Child and Adolescent Psychiatry and Mental Health最新文献

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.

Background: Hallucinogen use among adolescents is increasing worldwide. In this context, in recent years, hallucinogens have re-emerged in scientific and public discourse. However, whether there is an association between hallucinogens use in adolescents and the impact of such use in individuals with Early-Onset Psychosis (EOP), remains unclear. This systematic review and meta-analysis evaluated the prevalence and impact of hallucinogen use in adolescents with EOP, and the association between hallucinogen exposure and psychotic symptoms in community samples.

Methods: We carried out a PRISMA-compliant systematic search (PubMed, Web of Science, Cochrane Library, PsycINFO; last search in July 2025). We included observational studies enrolling individuals under 18 years. Independent reviewers performed study selection, data extraction, and risk-of-bias assessment (using the Newcastle-Ottawa Scale). We conducted a random-effects meta-analysis to estimate the prevalence of hallucinogen use in adolescents with EOP. Other clinical and functional outcomes, as well as evidence from community-based samples, were synthesized narratively. This was due to heterogeneity in design and reporting, which precluded the meta-analysis.

Results: Twelve articles met our inclusion criteria. 39.9% included individuals were female and the mean age was 16.1 years. In EOP, pooled prevalence of any hallucinogen use was 14.3% (k = 6; N = 713; 95% CI: 3.9%-40.9%). LSD use in the included studies ranged from 1.8 to 12.5%. MDMA use ranged from 3.5 to 42.9%. Hallucinogen use in EOP was consistently associated with polysubstance use and indicators of clinical complexity, including suicidality, conduct disorder, reduced educational attainment, and depot antipsychotic treatment. In the general population, hallucinogen use showed weak and inconsistent associations with psychotic symptoms and manic symptoms, but which largely attenuated after adjustment for other drugs and genetic vulnerability. Newcastle-Ottawa Scale (NOS) scores ranged from 4 to 9, with a mean score of 6.4.

Conclusions: Hallucinogen use is common in adolescents with EOP and seems to be associated with more complex clinical trajectories, particularly higher rates of suicidality. Although not an isolated causal trigger, hallucinogens may contribute to symptom exacerbation in neurodevelopmentally or genetically predisposed youth. Future research should prioritise longitudinal, large-scale studies and introduce clinical trials in the field.

Background: Psychotic-like experiences (PLEs), anxiety, and depressive symptoms frequently co-occur in adolescents. While traditional research has relied on cross-sectional data and overall symptom levels, this approach fails to clarify their dynamic interactions over time. Network analysis offers a novel methodological framework to address this critical limitation.

Methods: In this longitudinal study, 2,101 adolescent participants from Hunan Province, China, completed a battery of questionnaires at two assessment time points (T1: March 2024; T2: March 2025). The questionnaires measured psychotic-like experiences (PLEs) via the 15-item Community Assessment of Psychic Experiences (CAPE-P15), anxiety symptoms via the 7-item Generalized Anxiety Disorder Scale (GAD-7), and depressive symptoms via the 9-item Patient Health Questionnaire (PHQ-9), with sociodemographic and clinical characteristics also collected via this survey. Cross-lagged panel network (CLPN) analysis and contemporaneous network analysis were conducted.

Results: The contemporaneous network revealed extensive anxiety-depression comorbidity. The strongest connections were between "Worrying too much" (GAD3) and "Feeling bad about yourself" (PHQ6), and between "Trouble relaxing" (GAD4) and "Sleep problems" (PHQ3). "Perceptual abnormalities" (PA) and "Suicidal ideation" (PHQ9) showed the strongest cross‑domain connections between PLEs and depression. In the CLPN analysis, T1 "Persecutory ideation" (PI) predicted T2 "Irritability" (GAD6) and "Feeling bad about yourself" (PHQ6), while T1 "Bizarre experiences" (BE) predicted T2 "Fear of something terrible happening" (GAD7). Centrality analysis indicated that PI and BE had the highest out‑degree influence, whereas T2 anxiety symptoms "Feeling nervous" (GAD1), "Inability to stop or control worries" (GAD2), and "Worrying too much" (GAD3) had the highest in‑degree centrality, reflecting their susceptibility to influence from other symptoms.

Conclusions: This study pinpoints specific symptomatic pathways, particularly certain PLEs' predictive role for emotional symptoms. This provides a solid foundation for precise early intervention and prevention strategies for at-risk adolescents.

Background: Autism spectrum disorder (ASD) is a leading mental condition among adolescents globally and is associated with premature mortality. The analysis of hospitalization rates and trends in youth with ASD could be important for guiding earlier diagnosis and prompt interventions.

Methods: We retrospectively analyzed all hospitalizations in children and adolescents aged 11-18 years with ASD in Spain. The Spanish National Registry of Hospital Discharges was examined, spanning 2000 to 2021.

Results: During the 22-year study period, there were 2,015,589 hospitalizations among adolescents in Spain, of which 118,609 (5.9%) involved mental disorders. ASD was reported in 6,659 admissions, representing 5.6% of hospitalizations among youth with mental health disorders. Boys comprise 74.4%. Median age was 14 years old. Admissions with ASD experienced a 74-fold increase during the study period (p < 0.001). The in-hospital mortality rate for youth with ASD was 0.33%. Adolescents with ASD, as compared to those with other psychiatric conditions, had a higher rate of comorbid mental health disorders. However, intellectual disability was more frequent in youth with ASD than in the rest. Admissions of adolescents with ASD slightly declined during the first year of the COVID-19 pandemic but resumed their rising trend thereafter.

Conclusion: Hospitalizations in adolescents with ASD have significantly increased in Spain during the last two decades. Boys represent nearly three-quarters of admissions.

Background: Mental disorders are a major contributor to the burden of disease in children and adolescents, with peak age of onset in mid-adolescence. In Denmark, almost all children participate in a school health nurse examination at school start. This study aimed to investigate whether the school health nurse examination of children's well-being, developmental and relational risk indicators at age 5-7 years can predict incident psychiatric illness before age 16 years.

Methods: This prospective population-based cohort study followed 26,053 children from the school health nurse examination at age 5-7 years to age 16 years. School health nurses recorded systematic data on six risk indicators. Data on incident psychiatric illness in the observation period were obtained from national health registers.

Results: The incidence of any psychiatric illness was 11.3%: any behavioral or emotional disorder 7.2%, and any neurodevelopmental disorder 7.1%. All risk indicators were associated with increased risk of any incident psychiatric illness during follow-up [odds ratios 1.36 (1.19-1.55) to 2.23 (2.03-2.45)]. The risk increased with the number of risk indicators: odds ratio 1.94 (1.77-2.12) for at least one, 2.44 (2.17-2.74) for at least two, and 3.20 (2.67-3.83) for at least three risk indicators. Similar patterns were seen for the diagnostic subgroups, with the highest risk among children with at least three risk indicators [odds ratio 2.41 (1.93-3.01) for any behavioral or emotional disorder and 3.81 (3.12-4.44) for any neurodevelopmental disorder]. The predictive validity of all risk indicators showed low sensitivity (< 26%) and positive predictive value (≤ 20%), but high specificity (> 86%) and negative predictive value (> 89%). Diagnostic subgroups showed comparable sensitivity and specificity with lower positive predictive values and higher negative predictive values.

Conclusions: Child well-being, developmental, and relational risk indicators from the school health nurse examination at age 5-7 years were associated with an increased risk of incident psychiatric illness. While predictive validity is limited, these risk indicators may help school health nurses identify children at increased risk, supporting structured and measurement-based attention and guidance to families.

Background: The patterns of family-level mental health literacy (MHL) and their associations with adolescent depression and anxiety are not well understood. This study investigated the alignment of MHL between parents and children and its correlation with adolescent depression and anxiety, as well as identified factors linked to family MHL patterns.

Methods: We conducted a cross-sectional survey of 4633 parent-child dyads using multi-stage stratified sampling across eight cities in Guangdong Province, China. Family MHL and adolescent depression and anxiety symptoms were measured. Multinomial logistic regression identified factors associated with family MHL patterns, while linear regression models examined associations between proficiency patterns and adolescent mental health outcomes.

Results: Only 4.73% of parent-child dyads were both proficient in MHL, with slight concordance (κ = 0.169, 95% CI 0.141-0.197) and adolescents exhibited higher proficiency rates than parents (18.52% vs. 13.27%). Being in senior high school grade and rural residence were associated with child-only proficiency patterns. The quality of parental relationships was associated with patterns of proficiency in parents only. Rural residence and the quality of parental relationships were associated with mutual non-proficiency. Compared to mutual proficiency, mutual non-proficiency and parent-only proficiency were associated with increased symptoms of depression and anxiety in adolescents. Interactions were found between family literacy patterns and the quality of parent relationships.

Conclusions: Parents and children exhibit significant inconsistencies in MHL, with generational gaps present in most families. Interventions that focus on child-centered schools incorporating family involvement, could leverage adolescents' higher literacy and simultaneously enhance family relationships to foster better mental health.

Implications and contribution: Little is known about parent-child dyadic patterns of MHL and their associations with adolescent depression and anxiety. Using population-based sample, this study found that family mental health literacy concordance is low. Parental mental health literacy deficits were associated with increased adolescent depression and anxiety risks .

Background: Concerns have been raised about the impact of academic pressure on adolescents' mental health. Growing evidence suggests that perceived academic pressure reflects the interaction between contextual demands and individual vulnerabilities, conceptualized as the convergence of biological, psychological, and environmental factors. Furthermore, the impact of achievement goals and school climate on perceived pressure has been highlighted. This study examined the association between perceived academic pressure and individual vulnerabilities, and the role of school climate and achievement goals.

Methods: This was a cross-sectional study. At nine schools in Piedmont, Italy, participation was proposed to all the students from the first year of middle school to the fourth year of high school (aged 10-17 years). Students completed self-reported questionnaires assessing perceived academic stress (10-point Likert scale), individual vulnerabilities (Strengths and Difficulties Questionnaire, SDQ), school climate (Multidimensional School Climate Questionnaire, MSCQ), achievement goals (Achievement Goal Questionnaire-Revised, AGQ-R), and reported the number of school evaluations in the previous month as an indicator of objective academic pressure. Linear mixed-effect models examined the association between individual vulnerabilities and perceived academic stress, accounting for classroom clustering and adjusting for age, gender, school climate, and monthly evaluation number. Mediation analysis tested whether school climate mediated this association. Linear regressions tested associations between achievement goals and stress, and between vulnerabilities and school climate.

Results: A total of 889 students participated (58.7% female). Higher individual vulnerability (SDQ score) was associated with higher perceived academic stress (standardized β 0.24, p<.001) and poorer perceived school climate (standardized β 0.26, p<.001). The association between perceived pressure and vulnerabilities was stronger than that between perceived and objective pressure and was partially mediated by school climate (average causal mediation effect 0.11, p<.0001). Perceived academic pressure resulted negatively associated with mastery-approach (standardized β -0.07, p=.033) and positively with performance-avoidance (standardized β 0.14, p=.002).

Conclusions: Perceived academic pressure is more strongly associated with individual vulnerabilities than with objective pressure, and is shaped by perceptions of school climate. Achievement goal orientations modulate this experience, with performance-avoidance and low mastery-approach representing potential risk factors. School-based interventions should address emotional vulnerabilities, motivational processes, and school climate to promote student well-being.

Background: Maternal depressive symptoms are a well-documented risk factor for adolescent depression, yet the symptom-level mechanisms of intergenerational transmission remain insufficiently understood.

Methods: A total of 1140 mother-adolescent dyads completed the PHQ-9 at baseline (T1), with 921 dyads reassessed 6 months later (T2). Cross-lagged panel network analysis was applied to examine symptom-level stability, cross-symptom predictions, and intergenerational associations across time.

Results: The analysis revealed strong autoregressive effects for maternal sleep disturbance and adolescent suicidal ideation, indicating that these symptoms were particularly persistent over time. Within-group cross-symptom effects were also observed: adolescent suicidal ideation predicted later sad mood, anhedonia, and sleep problems, while maternal fatigue and guilt predicted subsequent anhedonia and appetite problems, and maternal psychomotor changes predicted later suicidal ideation. Intergenerational pathways were identified whereby maternal psychomotor symptoms at T1 predicted adolescent psychomotor symptoms at T2 (β = 0.11), and maternal depressed mood predicted adolescent sleep problems (β = 0.10), with a reverse pathway from adolescent guilt to maternal guilt (β = 0.08).

Conclusions: Depressive symptoms in mothers and adolescents are maintained through temporally stable and cross-activating symptoms within individuals, and transmitted across generations through specific symptom-to-symptom pathways. These findings refine theoretical understanding of how depressive symptoms persists and spreads in families and highlight key symptoms as promising targets for future research and preventive efforts.

Background: Love withdrawal, an emotionally manipulative practice where caregivers withdraw affection to elicit compliance, is theorized to harm child development. However, longitudinal evidence in early childhood, particularly within the Chinese context, remains scarce. This study therefore investigated the longitudinal relations between maternal love withdrawal and preschoolers' behavior problems, and explored the moderating effects of child gender and effortful control in China.

Methods: In this two-wave, one-year longitudinal study, participants were 148 Chinese preschoolers (86 boys, Mage = 4.02, SD = 0.79) and their mothers. Mothers reported their use of love withdrawal at Wave 1 and rated their children's effortful control and internalizing and externalizing problems at Wave 2. Data were analyzed using multi-group path analysis to examine gender-specific effects and the moderating role of effortful control separately for boys and girls.

Results: Wave 1 maternal love withdrawal positively predicted Wave 2 externalizing problems, but not Wave 2 internalizing problems. These effects varied by child gender and their levels of effortful control. For boys, maternal love withdrawal interacted with effortful control in predicting externalizing problems one year later, and only boys with lower effortful control exhibited more externalizing problems in response to love withdrawal. For girls, maternal love withdrawal positively predicted internalizing problems one year later, regardless of the child's effortful control level.

Conclusions: The findings underscore that maternal love withdrawal is a risk factor for behavior problems among Chinese preschoolers, though its effects vary by gender and effortful control. These results provided guidelines for future interventions: reducing caregivers' use of love withdrawal, strengthening boys' effortful control skills, and providing girls with greater support for managing internalizing problems.