Child and Adolescent Psychiatry and Mental Health最新文献

Objectives: Self-harm behaviors among adolescents, including suicide attempts (SA) and non-suicidal self-injury (NSSI), present critical public health challenges globally. While past-oriented rumination and future-oriented hopelessness are established core dimensions of maladaptive self-cognition, their distinct associations with different forms of self-harm remain poorly characterized.

Methods: Using latent profile analysis, we investigated the heterogeneous profiles of rumination and hopelessness in a sample of 951 adolescents (M_age: 16.58; male: 420). We further examined how these latent profiles differ in their associations with SA and NSSI, controlling for general affective symptoms.

Results: Three distinct cognitive profiles were identified: high rumination-high hopelessness (n = 77, 8.09%), moderate rumination-moderate hopelessness (n = 531, 55.84%), and low rumination-low hopelessness (n = 343, 36.07%). Specifically, the high rumination-high hopelessness profile emerged as being uniquely associated with SA, even after controlling for affective symptoms. NSSI was related to the severity of depressive symptoms, but not related to the specific cognitive profiles.

Conclusion: Our study provides novel insights that the interaction between rumination and hopelessness generates distinct cognitive phenotypes, which show different associations with SA and NSSI. These findings address a key theoretical gap in self-harm mechanisms and suggest the need to reshape prevention paradigms by enabling phenotype-specific interventions targeting cognitive constrictions for at-risk youth.

Background: Transgender and gender-diverse (TGD) adolescents experience elevated rates of depression, anxiety, and suicidality compared to cisgender peers. These outcomes are largely hypothesized to be linked to social stigma and gender minority stress. Resilience constructs like identity pride and community connectedness may buffer these stressors, but their role, especially in clinical populations, remains underexplored. This study investigates the interplay between gender minority stress, resilience, and mental health in clinic-referred Dutch TGD youth through network analysis.

Methods: A sample of 172 Dutch TGD adolescents was assessed using commonly employed measures of gender minority stress, resilience, and mental health. Network analysis was conducted to examine network structure and centrality of these constructs. Among the 172 clinic-referred Dutch participants (mean age = 15.70, SD = 0.79), 86.0% (n = 148) were assigned female at birth, 14.0% (n = 24) were assigned male at birth, and 9.9% (n = 17) of the total sample identified as non-binary and genderqueer (NBGQ).

Results: Among the participants, 41.7% scored within the clinical range for internalizing problems, and 32.7% exhibited scores indicative of mild to severe depression. Non-affirmation, an established construct in gender minority stress literature, emerged as the most central construct in the network, with strong associations to internalized transphobia and negative expectations for future events. Distal gender minority stressors, such as gender-related rejection and victimization, were less central within the network, but indirectly influenced mental health via pathways involving the more central stressors. Resilience constructs, specifically pride and community connectedness, showed limited centrality.

Conclusions: The findings highlight the substantial psychological vulnerabilities of Dutch TGD adolescents and underscore the importance of addressing non-affirmation, internalized transphobia, and negative expectations for future events in clinical settings to mitigate mental health challenges among TGD youth. The study also emphasizes the necessity of societal-level interventions, such as raising awareness about the value of affirming gender identity. Future research should explore the nuanced distinctions within and between different gender minority stressors and their specific impacts on TGD youth.

Background: Adolescent loneliness and mental health have become escalating public health concerns. However, despite previous findings, research on how the school environment influences the relationship between loneliness and mental health remains scarce.

Objectives: Therefore, the objectives of this study are to identify key socio-ecological factors associated with adolescent mental health, examine the gender differences in socio-ecological factors and investigate whether the association between loneliness and mental health varies across individual schools.

Methods: Data were drawn from the 2021/22 Czech dataset of the HBSC study, comprising 14,588 Czech adolescents aged 11-15 years old. Descriptive statistics and gender comparisons were conducted, followed by multilevel linear regression analyses accounting for the hierarchical structure of the data (students nested within schools). The nested models examined associations between mental health and key predictors using random intercepts and random slopes.

Results: Boys reported better mental health, higher life satisfaction, stronger self-rated health and lower loneliness than girls. Boys also experienced better family support, communication and more frequent family meals. Girls reported more peer support, stronger preferences for online communication and greater academic pressure. Mental health was positively associated with family and health-related variables, and negatively with loneliness, bullying and academic stress. The relationship between loneliness and mental health was consistent across schools, with minimal variation attributable to school-level factors.

Conclusions: While gender-based differences were observed, loneliness consistently showed a strong negative association with mental health for boys and girls. These findings emphasise the central role of individual and family-related factors in adolescent mental health. They also suggest that in more structurally and culturally homogeneous educational systems, school-level differences in mental health may be limited, with wider socioeconomic and cultural influences operating relatively uniformly across schools. This underscores the importance of system-wide and family-focused approaches as well as national school-based programmes.

Background: Nighttime fears are highly prevalent and are associated with sleep disturbances and later anxiety disorders. Despite their impact, research and treatment options remain limited. Few studies have examined the clinical profile of this population. Families have few intervention options, especially those that are accessible and evidence-based. This mixed-methods study aimed to [1] assess the clinical profile of children experiencing nighttime fears, and [2] explore parents' needs and preferences to inform the co-design of a digital, parent-led exposure-based intervention.

Methods: A co-design approach (N = 44) was used involving an online assessment battery with parents of children aged 7-12 years experiencing nighttime fears (n = 34; M child age = 9.6 years; 56% female), two phases of semi-structured interviews with a separate group of parents (n = 5; median child age = 10.7 years; 60% female), and a focus group with psychologists (n = 5; median age: 31.0; 60% female). The assessment battery included a diagnostic instrument assessing DSM-5 psychiatric disorders, and a measure of sleep disturbances. Interviews explored both parents' experiences and their feedback on a prototype intervention. Psychologists discussed clinical insights and treatment approaches. Quantitative data were analysed descriptively; qualitative data were analysed using framework analysis.

Results: Separation Anxiety Disorder (24%) and Specific Phobia - Natural/Environment type (23%) were the most common primary diagnoses. Sleep disturbances were prevalent, with 70% scoring in the pathological range for initiating and maintaining sleep. Qualitative findings revealed significant emotional distress for both children and parents, limited access to care and the need for clear guidance. Psychologists emphasised the central role of parents and the need for structured support.

Conclusions: Children with nighttime fears often meet criteria for psychiatric disorders and experience significant sleep issues. A co-designed and parent-led digital intervention may address a critical gap for families.

Background: Loneliness and social isolation are psychosocial factors linked to adverse health outcomes in adolescence, but their associations with the integrated 24-h movement guidelines, covering physical activity, screen time, and sleep, remain poorly understood, particularly over the life course. The aim of the study was to examine the associations of loneliness and social isolation with adherence to the 24-h movement guidelines during adolescence and in sustained patterns from adolescence into adulthood over a 22-24-year follow-up.

Methods: We analyzed longitudinal data from individuals who participated in Waves I (1994-1995, n = 20,603) and V (2016-2018; n = 10,979) of the Add Health study. Loneliness (single CES-D item) and social isolation (frequency of peer interactions) were assessed in adolescence (ages 12-17). Adherence to movement guidelines was self-reported at both waves. Generalized linear models with Poisson regression estimated relative risks (RR) for cross-sectional and sustained (adolescence-to-adulthood) adherence.

Results: At baseline, loneliness was reported by 8.4% and social isolation by 9.4% of adolescents. In women, loneliness was associated with lower adherence to physical activity (RR = 0.87; 95%CI 0.77-0.99), sleep (RR = 0.86; 95%CI 0.79-0.94), and all 24-h movement guidelines (RR = 0.68; 95%CI 0.51-0.90), with associations for sleep (RR = 0.77; 95%CI 0.65-0.91) and all guidelines (RR = 0.37; 95%CI 0.10-0.91) persisting into adulthood. In men, loneliness was associated with lower adherence to sleep (RR = 0.87; 95%CI 0.78-0.97) and all guidelines (RR = 0.78; 95%CI 0.59-0.92), with similar associations observed longitudinally. Social isolation was strongly associated with lower physical activity in both sexes (women: RR = 0.59; 95%CI 0.46-0.75; men: RR = 0.48; 95%CI 0.38-0.61) and with adherence to all guidelines (women: RR = 0.61; 95%CI 0.43-0.87; men: RR = 0.69; 95%CI 0.51-0.93), both cross-sectionally and longitudinally.

Conclusions: Addressing loneliness and social isolation as distinct, yet complementary, correlates of movement behaviors may enhance the effectiveness of strategies aimed at promoting healthier movement patterns and supporting social connectedness.

Background: Suicidal intent contributes both to the assessment of suicide risk and to long-term prognosis in adults. Although suicidal intent is a key component in suicide risk assessment, its specific features and clinical implications in adolescents after a suicide attempt remain underexplored in the literature. However, it could represent an improvement in the assessment and prognosis of adolescent suicidal crisis. The aim of this study is to describe how suicidal intent manifests in adolescents after a suicide attempt, and how it relates to associated clinical and contextual characteristics.

Method: We conducted a systematic review assessing suicidal intent in adolescents after a suicide attempt adhering to PRISMA guidelines. Five databases were searched up to September 2023. Seventeen studies met the inclusion criteria. We excluded studies focusing solely on suicidal ideation or on non-suicidal self-injury. Data were extracted and synthesized narratively. Study quality was assessed using standard tools.

Results: Several studies suggest that suicidal intent may be more frequently reported in older adolescents, with a significant difference before and after the age of 16. High suicidal intent seems to be more frequently linked to internalized disorders. While suicidal intent does not appear directly linked to the lethality of the attempt, the highest level of suicidal intent reported across previous attempts may represent a prognostic marker for later suicide mortality.

Conclusion: It seems essential to refine existing assessment tools or develop new ones specifically adapted to adolescents, in order to assess suicidal intent while taking into account the specificities of the adolescent population. This would help optimize interventions and support for both the patient and their family.