","DOIUrl":"10.1016/j.jaacop.2025.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>Extant research has focused on the risk factors for alcohol use in adolescence, but little work has examined these in childhood. Early alcohol sipping, defined here as sipping alcohol by ages 9 to 10, may be a unique and informative developmental precursor to future problematic alcohol use. This study employed machine learning to rank risk factors linked to early alcohol sipping by importance.</div></div><div><h3>Method</h3><div>Data from a subset of the Adolescent Brain Cognitive Development℠ (ABCD) Study sample were used (n = 10,707 children ages 9-10 years old; 48.1% girls). Two state-of-the-art machine learning techniques, eXtreme Gradient Boosting (XGBoost) and Shapley Additive exPlanations (SHAP), were combined to rank 341 environmental, 359 health, and 127 psychological factors and 1,332 indicators of brain function by their importance in classifying children with early alcohol sipping.</div></div><div><h3>Results</h3><div>The environmental classification model yielded the highest classification performance (area under the curve = 0.76; 95% CI, 0.749-0.774). Factors related to family norms, socioeconomic status, parental stress, and maternal alcohol use were most important for identifying a child with early alcohol sipping. The health classification model had the second highest performance (area under the curve = 0.68; 95% CI, 0.662-0.690), with sleep patterns, early puberty onset, and mental health symptoms the most important for classifying early sipping. The psychological model yielded the third highest classification performance (area under the curve = 0.65; 95% CI, 0.638-0.667) and linked negative affect, sensation seeking, impulsivity, and impaired reward processing to sipping. Models that included brain indices performed only marginally better than chance.</div></div><div><h3>Conclusion</h3><div>Taken together, these results suggest that the factors underlying early alcohol sipping are similar to the factors underlying problematic alcohol use later in life and that interventions targeting these early in life may be effective at preventing future alcohol use.</div></div><div><h3>Plain language summary</h3><div>Utilizing machine learning approaches, data from 10,707 children from the Adolescent Brain and Cognitive Development℠ (ABCD) Study was used to identify risk factors linked to taking a sip of alcohol before 9 to 10 years of age. Family-related factors such as parenting style, parental stress, socioeconomic status, and family rules around alcohol use were the most important risk factors for alcohol sipping in childhood. Health and psychological factors were the second most important, with sleep disruptions, negative emotional state, mental health symptoms, and sensation seeking being the most significant risk factors for early experimental alcohol use. These findings draw attention to important family and lifestyle targets for early intervention.</div></div><div><h3>Diversity & Inclusion Statement<","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 4","pages":"Pages 1129-1146"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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