Child and Adolescent Psychiatry and Mental Health最新文献

Objective: This study aimed to evaluate the effects of different physical activity (PA) types on executive functions (EFs) in children (6-12 years) and adolescents (13-18 years).

Methods: Data were analyzed using Bayesian network meta-analysis combined with model-based dose-response modeling. PA dose was standardized to metabolic equivalent of task minutes per week (METs-min/week). Effect sizes were estimated using standardized mean differences (SMDs) and 95% credible intervals (CrIs). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and certainty of evidence was evaluated with CINeMA. The protocol was registered in PROSPERO (CRD42023422762).

Results: Dance was identified as the most effective PA for enhancing working memory accuracy (SMD = 0.64, 95% CrI: 0.20 to 1.07) and cognitive flexibility reaction time (SMD = - 0.99, 95% CrI: - 1.91 to - 0.06) at optimal doses of 500 METs-min/week and 150 METs-min/week, respectively. Mixed exercise significantly improved inhibitory control accuracy (SMD = 0.52, 95% CrI: 0.21 to 0.82) at an optimal dose of 1500 METs-min/week. The certainty of evidence varied, with moderate confidence for some outcomes and low to very low confidence for others.

Conclusions: These findings highlight the importance of structured PA interventions optimized according to the most effective PA modality and dosage thresholds for improving specific executive function components. Such tailored PA programs may provide a more effective approach for enhancing cognitive development in children and adolescents.

Background: Exposure to family adversities including domestic violence, parental mental ill-health, and poverty in childhood increases the risk of self-harm and suicide attempts in adolescents. However, few studies have assessed the influence of clustered family adversity and poverty trajectories throughout childhood on self-harm behaviours and suicide attempts.

Methods: In this population-based longitudinal study, we used data on 9316 children from the UK Millennium Cohort Study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months-14 years). Multivariable logistic regression models were used to examine the association of trajectories with self-harm and suicide attempts at age 17. Population-attributable fractions were calculated to quantify the contribution of family adversity and poverty to the outcomes at the country level.

Results: Of 9316 participants, 2087 (22.4%) reported self-harm behaviours and 659 (7.1%) had made a suicide attempt. Compared with children experiencing low poverty and adversity, children in the persistent adversity groups were more likely to report both self-harm and suicide attempts; those exposed to persistent poverty and poor parental mental health were particularly at increased risk of self-harm (OR = 1.71, 95% CI: 1.30-2.24) and suicide attempts (OR = 3.98, 95% CI: 2.76-5.74). Overall, we estimated that about 13.2% of self-harm behaviours and 36.9% of suicide attempts were attributable to persistent family adversities and poverty.

Conclusions: Children growing up with persistent exposure to family adversities and poverty are more likely to harm themselves and attempt suicide, particularly those who experience the combination of persistent poverty and long-term poor parental mental health. Early detection of children at risk and intervention such as anti-poverty approaches to prevent long-lasting adversities are key to alleviating risky behaviours in UK adolescents.

Background: Young people in the transition from adolescence to adulthood face particular challenges in psychiatric care. Continuity of treatment is often disrupted, as services are typically divided between child and adolescent psychiatry and adult psychiatry. Few frameworks provide age-appropriate, integrated care for individuals aged 16-25. In Germany, a model project was established to address this gap. It offers treatment tailored to this age group within a cross-sector, integrated care model that combines outpatient and inpatient services under a jointly run ward staffed by both child and adolescent psychiatrists and adult psychiatrists. This study explores the distinctive features of this integrated adolescent ward and examines the experiences of patients and their parents.

Methods: Semi-structured interviews were conducted with 27 patients and 7 parents. Data were analyzed using qualitative content analysis, focusing on three domains: (1) framework conditions and access to care, (2) the concept and content of treatment, and (3) the environment of the integrated adolescent ward.

Results: Participants particularly valued the individualized therapeutic approach, flexible treatment across different settings, and transparent, responsive communication by staff. Age homogeneity and a focus on adolescence facilitated mutual identification and supportive peer interactions. Opportunities for self-determination and participation were also emphasized as important.

Conclusion: Findings suggest that specific structural elements contribute to the ward being perceived as an age-appropriate therapeutic environment. Further research should identify and define specific care components of integrated treatment for young people aged 16-25 to enable replication and evaluation of its implementation.

Background: Social inclusion of parents of children with autism spectrum disorder (ASD) affects their well-being and caregiving capacity. However, evidence on its factors remains limited in China. This study aimed to assess the social inclusion of parents of children with ASD and identify key factors, with attention to gender differences.

Methods: 1007 parents were enrolled from 33 rehabilitation centers in Hunan, China. Self-reported psychometric scales and a revised Chinese Social Inclusion Scale were used. Guided by the ecological model, univariate and multivariate regression analyses were performed to identify factors associated with social inclusion. Subgroup analyses and interaction effect tests were carried out to explore potential gender differences.

Results: At the individual level, higher education (B = 1.764, P = 0.02), self-esteem (B = 0.472, P < 0.001), and hope (B = 0.139, P = 0.03) demonstrated positive associations with social inclusion. At the external level, intergroup relations (B = 0.271, P = 0.001) and social support (B = 0.238, P < 0.001) showed significant positive associations, while perceived discrimination (B=-0.189, P < 0.001) exhibited a significant negative association. Gender subgroup analyses showed fathers' inclusion was mainly influenced by self-esteem and social support, while mothers' patterns aligned with the overall group, except hope was not significant.

Conclusions: Both psychological and social factors influence the social inclusion of parents of children with ASD, with gender-specific patterns. To enhance social inclusion of parents, healthcare providers could consider gender-responsive approaches that strengthen psychological resources while addressing external barriers.

Recent clinical trials conducted by both industry and academic institutions have demonstrated the therapeutic potential of psychedelics for a variety of mental health conditions in adults. Considering the neurodevelopmental aspects of many of these disorders and the widespread occurrence of these conditions among younger individuals, there is increasing interest in exploring the potential for psychedelic therapies in the adolescent population. Regulatory agencies globally are also expected to require clinical trials in younger populations once such products are approved for adults. This paper details some key considerations for the design and conduct of such trials along with safeguards and best practices tailored to adolescents, building upon established methodologies from adult trials and emphasizing the importance of increased psychological support and rigorous trial oversight. Our goal is to provide a framework that ensures that future clinical trials involving the adolescent population are performed safely, ethically, and in accordance with the highest scientific and regulatory requirements, and to foster a patient-centric dialog within the regulatory and scientific community.

Background: Suicide is a leading cause of death in adolescents in Canada and has been documented to occur mainly during evening hours. It is suspected to be due to the accumulation of waking hours combined with sleep disturbances causing poor decision making. Identifying modifiable factors associated with suicide risk remains an important part of suicide prevention.

Aims: To examine the timing of suicide attempts in adolescents admitted to a pediatric hospital following a suicide attempt and known to present sleep disturbances, to further strengthen the relationship between sleep disturbance and suicidality and its chronobiological manifestation.

Method: Descriptive retrospective study of patients < 18 years (N = 128) admitted to a tertiary care hospital for a suicide attempt between January 1, 2022, to June 30, 2023.

Results: As expected, a higher percentage of attempts occurred between 18:00-23:59, as compared to other time periods (p < 0.001), with peak days Sunday and Monday, for the 18:00-23:59 group. Time of day was not found to differ by gender (p = 0.45) nor was weekday/weekend (p = 0.48). The most common method of attempt was ingestion.

Limitations: Small sample limited to hospitalized patients and retrospective design.

Conclusion: The observation that this group of suicidal adolescents is known to present sleep disruptions offers an additional prevention opportunity. Knowledge of the presence of sleep disturbances and the peak time of suicide attempts could help in suicide prevention efforts. Future exploration of the evening phenomenological experience of this population to develop interventions for parents, community resources, pharmacies, and schools to further detect risk factors in adolescent suicidality.