Child and Adolescent Psychiatry and Mental Health最新文献

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.

Background: Given India's high rates of trauma exposure and mental health service shortages, age- and culture-appropriate self-report tools may enhance detection and treatment of trauma-related symptoms in low-resource settings. This study psychometrically evaluated Hindi versions of three trauma-related questionnaires: the Children's Revised Impact of Event Scale (CRIES-13), the Child Post-Traumatic Cognitions Inventory (CPTCI), and the Depression Self-Rating Scale for Children (DSRS-C), that were adapted for children and adolescents in previous research.

Methods: A total of 305 Hindi-speaking participants aged 6-18 completed the questionnaires online. Confirmatory factor analyses and Cronbach's alpha were conducted to evaluate the internal structure and internal consistency of the questionnaires, and Pearson's correlations were computed to evaluate their convergent validity.

Results: The CRIES-13 best fits a three-factor model, the CPTCI a two-factor model, and the DSRS-C a two-factor model. Internal consistency was acceptable to excellent across scales, except for the Arousal subscale of the CRIES-13. Convergent validity was supported by moderate to strong intercorrelations and associations with trauma exposure indices.

Conclusions: The adapted Hindi instruments are psychometrically promising tools for assessing trauma-related symptoms among Indian youth that could inform the diagnosis and treatment of trauma-exposed populations. Limitations and future research directions are discussed.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by social communication deficits and restricted, repetitive behaviors. Among evidence-based practices (EBPs), interventions grounded in applied behavior analysis (ABA) principles-including Early Intensive Behavioral Intervention and naturalistic developmental behavioral interventions-are widely used. While the evidence suggests potential benefits, the findings are inconsistent, most studies carry a high risk of bias, and the quality of evidence is generally low to very low. Gaps also remain in comparisons with treatment as usual (TAU) and across intervention intensities.

Aims: This mixed-methods systematic review and meta-analysis evaluated the quantitative effectiveness and qualitative experiences of ABA-based interventions for children and adolescents with ASD, addressing the methodological limitations of earlier studies, and examining comparisons with TAU.

Methods: Seven databases were searched up to August 2023 following the PRISMA guidelines. Twenty-five studies met the inclusion criteria (16 randomized controlled trials, 9 qualitative). The quantitative outcomes included adaptive behavior, cognitive ability (IQ/DQ), language, daily living skills, socialization, joint attention, and autism symptom severity. Qualitative studies explored parents' and practitioners' experiences. Random-effects models were used, with subgroup analyses by intervention intensity and TAU comparisons.

Results: The meta-analysis revealed significant improvements in adaptive behavior (SMD = 0.31, 95% CI: 0.04-0.59, GRADE = low), daily living skills (SMD = 0.36, 95% CI: 0.08-0.64, GRADE = low), language skills (SMD = 0.42, 95% CI: 0.24-0.60, GRADE = moderate), and joint attention behavior (SMD = 0.27, 95% CI: 0.04-0.49, GRADE = low) compared with the controls. High-intensity interventions had a notably greater effect on language skills (SMD = 0.72, 95% CI: 0.42-1.01) than low-intensity interventions (SMD = 0.34, 95% CI: 0.13-0.55). Comparisons with TAU revealed significant effects on adaptive behavior (SMD = 0.34, 95% CI: 0.02-0.66), daily living skills (SMD = 0.39, 95% CI: 0.07-0.71), and language skills (SMD = 0.51, 95% CI: 0.24-0.78). Qualitative findings highlighted perceived family and practitioner benefits but also barriers such as financial constraints and variability in training quality.

Conclusion: This study confirms the effectiveness of ABA in improving developmental and behavioral outcomes in children with ASD. However, systemic challenges and variability in outcomes underscore the need for targeted policy initiatives, enhanced training programs, and further research on the impact of ABA on core ASD symptoms.

Background: Secondary schools are increasingly delivering a range of mental health interventions with varied success. This trial examined the effectiveness of two implementation strategies, allocation of class time and provision of financial incentives, on the engagement of secondary students with a universal web-based mental health service, Smooth Sailing.

Methods: A three-arm, cluster-randomised trial was conducted over 12 weeks with Grade 8 and 9 students from 20 schools in two Australian states. Schools were randomised to: (1) the standard Smooth Sailing service, (2) the standard service plus extra class time, or (3) the standard service plus financial incentives. The primary outcome was student engagement, measured by the number of modules accessed at 12-weeks post-baseline. Secondary outcomes included uptake, retention, help-seeking intentions for mental health problems, service satisfaction, and barriers to use.

Results: A total of 20 schools consented, and 1295 students participated. Students accessed a higher number of modules in the enhanced conditions compared with the standard service, but the differences were not statistically significant (p = 0.14). There were no significant differences in uptake (p = 0.55) or retention (p = 0.95) between conditions. Help-seeking intentions significantly improved at 6- and 12-weeks in the standard service and class time conditions only. Common barriers to service use among students were forgetfulness and low motivation.

Conclusions: Neither class time allocation nor financial incentives significantly increased student engagement, as measured by modules accessed, highlighting the challenges of optimising engagement with digital mental health services in schools and emphasising the need to consider the broader school context. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12621000225819) and Universal Trial Number (U1111-1265-7440).

Background: Parents' adverse childhood experiences (ACEs) are associated with poorer mental health and elevated parenting stress, which could increase their children's risk of ACE exposure. Accordingly, understanding the mechanisms underlying the intergenerational transmission of ACEs is crucial for breaking this cycle.

Objective: Based on family systems theory and parenting stress model, this study aims to explore the sequential mediating role of parental depressive symptoms and parenting stress in the association between parental ACEs and adolescents' ACEs.

Methods: This cross-sectional study investigated 1479 Chinese families. Fathers and mothers completed self-report questionnaires assessing ACEs, depressive symptoms, and parenting stress independently, while their children (adolescents) filled out the ACEs assessment questionnaire only.

Results: This study found that both paternal and maternal ACEs had total effects on adolescents' ACEs. In addition, maternal ACEs were indirectly associated with adolescents' ACEs via maternal parenting stress. Moreover, both paternal and maternal ACEs were associated with maternal, but not paternal, depressive symptoms and parenting stress, which in turn contributed to adolescents' ACEs.

Conclusions: Targeting maternal depressive symptoms and parenting stress may offer a feasible entry point to interrupt intergenerational ACE transmission. These findings support school-based integrated screening and referral for students and caregivers, with attention to maternal depression and parenting stress.

Background: Anxiety and depression are increasingly prevalent public health concerns among adolescents. Group Behavioral Activation Therapy (GBAT), a structured school-based intervention, has shown promise as a potential approach for alleviating these conditions.

Methods: This quasi-experimental trial evaluated the efficacy of school-implemented GBAT in reducing anxiety and depressive symptoms among Chinese adolescents. Participants (N = 139; aged 12-17 years; 44.6% male) were assigned to either a GBAT group (n = 72) or a waitlist control group (n = 67). The GBAT protocol consisted of eight weekly 90-minute sessions. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Depression Self-Rating Scale for Children (DSRSC).

Results: A total of 93.06% of students completed all eight GBAT sessions. Post-intervention SCARED scores decreased significantly, t (135) = 2.44, MD = 4.20, 95% CI [0.79, 7.60], p = 0.016, Cohen's d = 0.42. Linear mixed-model analysis revealed a significant group effect (F (1,397) = 10.60, p = 0.001), indicating lower anxiety scores in the GBAT group compared with the waitlist control. A significant time effect was also observed, F (1,397) = 7.64, p < 0.001. At 3-month follow-up, GBAT maintained significant improvement in anxiety (SCARED: MD = 8.69, 95% CI [3.58, 13.80], p < 0.001 Cohen's d = 0.82) and depressive symptoms (DSRSC: MD = 2.28, 95% CI [0.10, 4.46], p = 0.037, Cohen's d = 0.43), indicating moderate to large effect sizes.

Conclusions: These preliminary findings suggest that GBAT may be a promising primary prevention strategy for adolescent mental health. This study provides a foundation for future research exploring its potential integration into school-based mental health frameworks.

Background: Even though the theoretical rationale for extending Family Stress Model (FSM) to include family long-term care needs is substantiated, it has seldom been empirically integrated within the FSM framework, especially in Asian cultural settings. The current study longitudinally investigated how family stressors (economic hardship and long-term care needs) affect adolescent depression and aggressive behaviors through family relational mechanisms (parental conflict and parent-child relationship) and how these relationships differ by gender in mainland China.

Methods: This study employed structural equation modeling to analyze two-wave longitudinal national data from the China Education Panel Survey. The sample consisted of 9,433 student-parent pairs across 112 schools in 28 county-level units throughout mainland China who participated in both waves.

Results: The results of serial structural equation modeling indicated that family economic hardship in Wave 1 did not significantly predict adolescent depression and aggressive behaviors in Wave 2 directly. However, it showed significant indirect effects on depression and aggressive behaviors through parental conflict in Wave 1 and parent-child relationship in Wave 2. Family long-term care needs in Wave 1 directly predicted adolescent depression in Wave 2 and indirectly predicted both depression and aggressive behaviors in Wave 2 through parental conflict. The overall model explained 10.4% of variance in depression and 6.1% in aggressive behaviors. Multi-group analysis revealed that the theoretical model of this study was applied to both genders. However, female adolescents showed stronger sensitivity to family stressors and relational processes. The model accounts for 13.6% of variance in depression and 10.8% in aggressive behaviors for females, compared to 9.2% and 4.4% for males, respectively.

Conclusions: The findings suggest that economic hardship is a stronger family stressor than long-term care needs, and parental conflict serves as a more significant mediator than parent-child relationship quality in predicting adolescent depression and aggressive behaviors in Chinese contexts. These results highlight the importance of developing stressor-specific and culturally sensitive family interventions that interparental conflicts to effectively reduce the negative impacts of family stress on adolescent mental and behavioral health. Additionally, gender-sensitive interventions may be particularly beneficial due to stronger family stress effects on relational outcomes, depression, and aggressive behaviors among female adolescents.

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: 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.

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.