Child and Adolescent Psychiatry and Mental Health最新文献

Background: Recent approaches to treating selective mutism (SM) have increasingly emphasized parent involvement, and several parent-mediated programs have shown promising efficacy. However, in regions where SM specialists are scarce, families have limited access to appropriate support. In this context, online behavioral parent training (BPT) may serve as a promising and scalable option that can overcome geographic barriers. Nevertheless, empirical studies specifically targeting SM-focused BPT remain limited. This pilot study evaluated the feasibility and preliminary effectiveness of an online BPT program developed for parents of children with SM.

Methods: This pilot study evaluated the feasibility and preliminary effectiveness of a nine-session online behavioral parent training program (SM-BPT) for parents of children aged 3 to 9 years with diagnosed or suspected SM. Seventeen parents enrolled in the program, and 13 completed both the intervention and the pre- and post-assessments. Changes in children's SM symptoms, anxiety, and behavioral problems were assessed alongside parenting behaviors and parental mental health.

Results: Following the intervention, significant improvements were observed in children's school-based SM symptoms (p = .04), anxiety (p = .03), and internalizing (p = .03) and externalizing behaviors (p = .02). However, no significant changes were found in total SM symptoms (p = .22) or home/family communication (p = .83). Parents reported reduced negative parenting behaviors (p < .001) and improved mental health (p < .01). In contrast, positive parenting did not significantly change (p = .72). High attendance (mean = 93.5%) and homework completion (mean = 73.5%) supported the program's feasibility and acceptability.

Conclusions: The SM-BPT demonstrated preliminary effectiveness in reducing children's SM symptoms at school, as well as anxiety and behavioral problems, and in improving parental mental health. High attendance rates also suggested good feasibility. Because the program can be delivered online, it may serve as a practical option for families with limited access to specialized support. Further research, including randomized controlled trials, is needed to examine its effectiveness across diverse family situations. Trial registration UMIN Clinical Trials Registry UMIN000043686, registered on 21 March 2021.

Objective: This study aimed to explore longitudinal associations between bullying victimisation, coping, and self-harm among adolescents living in a diverse, densely-populated urban population in London, United Kingdom.

Method: Data on bullying victimisation, dispositional use of four coping strategies (active, avoidant, distraction, support seeking), and self-harm were drawn from REACH (Resilience, Ethnicity and AdolesCent mental Health), an accelerated cohort study of adolescent mental health in South London. Data was available for 3,060 adolescents aged 11-14 years (M_age = 12.4, 50.6% girls, > 80% ethnic minority groups) who were followed up 12 months' later. Models used a combination of inverse probability weights with multiple imputation. Results are presented as adjusted risk ratios (aRRs), with all analyses adjusting for baseline self-harm, sex, age, free school meals and ethnic group.

Results: Bullying victimisation at baseline was associated with self-harm at one-year follow up (aRR 1.66). Avoidant (aRR 1.36) and distraction (aRR 1.20) coping were associated with increased risk of self-harm. Active (aRR 0.74) and support seeking (aRR 0.78) coping were associated with decreased risk. None of the coping strategies moderated the association between bullying victimisation and self-harm, and no clear sex differences were found for any results.

Conclusions: Findings underline the importance of tackling bullying and promoting coping as part of a wider holistic approach to modifying the impact of adverse experiences. Among victims of bullying, future research should investigate situation-specific measures of coping, as this will better explain how young people cope specifically with this form of childhood adversity.

Background: Exposure to adverse childhood experiences (ACEs) has been linked to mental health difficulties later in life. However, much of the existing research relies on cross-sectional designs and retrospectively reported ACEs, which are susceptible to recall bias and confounding by early life factors, such as family socioeconomic status or childhood temperament. Moreover, the majority of these studies have been conducted in the United States and the United Kingdom, limiting the generalizability of their findings. To address these limitations, we examined the association between prospectively measured ACEs and adolescent adjustment using data from a longitudinal, population-based birth cohort in Central Europe.

Methods: Data were obtained from the Czech part of the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ; N = 2,741). ACE score was calculated as a sum of eight intra-familial adversities assessed prospectively between 6 months and 11 years postpartum. Adolescent internalizing and externalizing problems were measured via Strength and Difficulties Questionnaire (SDQ) at 11 years and were reported by adolescents and their mothers.

Results: Linear regression models showed that ACE score was associated with internalizing problems reported by adolescent (β = 0.063, 95% CI [0.019, 0.107]) and mother (β = 0.120, 95% CI [0.077, 0.163]), and externalizing problems reported by adolescent (β = 0.088, 95% CI [0.045, 0.132]) and mother (β = 0.114, 95% CI [0.072, 0.157]). The association was driven particularly by physical and emotional abuse.

Conclusions: ACE were common in ELSPAC-CZ sample (69% of children experienced at least one ACE) and were prospectively associated with adjustment in adolescents, independently from family socioeconomic status, prenatal and birth characteristics, and early childhood temperament, suggesting a robust link between ACE and adolescent adjustment.

Background: Perceived social support is considered a crucial protective factor for mental health, particularly among marginalized populations. This study investigated the association between perceived social support and internalizing symptoms (depression, anxiety) in young refugees and immigrant-origin peers from the Middle East. It further examined whether social support buffers the adverse impact of post-migration stress on internalizing symptoms.

Methods: The sample consisted of 135 male adolescents and young adults living in Germany, including n = 75 young refugees (primarily from Syria and Afghanistan) and n = 60 immigrant-origin peers, all with a Middle Eastern background. Validated self-report instruments were used to assess perceived support from friends, family, and significant others, as well as post-migration stress and internalizing symptoms.

Results: While higher perceived support was consistently associated with fewer internalizing symptoms across both groups, a buffering effect on post-migration stress was found among young immigrants for all support sources, but not for their refugee peers (three-way interaction: β = - 0.46, SE = 0.18, p = 0.012; conditional interaction effect for immigrants: β = - 0.04, SE = 0.01, p = 0.008; for refugees: β = 0.01, SE = 0.01, p = 0.448). Refugees reported significantly higher post-migration stress than immigrant-origin peers (t(131) = 5.11, p < 0.001) and perceived less support from friends (t(132) = - 3.29, p = 0.001) and significant others (t(133) = - 2.41, p = 0.017) but not from family (t(130) = - 1.88, p = 0.063).

Conclusions: These findings suggest that, for young male Middle Eastern refugees, perceived social support alone may be insufficient to buffer post-migration stress, underscoring the importance of expanding structural and instrumental support systems in Germany.

Background: The rising rates in depression and other mental health problems among adolescents in recent years, combined with delayed help-seeking, highlights a clear need for action in key areas of adolescents' lives. The school environment, including teachers, can provide mental-health support for children and adolescents.

Methods: The study used a pre-post-follow-up design to investigate whether a two-hour online training course on depression and mental health in childhood and adolescence leads to knowledge acquisition, confidence in supporting pupils with depression and a decrease in stigmatisation in N = 97 teachers, school social workers and school social pedagogues.

Results: We found a significant increase in knowledge and confidence in supporting pupils with depression at post-assessment, which was maintained at a four-week follow-up. A decrease in stigmatisation was found at post-assessment, which was no longer evident at follow-up.

Conclusion: The results suggest that approaching educational professionals through a concise practical online training course can be a promising strategy for knowledge transfer. Future studies could examine whether such trainings can be adapted to other mental health disorders. Trial registration ClinicalTrials.gov, Identifier: NCT06387108. Registered on 24.04.24.

Background: Suicidality is alarmingly prevalent among adolescents placed in residential child welfare facilities, often as a consequence of early adverse childhood experiences (ACEs) and disrupted attachment relationships. Although these vulnerabilities are well established, the gender-specific mechanisms underlying suicidality in institutionalized youth remain poorly understood. Clarifying how trauma exposure and attachment insecurity interact with mental health symptoms is critical to inform targeted prevention.

Methods: In a cross-sectional study, 98 adolescents aged 12-17 years (54 girls, 44 boys; M = 14.34, SD = 2.08) living in French residential care completed validated self-report instruments assessing ACEs, attachment security, depressive and anxiety symptoms, and suicidality. Descriptive statistics, gender comparisons, and multivariate logistic regressions were used to identify predictors of suicidality, with all predictors standardized prior to entry.

Results: One-third of participants (33%) reported suicidal ideation or at least one suicide attempt. Emotional and physical abuse were the most frequent ACEs. Cumulative ACEs and attachment insecurity were independently associated with suicidality, and both correlated with heightened anxiety and depressive symptoms. Gender-stratified analyses showed that suicidality in girls was primarily linked to maternal alienation and emotional dysregulation, whereas in boys it was more strongly related to cumulative trauma exposure and depressive symptoms.

Conclusions: Findings highlight suicidality as a major concern in residential care and identify two complementary risk pathways: adversity-related and attachment-related. Trauma-informed and attachment-based approaches-supported by systematic screening and the integration of mental health professionals within child welfare systems-may enhance early detection and individualized care. While contextualized in the French system, these mechanisms likely generalize across jurisdictions, underscoring the global need for gender-sensitive, relationally focused suicide prevention.

Background: Autism spectrum disorder is a neurodevelopmental condition with a rising prevalence and limited effective pharmacological treatments. As non-pharmacological interventions gain traction, gamified digital health interventions have emerged as a promising alternative due to their accessibility and scalability. This systematic review and meta-analysis evaluated the efficacy of gamified digital health interventions in improving key functional domains in children and adolescents with autism spectrum disorder.

Methods: Following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, a systematic search was conducted in six electronic databases (PubMed, Web of Science, EMBASE, Cochrane Library, PsycINFO, and Scopus) and reference lists of relevant articles up to November 2024. A total of 21 randomized controlled trials (RCTs) comprising 1,050 participants met the inclusion criteria. Standardized mean differences (SMDs) were pooled using a random-effects model, and subgroup analyses were conducted to explore the effects of different types of interventions.

Results: Meta-analysis revealed significant improvements in emotional skills (SMD = 0.56), social skills (SMD = 0.45), executive functions (SMD = - 0.43), and motor skills (SMD = 1.53). Subgroup analyses indicated that sensor-based games demonstrated superior efficacy. However, no significant effect was observed in reducing behavioral problems (SMD = - 0.14).

Conclusions: Gamified digital health interventions show promise in enhancing emotional, social, executive, and motor skills in children and adolescents with autism spectrum disorder. Future research should focus on optimizing intervention strategies, refining behavioral outcome measures, and conducting high-quality longitudinal studies to evaluate long-term effectiveness.

Background: Bullying, problematic internet gaming, and problematic social media use are concerning phenomena, especially among youth. However, studies including all three of them are scarce. Therefore, this study investigated the associations between bullying victimization and the two internet-related outcomes. Furthermore, differences between problematic internet gaming and problematic social media use regarding the individual and moderating effects of gender, age, educational background and mental health problems were examined.

Methods: Adolescents (N = 6,735; 48.85% females) answered a school-based survey on bullying, problematic internet gaming, problematic social media use and mental health problems. The age ranged from grade 5 with M = 10.77 years (SD = 0.68) to grade 9 with M = 14.75 years (SD = 0.87) and overall M = 12.73 years (SD = 1.60). A-level school students represented higher educational background (39.52%) while B-level school students represented lower educational background (60.48%). Multilevel modelling was used to examine the associations of bullying victimization with problematic internet gaming and problematic social media use as well as the influences of gender, school grade as a correlate of age, school type and mental health problems.

Results: Victims of bullying showed higher odds for problematic internet gaming and problematic social media use. Overall, boys showed higher levels of problematic internet gaming, whereas girls showed higher levels of problematic social media use. Younger adolescents reported higher odds for problematic internet gaming, while no age effect was found for problematic social media use. Students with lower educational background and those with more mental health problems reported more problematic social media use than problematic internet gaming. Mental health problems moderated the association of bullying victimization with problematic internet gaming and problematic social media use, with stronger relations for students with less mental health problems. Furthermore, gender was a significant moderator for problematic social media use but not for problematic internet gaming, with a stronger association for boys.

Conclusions: Bullying victimization is strongly related to different types of problematic internet use. As differences in the impact on problematic internet gaming and problematic social media use can be identified, prevention should also consider gender, age, educational background and mental health problems. Trial registration DRKS00028183.

Globally, the rising burden of suicide among pre-adolescent children is a pressing clinical problem for mental health practitioners. Over 90% of the world's youth live in low- and middle-income countries, where suicide is the second-leading cause of death among children and youth. Literature about completed suicide in Ugandan children below 10 years of age is limited, although there is a growing body of research predominantly from high-income countries. We present the only available literature in Uganda about pre-adolescent suicide as reported in press-media reports. We utilized the multilevel risk framework to discuss the multi-sociocultural perspective regarding child rearing, the role of childhood trauma, the evolving digital environment, and legal and policy frameworks. We discussed challenges to the practice of Child and Adolescent psychiatry in Uganda, where childhood mental health disorders continue to receive limited attention in clinical practice. We recommend future research efforts to develop a robust methodology to better understand pre-adolescent suicide. Implementation of actionable interventions like school-based suicide screening, community gatekeeper trainings, and child helplines are key. Intersectoral collaborations among diverse stakeholders are essential for co-creating actionable and evidence-based preventive interventions that place the community at the centre.