Child and Adolescent Psychiatry and Mental Health最新文献

Background: Depression and anxiety symptoms in adolescents and young adults represent a significant global public health challenge. Digital health interventions (DHIs) offer potential solutions to supplement traditional mental health services, though the relative efficacy of different types of interventions remains unclear.

Objective: This study aims to systematically compare the treatment effects of digital health interventions driven by different mechanisms on depression and anxiety symptoms in this population through a Bayesian network meta-analysis.

Methods: A systematic search was conducted in major databases such as PubMed, Embase, and PsycINFO (up to September 2025), including randomized controlled trials (RCTs) targeting depression or anxiety symptoms in individuals aged 12-25 years. Interventions were categorized based on treatment mechanisms into four types: cognitive behavioral therapy-based digital interventions (CBT-DI), third-wave digital therapies (TWDT), general digital mental health support (GDMHS), and technology-enhanced innovative interventions (TEII). The primary outcome measure was the standardized mean difference (SMD), with the cumulative ranking probability assessed using the surface under the cumulative ranking curve (SUCRA).

Results: A total of 18 RCTs involving 5, 821 participants were included. Network meta-analysis indicated that CBT-DI achieved the highest surface under the cumulative ranking curve (SUCRA) values for both depression (79.3%) and anxiety (83.4%). In pairwise comparisons with no intervention controls, CBT-DI demonstrated a statistically significant improvement in anxiety symptoms (SMD = 0.33, 95% CrI: 0.05 to 0.69). However, for depression, the improvement associated with CBT-DI did not reach statistical significance (SMD = 0.44, 95% CrI: -0.02 to 0.91), suggesting that the high ranking probability reflects a potential trend rather than confirmatory evidence of superiority. TWDT and GDMHS demonstrated moderate efficacy for both symptoms, ranking above usual care and no intervention controls. The evidence quality assessment (GRADE) indicated that the primary outcomes were of low to moderate quality.

Conclusion: Digital health interventions, particularly CBT-based interventions (CBT-DI), were associated with statistically significant improvements in anxiety symptoms. For depression, while CBT-DI ranked highest in probability, it did not demonstrate statistical superiority over controls. Given the imprecision in effect estimates, CBT-DI may be considered a potential complementary measure within a stepped-care mental health system. Results should be interpreted with caution due to wide credible intervals, and further high-quality studies are required to confirm these findings.

Background: Although adolescent aggression has received increasing attention, existing interventions often lack specificity and fail to meet the needs of digital-native youth. This study developed a filmmaking intervention, grounded in the Social Information Processing model, art therapy, and narrative therapy, to reduce proactive and reactive aggression.

Methods: An explanatory sequential mixed-methods design was used. Sub-study 1 was a randomized controlled trial with 82 adolescents assigned to an intervention group (n = 40) or waiting-list control (n = 42). The filmmaking intervention comprised ten sessions over two months, with assessments of aggression, emotion regulation, and empathy at baseline, post-test, and 3-month follow-up. Sub-study 2 qualitatively explored underlying mechanisms through analysis of 4 micro-films and interviews with 12 students and 4 facilitators using Grounded Theory.

Results: Quantitative analyses showed significant time×group interactions in overall aggression (F = 3.28, p = .047, η_p² = 0.05), reactive aggression (F = 4.69, p = .013, η_p² = 0.07), and emotion regulation (F = 7.54, p = .001, η_p² = 0.11). Post hoc tests indicated reductions in overall aggression (MD = - 5.18, p<.001) and reactive aggression (MD = - 3.82, p<.001), and an increase in emotion regulation (MD = 3.97, p<.001) from pre- to post-test. Compared with the control group, the intervention group showed lower overall aggression (MD = - 4.57, p<.001) and reactive aggression (MD = - 3.30, p = .001) and higher emotion regulation (MD = 5.01, p<.001) after the intervention. Qualitative analyses identified 10 categories, suggesting that the intervention reduced aggression by enhancing cognitive competence, emotional intelligence, interpersonal competence, engagement, and psychological capital. Filmmaking was characterized as a narrative therapy approach integrating humanistic and art therapy elements, with recommendations for implementation identified.

Conclusions: The filmmaking intervention is moderately effective in reducing adolescent aggression, suggesting its potential as an innovative approach for fostering multiple aspects of adolescent development.

Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (TRN: ChiCTR2500113469; Registration date: 28/11/2025; https://www.chictr.org.cn/showproj.html?proj=289296 ).

Background: Both camouflaging and social anxiety are adolescence-emerging phenomenon, rooted in social situations, and associated with mental health. The directionality between camouflaging and social anxiety in autistic versus non-autistic adolescents is underexplored. This study aims to investigate the inter-relations between camouflaging, social anxiety, and depression, and the moderating role of autism diagnosis on these inter-relations.

Methods: A total of 205 Taiwanese adolescents (100 autistic, 105 non-autistic) completed self-reported measures, including the Camouflaging Autistic Traits Questionnaire, Chinese version (CAT-Q-Ch), Social Interaction Anxiety Scale, Chinese version (SIAS-C), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire 9-item (PHQ-9). Network analysis was used to examine the inter-relations among items of the CAT-Q-Ch and SIAS-C. Moderated mediation models, adjusted for generalized anxiety, examined the inter-relations among camouflaging, social anxiety, and depression, and how these associations varied by autism diagnosis.

Results: Autistic adolescents reported significantly higher scores on camouflaging, depression, generalized anxiety, and social anxiety than non-autistic adolescents. A network analysis showed that items from the CAT-Q-Ch formed two communities, and most SIAS-C items formed a third community, supporting the interpretation that camouflaging and social anxiety are related yet distinct constructs. For both autistic and non-autistic adolescents, social anxiety and camouflaging showed bidirectional indirect associations with depression. Critically, having an autism diagnosis significantly weakened the link between camouflaging and depression, as part of the indirect association between social anxiety and depression via camouflaging.

Conclusion: The findings highlight the complex inter-relations among camouflaging, social anxiety, and depression, which may differ between autistic and non-autistic adolescents in Taiwan. Camouflaging may serve different functional roles and have different mental health implications for autistic and non-autistic adolescents. Future research should focus on teasing apart the complex conceptual, measurement, and causal mechanisms underlying the inter-relations between social anxiety and camouflaging in autistic versus non-autistic people.

Traditional mental health systems require children to fail multiple lower-intensity interventions before accessing residential treatment; emerging evidence suggests this "fail-first" approach may be clinically and economically inefficient. For youth with severe psychopathology-including suicidality, psychosis, or aggressive behavior-early intensive intervention can prevent symptom entrenchment, reduce crisis escalation, and minimize family trauma. While residential treatment involves substantial upfront costs, sequential failed interventions, emergency department visits, and repeated hospitalizations often generate higher total expenditures. Systems of care providing early intensive services demonstrate cost savings up to 68% ($35,000-$40,000 annually per child) through subsequent reduced emergency and inpatient utilization. Early intervention during critical developmental periods may optimize long-term functioning and reduce adult mental health costs. The current paradigm disproportionately harms marginalized children with inconsistent access to community services. Clinical best practice frameworks recommend matching service intensity to clinical need rather than requiring documented treatment failure. This evidence-based approach represents an opportunity to improve life-course outcomes, advance health equity, and more responsible manage resources.

Adolescent mental health is a growing global concern, with depressive and anxiety symptoms on the rise over recent decades. The significance of supportive social relationships, particularly within family and peer groups, is well-established in research. However, limited evidence exists on the impact of social relationships in predicting the developmental trajectories of mental health problems over time. This study aims to fill this gap by identifying groups with distinct trajectories of depressive and anxiety symptoms among adolescents and exploring the impact of various factors, including family relationships, peer relationships, sex, and country of origin, on predicting individuals' likelihood of belonging to specific trajectories. Data come from a community sample of Swedish young people born in 1997 and 1999 (N = 1834, 50% female) and followed over 12 years (four waves conducted at three-year intervals). The Group-Based Trajectory Modeling (GBTM) was used to identify profiles of young people longitudinally. Moreover, multinomial logistic regression models were conducted to examine the predictive effects of social relationships, sex and country of origin on depressive and anxiety symptom trajectories. Four groups were identified for both depression (Stable-Low, Declining, Rising-D, Persistent High) and anxiety (Low and Declining, Stable-Moderate, Rising-A, High). Positive social relationships with family and peers emerged as robust predictors across depressive and anxiety symptom trajectories. Female participants consistently exhibited higher mean scores of depressive and anxiety symptoms than males, while participants originating from countries outside the Nordic region were at higher risk of belonging to risky depressive symptom trajectory groups. These findings highlight the critical importance of strengthening supportive family and peer environments for preventive strategies and targeted interventions in adolescent mental health.

Background: Adolescent mental health outcomes are often poorer in rural areas of Australia, and most adolescents do not seek help, highlighting a critical gap in understanding help-seeking behaviours. This study examined mental health help-seeking patterns and associated factors among rural Australian adolescents.

Methods: Data from Wave 8 of the Longitudinal Study of Australian Children, including 4,837 adolescents aged 14-19 years, were analysed. The prevalence of help-seeking overall and by remoteness, as defined by the Australian Bureau of Statistics were estimated. Cluster-adjusted multiple logistic regression models were used to examine factors associated with help-seeking behaviours.

Results: Help-seeking behaviours were generally lower among adolescents from rural areas compared to their urban counterparts. Seeking face-to-face mental health professional help was significantly less common in outer regional and remote areas (7.72%, 95% CI: 5.39-10.93) compared to urban areas (12.20%, 10.97-13.54). Furthermore, males reported significantly lower professional help-seeking behaviours (2.76%, 1.33-5.63) than females (13.53%, 9.08-19.70) in outer regional and remote areas. Similar sex disparities were observed in non-face-to-face (e.g., internet, phone) help-seeking. The most common predictors of help-seeking behaviours were ongoing anxiety or depression and good parent-child relationships. Other statistically significant predictors included suicidal thoughts and behaviours, single-parent family, community participation, social media exposure and drug use. Two predictors (i.e., financial hardship for formal help-seeking and community engagement for informal help-seeking) varied statistically significantly between rural and urban settings.

Conclusion: Strategies to address lower prevalence of mental health help seeking among rural male adolescents in Australia should be sensitive to context-specific barriers and designed to meet their unique needs. Adolescent-focused digital interventions and strengthened family and community engagement are vital to ensuring equitable access to mental health services for adolescents in rural Australia.