Clinical child psychology and psychiatry最新文献

While adolescent voice-hearing is relatively common, little is known about the experiences of their siblings. This study explored the perspectives of 14 siblings from the UK, USA, and Australia through an online qualitative survey. Using Foucauldian-informed Narrative Analysis (Parry & Varese, 2021a), an approach that accounts for how social power, discourse, and dominant cultural narratives shape lived experience, the research examined how stigmatized societal narratives around voice-hearing influenced siblings' perspectives. Findings revealed emotional journeys involving initial shock, evolving roles, relationship strains, and limited support. Many siblings faced isolation, yet also described opportunities for growth and stronger connections through open communication. The study highlights siblings' complex roles and underscores their need for recognition and tailored support. Recommendations include creating dedicated sibling support spaces, providing psychoeducation, and involving siblings in family interventions. Recognising and including siblings in care can enhance their wellbeing and strengthen the support system around young voice-hearers.

Adolescence, characterized by both remarkable brain plasticity and vulnerability to psychiatric disorders; represents a uniquely propitious time window for targeted early interventions. Mindfulness-based interventions (MBI) have garnered increasing interest as cost-efficient, non-invasive and non-pharmacological approaches to enhancing mental health. While solid evidence supports the mental health benefits of MBI in adults, results in adolescents remain mixed. In particular, there is contradictory evidence regarding the use of MBI for healthy adolescents, underscoring the need for further research on its underlying mechanisms. One emerging mechanism mediating the beneficial effects of MBI is improved emotion regulation. Indeed, impaired emotion regulation is increasingly recognized as an early and transdiagnostic marker for psychiatric disorders. Therefore, we aimed to examine the impact of MBI on emotion regulation (ER) strategy use in healthy young adolescents. This study is a two-arm, wait-list, randomized controlled trial (RCT) of an 8-week MBI involving 70 adolescents from a non-clinical sample, aged 13 to 15. This study reports secondary outcomes on the impact of the MBI on emotion regulation strategy (ERS) use during a naturalistic task of emotion reactivity and regulation. Post-hoc t-tests on a multilevel logistic regression model (GLMM) revealed a significant decrease in the use of acceptance and problem solving, and a highly significant increase in the use of relaxation in adolescents' emotion regulation strategies after the MBI, compared to the wait-list controls. Despite the limited sample size, these secondary results of the study point to the effectiveness of MBI in improving emotion regulation strategies in adolescents from the general population, paving the way to future wider-scale research into specific mechanisms of action and into the clinical relevance of MBI in adolescents. Shedding light on these points is pivotal for validating MBI as a potential early intervention aimed at improving mental health and reducing the risk of psychiatric disorders in adolescents.

Youth non-suicidal self-injury (NSSI) and suicidality have increased worldwide, yet funding is limited, and the workforce is stretched. This context of scarcity and risk influences service responses: thresholds for accessing services are raised, with increased gatekeeping. This commentary draws on behavioural and attachment theories to describe how reactive resource allocation can be harmful and inadvertently maintain distress. This occurs through unpredictably providing and then withdrawing access to mental health services. The mental health system itself can be seen as a participant in the therapeutic relationship, providing inconsistent and unpredictable responses to suicidal young people. Trauma- and attachment-related difficulties influence youth perceptions, and small interactions with services can maintain suicidality. When this pattern is recognised, it is possible to alter service responses to emulate interpersonal qualities that provide a sense of safety for those who seek help. For example, predictable responses, clear communication, validation throughout case progression, and consistent adherence to boundaries, all increase trust within the agency-client relationship.

IntroductionMental health in children is significantly influenced by socio-economic status, poverty, and income inequality. However, existing child psychiatric research focuses on clinical variables and developed nations. Hence, this study explored the impact of these factors on the psychosocial functioning of children visiting a mental health clinic in India.MethodsA cross-sectional research design was employed, with data collected from children and their parents/caregivers using the Children's Global Assessment Scale (CGAS) and Indian Disability Evaluation and Assessment Scale (IDEAS). Participants included 120 children recruited from an out-patient clinic in a tertiary mental healthcare center. Non-parametric tests were employed to examine the influence of socio-economic status and poverty on functioning among the participants.ResultsOur study observed significant differences in functioning scores related to socio-economic status, monthly family income, and sources of income, with family income source significantly affecting disability scores. A significant proportion of the participants scored below the functioning benchmark and above the disability benchmark.ConclusionSocio-economic disparities and income inequality significantly influence mental health outcomes. The findings emphasize the role of social determinants of mental health and underscore the importance of integrating mental health services with socio-economic support systems.

BackgroundPublished research on the effects of the COVID-19 pandemic reveals increased eating disorders (EDs), exacerbated conditions, and the reduction in accessibility of already inadequate supports available.ObjectiveTo explore the perspectives of healthcare professionals on the impact of COVID-19 on EDs and ED treatment and service provision for the paediatric population.MethodSemi-structured interviews were completed with participants, and data were analysed using code-book thematic analysis.ParticipantsParticipants included 13 healthcare professionals from Ireland with experience working with EDs ranging from 5-21 years (M = 11.46, SD = 2.94).ResultsSix themes and fourteen subthemes were established. The first three themes, 'Increased severity and frequency of paediatric EDs', 'Psychological impact and coping mechanisms', and 'Shifts in epidemiological trends', identify the impact of the pandemic on the severity and frequency of EDs. The second three themes, 'Challenges in accessing ED services', 'Adaptions and innovations in ED treatment', and 'Implication for service provision and healthcare systems', identify how the pandemic affected treatment and service provision.ImplicationsThe results emphasise the need for increased funding for ED services, grants for further professional training, and medical practitioners' education on psychiatric conditions. This study also discovered increased comorbid OCD and ASD presentations since the onset of the pandemic.

Clinical decision-making in infant and early childhood mental health can be complex, shaped by clinical, legal, contextual, and personal factors. At the core of this complexity, however, lies an ethical dimension, which interacts with all other aspects of decision-making. This paper introduces a multidimensional model that places ethics at the centre of clinical formulation, offering a structured yet flexible approach to understanding complex challenges faced by practitioners. Through a series of illustrative cases, we demonstrate the model's applicability across diverse practice settings. A Mother-Baby Unit case highlights tensions between maternal mental health and infant well-being. A home visiting case examines how to balance a mother's autonomy with concerns for infant safety in the context of domestic violence. A neonatal case explores how a physician's personal history influences treatment recommendations, raising questions about consent. A childcare case considers conflicts between institutional caregiving policies and parental preferences. These cases demonstrate how ethical considerations should underpin clinical reasoning, even when not obvious. By explicitly integrating ethics into clinical formulation, this model provides a tool for practitioners navigating complexity. It has applications in clinical training, professional development, and reflective supervision, fostering a culture of ethical awareness in infant and early childhood mental health practice.

Approximately 22.1% of youth would engage in Non-Suicidal Self-Injury (NSSI). While studies have examined the prevalence of NSSI in the local context, there is a lack of studies on the presentation and phenomenology of NSSI in Singapore. This study used the Non-Suicidal Self-Injury - Assessment Tool (NSSI-AT) to examine the functions, characteristics, and NSSI experiences of local youths. 121 youths between 12 and 25 years old were recruited. Outcomes for the NSSI-AT, including the actions, functions, frequency, age of onset, initial motivations, severity, practice patterns, and disclosure of self-harm, were reported using descriptive analysis. Personal reflections were analysed using thematic analysis. Participants engaged in NSSI actions such as cutting and scratching to manage agitating and depressive emotional states. Most participants started engaging in NSSI in early adolescence (mean = 13.0 years, SD = 2.37, range = 7-23) and had disclosed their NSSI with others' initiation. When reflecting on NSSI experiences, participants gave encouragement to others and reported the negative aspects of self-harm. Findings support emotional regulation as a function of NSSI in the local population, who may be more vulnerable during early adolescence. This study also suggests the importance of having a person-centred treatment approach to effectively serve this age group and their challenges.

IntroductionParental cancer disrupts family dynamics. Children who have parents suffering from cancer may suffer from caregiver burden syndrome, including physical and psychological symptoms. Few support programs are available for them. In France, these programs are mainly discussion groups.MethodsThe aim of this work was to elaborate a support program for young minor caregivers. The first step was to conduct a systematic literature review, followed by the Delphi method to reach a consensus.Results26 articles were retrieved during the literature review step. 57 items were identified. Two questionnaires (one for children and one for teenagers) were sent by email to 14 experts, working as general practitioners, oncologists, psychologists, or pediatric nurses. After four rounds, experts reached a consensus for each question. Items were evaluated by a yes-no scale. The consensus was validated if a question obtained over 70% of votes. The number, length and content of the sessions, and the healthcare professionals required for their organization were determined by consensus.DiscussionThe next step will be to implement support programs based on this method and test them in real life to evaluate their impact.

Children with congenital heart disease are more likely to receive special educational services in schools and have an increased risk of mental health issues. We explored the lived experiences of parents caring for a child with heart disease and concurrent mental health issues in Denmark. Semi-structured interviews with ten parents (age 39-57 years) to these children (age 5-17 years) were analysed using interpretative phenomenological analysis. Three Group Experiential Themes (GETs) were generated from the analysis: The first GET, Parental roles and caring behaviours, described parental struggles of fulfilling their parenting role ideals and experiences with stigmatization of MHI. GET two, Parental reflections on their illness explanations, portrayed how parents utilize different illness explanations to make sense of their child's MHI. GET three, Differences in access to help and support, captured how the CHD affected overall access to mental health support. The results may inform various topics of importance for health professionals to address in their clinical encounters with these families.

BackgroundIndia faces a substantial mental health treatment gap, particularly regarding the underutilization of psychotherapy among adolescents. This mixed-methods study aimed to identify the barriers and facilitators influencing the uptake of psychotherapy for mental health issues among adolescents attending a tertiary care referral center in India.MethodsA mixed-methods design was employed. Quantitative data were collected from 74 adolescents recruited via purposive sampling using standardized scales assessing attitudes toward seeking professional psychological treatment, self-stigma, perceived barriers to seeking help, and the working alliance. Qualitative data were gathered through focus group discussions to further explore barriers and facilitators of psychotherapy.ResultsMost participants were diagnosed with neurotic spectrum disorders and had no prior psychotherapy experience. Higher self-stigma and perceived barriers were associated with less favorable attitudes toward seeking psychotherapy, while a stronger working alliance was associated with more positive attitudes. Thematic analysis identified key barriers including stigma, apprehension, poor awareness, negative social influences, and reliance on informal support. Facilitators included greater mental health literacy, perceived symptom severity, and encouragement from informal networks. Urban adolescents reported stronger working alliances compared to their rural counterparts.ConclusionFindings highlight the need to address stigma, enhance mental health literacy, and consider contextual factors in service delivery.