Child and Adolescent Psychiatry and Mental Health最新文献

Background: Few studies have examined the point prevalence and incidence of perinatal mental disorders among the general population of pregnant women and no prior studies have investigated these in adolescent mothers. This study aimed to fill this gap by estimating the point prevalence and incidence of depressive and generalized anxiety symptoms, and their associated factors from pregnancy to 3 months post-delivery.

Methods: A longitudinal study was conducted among 533 adolescent pregnant women in their second trimester. A convenience sampling strategy was used to recruit participants from preselected antenatal clinics in Mwanza, Tanzania from 5th August 2023 to 30th June 2024. We used the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms and the Generalized Anxiety Disorder - 7 (GAD-7) scale to screen for generalized anxiety symptoms. The Screening was done in the second trimester of pregnancy (T1), the third trimester (T2), four weeks postpartum (T3) and three months post-delivery (T4).

Results: The point prevalence of both depressive and generalized anxiety symptoms decreased from the second trimester of pregnancy (T1) to 3 months post-delivery (T4). The point prevalence of depressive symptoms fell from 20.64% (95% CI, 0.17-0.24) at T1 to 9.90% (95% CI, 0.07-0.12) at T4, while the point prevalence of generalized anxiety symptoms fell from 22.33% (95% CI, 0.19-0.26) at T1 to 10.48% (95% CI, 0.08-0.13) at T4. In contrast, the incidence of both depressive and anxiety symptoms increased from recruitment (T1) through to 3 months post-delivery. Specifically, the incidence of depressive symptoms rose from 9.00% (95% CI, 0.07-0.12) at T2 to 11.89% (95% CI, 0.07-0.12) at T4, while the incidence of generalized anxiety symptoms rose from 7.20% (95% CI, 0.05-0.10) at T2 to 10.81% (95% CI, 0.06-0.11) at T4. At all-time points, being classified as displaying depressive symptoms was highly associated with being classified as displaying symptoms of anxiety.

Conclusions: There was an increase in incidence in depressive and anxiety symptoms in adolescent women from the second trimester of pregnancy to three months post-delivery, but a decrease in point prevalence. These findings support the importance of integrating mental health services into existing antenatal and postnatal care services for adolescent women.

Background: Adolescence is a sensitive period of social, biological, and cognitive development. Prolonged suffering from psychiatric symptoms during this important phase of development has well-established social, health, and occupational costs in adulthood. The purpose of this study was to identify the barriers to engaging in mental health treatment among symptomatic, community-dwelling adolescents.

Methods: In a cross-sectional study, barriers to mental health service use and psychiatric symptoms, including depressive symptoms, anxiety symptoms, and sleep disturbance, were self-reported by 277 adolescents (age 15.14 ± 2.21 years; 52% female; 93.5% Hispanic or Latino).

Results: Clinically elevated psychiatric symptoms were common in this sample; 26% self-reported clinically significant depressive symptoms, 41% self-reported clinically significant anxiety symptoms, and 46% self-reported clinically significant sleep disturbance. Having clinically elevated symptoms of anxiety was associated with more barriers overall, p < 0.001. Having more exposure to early life adversity (ELA), being in high school or college relative to middle school, and having clinically elevated symptoms of anxiety were each independently associated with more cost concerns, ELA p = 0.02, school p = 0.01, anxiety p = 0.006. Adolescents in this sample with clinically elevated psychiatric symptoms disproportionately reported barriers to seeking mental health treatment pertaining to not wanting to discuss their mental health concerns with a physician, depression p < 0.001 and sleep disturbance p = .005, not knowing how to access a mental health provider, anxiety p < 0.001, and feeling like their symptoms were not pathological given their current circumstances, for both depressive and anxiety symptoms p < 0.001.

Conclusions: Among at-risk youth-predominantly Hispanic/Latino-both intrinsic (normalization, fear/limited knowledge) and extrinsic (cost, transportation, physician referral) barriers shape perceived access to care, with anxiety and sleep problems most strongly tied to overall barriers. Social ecological approaches to addressing these barriers may reduce the time at-risk adolescents delay seeking support or intervention.

Background: Loneliness is currently very prevalent among adolescents, negatively affecting their physical, mental, and social health. Playing videogames is one of the most common leisure activities, which has been associated with multiple negative and positive outcomes for mental health. Depending on their use, they can generate mental and social health benefits or lead to an addiction that disrupts daily life and affects the adolescent's mental health. Community spaces for young people create safe environments where adolescents can gain access to different meaningful leisure activities, but the association of community videogame play with feelings of loneliness has not been researched to this date. Therefore, the purpose of this study is to understand the feelings of loneliness among adolescents aged 14 to 20 who attend community spaces to play videogames.

Methods: This descriptive cross-sectional study included adolescents aged between 14 and 20. A sociodemographic questionnaire, questions related to videogame use, and the Richaud de Minzi and Sacchi Adolescent Loneliness Scale were administered.

Results: A total of 112 adolescents with a mean age of 18.21 years (± 1.52) were included. It was found that adolescents who played alone had a worse perception of their friendships, family ties, themselves, and their social and adaptive skills, compared to adolescents who exclusively played when accompanied.

Conclusions: Participation in meaningful activities, such as shared videogame use within community resources, may decrease the likelihood of developing feelings of loneliness in the adolescent population.

Background: The severity of tics may influence executive function in children and adolescents diagnosed with tic disorders. The underlying mechanism is still inadequately researched. This study investigates the mediating role of premonitory urges in the relationship between tic severity and executive functioning, alongside the moderating effect of comorbidities.

Methods: A total of 154 children and adolescents, aged 6 to 15 years, diagnosed with tic disorders, were recruited from Fujian, China. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urges for Tics Scale (PUTS), and Behavior Rating Inventory of Executive Function (BRIEF) were utilized to evaluate tic severity, premonitory urges, and executive functioning. R software version 4.4.3 was used for descriptive statistics and Pearson correlation studies. The moderated mediator models were tested using Bayesian Structural Equation Modeling (BSEM).

Results: A Bayesian simple mediation model revealed that the premonitory urge fully mediated the association between tic severity and executive functioning. Additionally, comorbidity was found to independently predict both the premonitory urge and executive functioning. In the context of a moderated mediation model, comorbidity intensified the association between tic severity and the premonitory urge, resulting in more pronounced indirect effects on behavioral regulation (BRI) and metacognition (MI). The Index of Moderated Mediation was significant for both BRI and MI, thereby confirming the enhancement of the mediation pathway driven by comorbidity.

Conclusions: This study is the first application of BSEM to clarify the mediating mechanism through which tic severity affects executive functioning via the premonitory urge, while concurrently validating the moderating effect of comorbidities. This finding supports the optimization of clinical assessment and intervention strategies.

Background: Violence and mental health have a large proportion within the global burden of disease for children and youth, especially with the growing magnitude of suicidal behaviour and non-suicidal self-injury. This longitudinal study examined for the effects of physical and psychological family and community violence during childhood, adolescence and youth and the emergence of suicidal behaviour and non-suicidal self-injury among young people.

Methods: 129 participants, from a cohort of 500 students (mean age 8 years, SD 1.2) sampled at schools in a Brazilian metropolis (2005), were followed up for 16 years (2006, 2008, 2012, 2021). Suicidal behaviour/non-suicidal self-injury by the youth was the dependent variable assessed at the fifth wave of the study by Adult Self Report/Achenbach System of Empirically Based Assessment (ASR/ASEBA) and Youth Risk Behavior Survey Scale (YRBSS). The independent variables were 193 questions on violence (Conflict Tactics Scale - CTS - and "Things I have seen and heard"), which were assessed longitudinally. Three groups of violence (physical family violence, psychological family violence and community violence), plus the three stages of development studied (childhood, adolescence and youth), resulted in nine violence events, which were examined descriptively and input to structural equation modelling.

Results: The outcome was found in 37% of the participants, combining all time points. The forms of violence that occurred in childhood, adolescence and youth were, respectively: physical family violence: 84.5%, 14% and 15.5%; psychological family violence: 76.7%, 3.9% and 76.7%; and community violence: 18%, 12.4% and 40.3%. The modelling revealed a network between types of violence: community and psychological (0.348; p < 0.001) in childhood; community and psychological (0.302; p < 0.001) and physical and psychological (0.374; p = 0.001) in youth; and among all types of violence in adolescence. Regarding the outcome, the following factors were prominent: psychological family violence in childhood (0.656; p = 0.006), community violence in adolescence (0.517; p < 0.001) and psychological family violence in youth (0.398; p < 0.001).

Conclusions: The study highlighted the effect of different forms of violence longitudinally with suicidal behaviour and non-suicidal self-injury in youth, underlining the value of preventing violence as an important vector in related intervention.

Background: Adolescents' mental health issues may require psychiatric hospitalization, highlighting the need for effective interventions during hospitalization. This study explored statistical and clinical (through reliable change index; RCI) changes in mental health difficulties across hospitalization and their moderating factors potentially affecting clinical progress and discharge outcomes.

Methods: We examined retrospective socio-demographic and clinical data from 593 adolescents first hospitalized at the Adolescent Psychiatric Hospitalization Unit (UHPA) of the Lausanne University Hospital (CHUV) between 2014 and 2021. Statistical significance (analyzed via t-tests for paired samples) used scores on the Health of the Nation Outcome Scales for Children (HoNOSCA) at admission and discharge, whereas RCI was used to assess clinical significance. Moderating factors were examined through multivariate regression analyses on clinical changes and outcomes at discharge.

Results: Statistically, we observed a significant reduction in mental health issues, as reflected by decreases in the "Total", "Behavioral" and "Symptoms" HoNOSCA scores from admission to discharge. However, clinical improvements (RCI > 1.96) were reached in 20% of patients, while 65% remained stable. Finally, considering moderating factors, while clinical changes during hospitalization remained largely unexplained, moderators such as sex, behavioral and emotional disorders (F9x), antipsychotic intake, voluntary admission, pre-hospitalization occupation, patient-clinician discharge agreement, and length of stay accounted for a significant proportion of clinical outcomes at discharge.

Conclusions: While hospitalization may contribute to stabilizing acute crises, clinically meaningful improvements were limited for many patients. This highlights the importance of integrative and coordinated approaches tailored to adolescents' heterogeneous profiles.

Background: Women with psychiatric disorders tend to have lower rates of exclusive breastfeeding despite of the benefits. Maternal use of psychotropic drugs has been suggested to influence their infant feeding methods. In this study, we retrospectively investigated differences in infant feeding methods (exclusive breastfeeding, formula feeding, and mixed feeding) among mothers with psychiatric disorders one month postpartum (n = 149), as well as the factors influencing infant feeding methods.

Methods: Data on the infant feeding methods of individuals with schizophrenia spectrum disorders (SSDs, n = 32), bipolar disorders (BDs, n = 23), depressive disorders (DDs, n = 33), and anxiety disorders, and stress-related disorders (ASRDs, n = 61) were extracted from medical records at a single institute between 2008 and 2024. Differences in infant feeding methods among the disorder groups, and the influences of individual factors, including the regular use of psychotropic drugs at the time of childbirth, as well as newborn information, on the infant feeding methods were assessed.

Results: Among the diagnostic groups, significant differences in infant feeding methods were observed (F = 6.52, p = 3.64 × 10⁻⁴), with a higher rate of formula feeding in the SSD group (72%) than in the other groups (BDs, 35%; DDs, 24%; ASRDs, 35%). In the SSD group, formula feeding was significantly correlated with the presence of antipsychotic (beta = 0.52, p = 2.93 × 10^- 3). In the non-SSD group, formula feeding was significantly correlated with the regular use of benzodiazepines (beta = 0.43, p = 3.46 × 10^- 6), the number of benzodiazepines used(beta = 0.38, p = 3.71 × 10^- 5), the diazepam equivalent (beta = 0.31, p = 6.78 × 10^- 4), and the number of psychotropic drugs used (beta = 0.41, p = 8.42 × 10^- 6).

Conclusion: Individuals with SSDs were more likely to choose formula feeding because of the use of antipsychotics at the time of childbirth, whereas individuals with non-SSDs tended to choose formula feeding because of psychotropic polypharmacy, including the use of benzodiazepines. These findings suggest that providing education on the safety of antipsychotics for patients with SSDs and avoiding polypharmacy in non-SSD patients might help promote exclusive breastfeeding.

Background: Mental health is the state of well-being that manages our emotions, psychological stress, social well-being and it is essential at all stages of life. Depression is a mental health condition that causes repeated changes in mood and in how a person feels about everyday life. It can impact every aspect of life, including relations with friends, family, and the community. Depression, like most other mental health conditions, begins at the time of childhood or adolescence and can continue into adulthood. Depression among young people is widespread in developing nations like Ethiopia. This review aimed to compile data on Ethiopia's youth depression.

Methods: We searched through papers on the topic within the electronic databases of Worldwide Science, Google Scholar, Cochrane Library, PubMed, and Web of Science. The data were extracted using a Microsoft Excel™ format and exported to R (software) for management and further analysis. The heterogeneity among the former studies' proportions was checked using the I2 test with p-values (I² = 97, p < 0.01). Due to the presence of heterogeneity, a random-effects model was used to estimate the pooled depression among youth in Ethiopia. Additionally, subgroup analysis and publication bias were tested.

Results: Overall pooled depression prevalence among youths in Ethiopia was 36% (95% CI: 31% to 42%). The level of social support, gender, and use of alcohol were significant predictors of youth depression.

Conclusion: The magnitude of youth depression in Ethiopia is high as compared to the WHO mental health report (2022). Female gender, poor alcohol use, and a lack of social support were associated with youth depression. Educational and social support, particularly for females, and opportunities for youth to engage in various social and economic activities, should be implemented.

Background: Autism Spectrum Disorder (ASD) contributes significantly to the disease burden among children and adolescents. Early diagnosis and intervention significantly improve outcomes; however, in Africa, children and adolescents with ASD are frequently identified and diagnosed late. This has been attributed to long and tortuous pathways to diagnosis. The objective of the study was to document and evaluate the pathways to a diagnosis of ASD, measure the delay in diagnosis, and document factors influencing these.

Methods: A cross-sectional survey of 70 caregivers of children aged 2-18 years with ASD. The Encounter Form, developed by the World Health Organisation, was used to describe pathways to diagnosis, and structured clinical interviews and assessments were used to determine how children's clinical factors, caregiver socio-demographic factors, and cultural and contextual factors influence the pathways and delays in diagnosis. ASD was diagnosed by a consultant psychiatrist or paediatrician using the Diagnostic and Statistical Manual version 5. SPSS version 23.0 was used for data analysis. Correlations between variables were analysed using Kruskal-Wallis, Mann-Whitney U tests, and logistic regression models.

Results: A mainstream (healthcare) and traditional/spiritual-based pathway was utilized by N = 51 (73%) and N = 19 (27%) caregivers, respectively. The mean age of diagnosis was five years, with a delay of 34.9 ± 33.5 months between caregiver symptom recognition and diagnosis. A median of four points of contact was made with care providers before diagnosis, with special needs teachers serving as the primary referral source. Clinical factors associated with a delay in diagnosis included: echolalia (p = 0.03), delayed walking (p = 0.01), attention deficit hyperactivity disorder (p = 0.04), and intellectual developmental disorder (p = 0.02). Conversely, challenges in recognizing, interpreting, and responding to emotional cues (p = 0.03) and "selectiveness in clothing" (p = 0.01) were associated with an earlier diagnosis.

Conclusion: Despite early recognition of ASD symptoms by caregivers and the predominant use of mainstream healthcare-based pathways, diagnosis was often delayed in this Kenyan sample. Distinct factors associated with the delay in diagnosis were identified, and further research is needed in larger and more diverse groups to facilitate earlier diagnosis and intervention.

Background: Childhood ADHD is associated with greater risk of depression in adolescence and adulthood, with emotion regulation (ER) identified as a potential mediator. However, it remains unclear how distinct domains of ER differentially relate to ADHD and depression symptoms in early adolescence.

Methods: The current analysis estimated a network model using longitudinal, parent-reported data from the Adolescent Brain and Cognitive Development (ABCD) Study 5.1 Data Release in 2023 (n = 4,460 complete cases). Nodes were item-level ADHD symptoms averaged across ages 9-12, ER domains (Catastrophize, Distracted, Attuned, and Negative Secondary Emotions) at ages 12-13, and item-level depression symptoms at ages 13-14. In exploratory analyses, we also examined potential differences in network structure and connectivity by sex, history of ADHD diagnosis at ages 9-12, and ADHD polygenic score (PGS).

Results: Catastrophize and Distracted were the most important ER bridges between earlier ADHD and later depression symptoms in the network. Two distinct pathways emerged: inattentive ADHD symptoms were linked to depression symptoms (poor eating, feeling worthless) via the Distracted ER dimension, while hyperactive-impulsive ADHD symptoms were linked to depressed mood and anhedonia via the Catastrophize ER dimension. Exploratory network comparisons found similar networks by sex, structural differences by history of ADHD diagnosis, and differences in structure and connectivity by ADHD PGS.

Conclusions: Multiple pathways from ADHD in childhood to depression in early adolescence may include ER difficulties through catastrophizing and distraction when upset. A denser, more interconnected network of symptoms was found among youth with higher genetic liability to ADHD.