Child and Adolescent Psychiatry and Mental Health最新文献

Background: The COVID-19 pandemic has had a well-evidenced impact on adolescents, who are especially sensitive to pandemic disruptions given the critical role of socialization in their development. In Chile too, evidence shows increases in mental health complaints among adolescents over the lockdown period. Our study aimed at exploring the experiences of Chilean adolescents regarding their mental health during the lockdown and school closure (March 2020-December 2021), and during the return to on-site education (2022) as informed by adolescents and school staff, with a focus on family, school, and social sources of risk and support for adolescents' wellbeing during these periods.

Methods: Using a qualitative approach, we conducted semi-structured interviews with 19 adolescents and 16 staff members from schools in an urban area of Chile.

Results: Through thematic analysis, we generated five themes: [1] Adolescents in a mental health crisis, comprising a range of distressing experiences and mental health problems. This crisis was fueled by alterations in the functioning of adolescents' systems: [2] Broken support systems (peers and school); [3] The school agenda must go on, reflecting schools' strict compliance with the educational curriculum; and [4] Blurred boundaries between home and school life and within the family. Finally [5], Development will (try to) find its way describes how most participants experienced a bouncing back to wellbeing in the course of the school year upon return, and how some developmental milestones took place despite the abnormal conditions, providing evidence for resilience amid pandemic adversity.

Conclusions: The findings give insight into how the exchanges between the adolescent and the social systems they are embedded in were interfered. The results help us understand the challenges for mental health during and after the pandemic, and highlight adolescents' capacity to thrive as normality was restored. The results also underscore the importance of upholding stability across adolescents' systems and routines, in order to mitigate impacts on wellbeing amid abnormal circumstances. The findings are relevant for development-informed initiatives in policy design in the aftermath of the pandemic and in future crisis management responses.

Background: Harsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements.

Methods: A total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, M_age = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father.

Results: Correlational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents' living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms.

Conclusions: This study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting.

Background: Adolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work's high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement.

Method: The intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models.

Results: Pre-post comparisons revealed increased self-efficacy (d = -0.80) and self-esteem (d = -0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study.

Conclusions: The results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention.

Background: Proximal and distal factors interact to shape children's development and well-being. The present study aimed to examine socioeconomic status (SES), linguistic skills, and language background as concurrent predictors of socio-emotional and behavioural outcomes in heritage bilingual and monolingual children attending preschool.

Methods: Parents of 1810 children (mean age = 63.42 months ± 7.36), attending preschool in Italy, completed the Four Factor Index of SES and the Strengths and Difficulties Questionnaire (SDQ). Teachers (n = 99) completed a questionnaire on children's linguistic skills and emotional and behavioural profiles. A subsample of 995 children was administered an expressive vocabulary task in Italian.

Results: Regression analyses showed that linguistic skills were the only concurrent predictor of conduct problems, as well as the dominant predictor of hyperactivity/impulsivity, peer problems, and better prosocial behaviour. SES was negatively related to ADHD traits, peer problems, and prosocial behaviour. Finally, heritage bilingualism background was associated, although not as a primary predictor, with increased emotional problems, peer relationship problems, and lower teacher-rated emotional and behavioural skills. However, it was the main factor positively associated with prosocial behaviour.

Conclusions: The implications of these findings for research in this area and for educational policy are discussed, highlighting the need for a multidimensional perspective that includes linguistic skills and SES in the assessment of children's emotional and behavioural outcomes.

Background: Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

Methods: Adolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.

Results: Results suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.

Conclusions: Data from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Background: Worldwide, suicide is one of the leading causes of death among adolescents and young adults. Given that suicide in this age group is common within vocational students, this study aims to provide insights into the prevalence, course, and risk factors of suicidal ideation (SI) and suicide attempts (SA) among students in vocational education over the past 10 years.

Methods: This study has a repeated cross-sectional design, utilizing data from 2013 to 2023 provided by the 'Testjeleefstijl' foundation in the Netherlands ('Test Your Lifestyle'). In total, 101,182 students in vocational education completed a web-based standardized questionnaire. Univariate logistic regression was used to test the predictive value of risk factors separately (anxiety and depression, gender, age and school year) on SI and SA. In addition, a machine learning model (Berkelmans et al., 2023) ​was used for high-risk identification of combined risk factors (multivariate models).

Results: Within vocational students, 12-month SI and SA prevalence increased from respectively 17.7% and 2.3% in schoolyear 2013-2014 to 23% and 3.2% in 2022-2023. Although female gender significantly predicted SI and SA in the univariate analyses, the multivariate models revealed that female gender decreased the likelihood of both SI (OR 0.9) and SA (OR 0.7). A high risk for anxiety and depression was the strongest predictor in the multivariate models for SI (OR 42.8) and SA (OR 19.0).

Conclusion: Over the past decade, the prevalence of SI and SA increased in students in vocational education, with the risk of anxiety and depression being the strongest contributing factor. While females had a higher prevalence of anxiety and depression, the results suggest these conditions tend to lead to SI and SA more quickly among male students. Early intervention in suicide prevention is crucial, highlighting the need to identify and address anxiety and depression. Vocational education schools have a critical role in this, emphasizing early screening and intervention, with specific attention to gender-specific factors.

Background: Adolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context.

Methods: The study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services.

Results: The findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates.

Conclusion: The study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region.

Background: There is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda.

Methods: We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders.

Results: Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001).

Conclusion: This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority.

Trial registration: Trial registration: ISRCTN 45461276. Registered on 16 September 2021.