Child and Adolescent Psychiatry and Mental Health最新文献

Background: Women with psychiatric disorders tend to have lower rates of exclusive breastfeeding despite of the benefits. Maternal use of psychotropic drugs has been suggested to influence their infant feeding methods. In this study, we retrospectively investigated differences in infant feeding methods (exclusive breastfeeding, formula feeding, and mixed feeding) among mothers with psychiatric disorders one month postpartum (n = 149), as well as the factors influencing infant feeding methods.

Methods: Data on the infant feeding methods of individuals with schizophrenia spectrum disorders (SSDs, n = 32), bipolar disorders (BDs, n = 23), depressive disorders (DDs, n = 33), and anxiety disorders, and stress-related disorders (ASRDs, n = 61) were extracted from medical records at a single institute between 2008 and 2024. Differences in infant feeding methods among the disorder groups, and the influences of individual factors, including the regular use of psychotropic drugs at the time of childbirth, as well as newborn information, on the infant feeding methods were assessed.

Results: Among the diagnostic groups, significant differences in infant feeding methods were observed (F = 6.52, p = 3.64 × 10⁻⁴), with a higher rate of formula feeding in the SSD group (72%) than in the other groups (BDs, 35%; DDs, 24%; ASRDs, 35%). In the SSD group, formula feeding was significantly correlated with the presence of antipsychotic (beta = 0.52, p = 2.93 × 10^- 3). In the non-SSD group, formula feeding was significantly correlated with the regular use of benzodiazepines (beta = 0.43, p = 3.46 × 10^- 6), the number of benzodiazepines used(beta = 0.38, p = 3.71 × 10^- 5), the diazepam equivalent (beta = 0.31, p = 6.78 × 10^- 4), and the number of psychotropic drugs used (beta = 0.41, p = 8.42 × 10^- 6).

Conclusion: Individuals with SSDs were more likely to choose formula feeding because of the use of antipsychotics at the time of childbirth, whereas individuals with non-SSDs tended to choose formula feeding because of psychotropic polypharmacy, including the use of benzodiazepines. These findings suggest that providing education on the safety of antipsychotics for patients with SSDs and avoiding polypharmacy in non-SSD patients might help promote exclusive breastfeeding.

Background: Mental health is the state of well-being that manages our emotions, psychological stress, social well-being and it is essential at all stages of life. Depression is a mental health condition that causes repeated changes in mood and in how a person feels about everyday life. It can impact every aspect of life, including relations with friends, family, and the community. Depression, like most other mental health conditions, begins at the time of childhood or adolescence and can continue into adulthood. Depression among young people is widespread in developing nations like Ethiopia. This review aimed to compile data on Ethiopia's youth depression.

Methods: We searched through papers on the topic within the electronic databases of Worldwide Science, Google Scholar, Cochrane Library, PubMed, and Web of Science. The data were extracted using a Microsoft Excel™ format and exported to R (software) for management and further analysis. The heterogeneity among the former studies' proportions was checked using the I2 test with p-values (I² = 97, p < 0.01). Due to the presence of heterogeneity, a random-effects model was used to estimate the pooled depression among youth in Ethiopia. Additionally, subgroup analysis and publication bias were tested.

Results: Overall pooled depression prevalence among youths in Ethiopia was 36% (95% CI: 31% to 42%). The level of social support, gender, and use of alcohol were significant predictors of youth depression.

Conclusion: The magnitude of youth depression in Ethiopia is high as compared to the WHO mental health report (2022). Female gender, poor alcohol use, and a lack of social support were associated with youth depression. Educational and social support, particularly for females, and opportunities for youth to engage in various social and economic activities, should be implemented.

Background: Autism Spectrum Disorder (ASD) contributes significantly to the disease burden among children and adolescents. Early diagnosis and intervention significantly improve outcomes; however, in Africa, children and adolescents with ASD are frequently identified and diagnosed late. This has been attributed to long and tortuous pathways to diagnosis. The objective of the study was to document and evaluate the pathways to a diagnosis of ASD, measure the delay in diagnosis, and document factors influencing these.

Methods: A cross-sectional survey of 70 caregivers of children aged 2-18 years with ASD. The Encounter Form, developed by the World Health Organisation, was used to describe pathways to diagnosis, and structured clinical interviews and assessments were used to determine how children's clinical factors, caregiver socio-demographic factors, and cultural and contextual factors influence the pathways and delays in diagnosis. ASD was diagnosed by a consultant psychiatrist or paediatrician using the Diagnostic and Statistical Manual version 5. SPSS version 23.0 was used for data analysis. Correlations between variables were analysed using Kruskal-Wallis, Mann-Whitney U tests, and logistic regression models.

Results: A mainstream (healthcare) and traditional/spiritual-based pathway was utilized by N = 51 (73%) and N = 19 (27%) caregivers, respectively. The mean age of diagnosis was five years, with a delay of 34.9 ± 33.5 months between caregiver symptom recognition and diagnosis. A median of four points of contact was made with care providers before diagnosis, with special needs teachers serving as the primary referral source. Clinical factors associated with a delay in diagnosis included: echolalia (p = 0.03), delayed walking (p = 0.01), attention deficit hyperactivity disorder (p = 0.04), and intellectual developmental disorder (p = 0.02). Conversely, challenges in recognizing, interpreting, and responding to emotional cues (p = 0.03) and "selectiveness in clothing" (p = 0.01) were associated with an earlier diagnosis.

Conclusion: Despite early recognition of ASD symptoms by caregivers and the predominant use of mainstream healthcare-based pathways, diagnosis was often delayed in this Kenyan sample. Distinct factors associated with the delay in diagnosis were identified, and further research is needed in larger and more diverse groups to facilitate earlier diagnosis and intervention.

Background: Childhood ADHD is associated with greater risk of depression in adolescence and adulthood, with emotion regulation (ER) identified as a potential mediator. However, it remains unclear how distinct domains of ER differentially relate to ADHD and depression symptoms in early adolescence.

Methods: The current analysis estimated a network model using longitudinal, parent-reported data from the Adolescent Brain and Cognitive Development (ABCD) Study 5.1 Data Release in 2023 (n = 4,460 complete cases). Nodes were item-level ADHD symptoms averaged across ages 9-12, ER domains (Catastrophize, Distracted, Attuned, and Negative Secondary Emotions) at ages 12-13, and item-level depression symptoms at ages 13-14. In exploratory analyses, we also examined potential differences in network structure and connectivity by sex, history of ADHD diagnosis at ages 9-12, and ADHD polygenic score (PGS).

Results: Catastrophize and Distracted were the most important ER bridges between earlier ADHD and later depression symptoms in the network. Two distinct pathways emerged: inattentive ADHD symptoms were linked to depression symptoms (poor eating, feeling worthless) via the Distracted ER dimension, while hyperactive-impulsive ADHD symptoms were linked to depressed mood and anhedonia via the Catastrophize ER dimension. Exploratory network comparisons found similar networks by sex, structural differences by history of ADHD diagnosis, and differences in structure and connectivity by ADHD PGS.

Conclusions: Multiple pathways from ADHD in childhood to depression in early adolescence may include ER difficulties through catastrophizing and distraction when upset. A denser, more interconnected network of symptoms was found among youth with higher genetic liability to ADHD.

Background: Individuals with autism spectrum disorder (ASD) have a wide range of challenges related to sensory and cognitive awareness. In Ethiopia, the increasing prevalence of ASD underscores the need for a comprehensive understanding of the associated challenges and impairments, an area that has not been studied so far.

Objective: The objective of this study was to investigate the underlying patterns of sensory and cognitive awareness impairments in children diagnosed with ASD at autism centers in Addis Ababa, Ethiopia.

Methods: An institution-based cross-sectional study was conducted at the Nehemia Autism Center and the Nia Foundation in Addis Ababa, Ethiopia. The study included children aged 4 to 16 years who had a confirmed diagnosis of ASD. A total of 145 study participants involved in this study. Study subjects were identified in collaboration with staff and caregivers. Caregivers of the study subjects were approached by trained data collectors, and written informed consent was obtained. The sensory/cognitive awareness subscale of the Autism Treatment Evaluation Checklist (ATEC) was administered to caregivers. This questionnaire tool has been validated for the autism population in Ethiopia. A face‒to-face interview was conducted. Data analysis was conducted IBM SPSS Version 22 Statistical Software. Principal component analysis with varimax rotation was employed to examine the patterns of sensory and cognitive awareness impairments. The numbers of principal components and factors to be retained were determined by examining the Eigenvalues and scree plot. Eigenvalues greater than 1 were used. The variable composition of each factor was examined by analyzing the factor loadings in the rotated component matrix. High variable loadings above 0.3 were considered for each factor.

Results: This study revealed five patterns of sensory and cognitive awareness impairments in children diagnosed with ASD. Pattern 1, limitation in social engagement and exploration (α = 0.822); Pattern 2 challenges in emotional awareness and cognitive responsiveness (α = 0.743); Pattern 3 challenges in story comprehension and creativity (α = 0.62); Pattern 4 difficulties in social reciprocity and reward (α = 0.34); and Pattern 5 trouble with focus and attention (α = 0.12). All of these patterns accounted for 60% of the total variance.

Conclusion: In this study, five patterns of sensory and cognitive awareness impairments were identified. Clinicians and therapists may need to consider these patterns for more personalized and effective support of children with ASD.

Background: The prevalence of mental health problems among adolescents is on the rise globally, and is a pressing public health concern in many developing countries, including China. While a growing body of epidemiological research has identified potential factors affecting adolescent mental health, few have considered both risk and protective factors across multiple domains or utilized machine learning approaches to identify and rank these factors.

Methods: This is a cross-sectional study based on data from 3,526 adolescent participants aged 11-15 years in the Qu County Study in China, and aims to identify and rank factors across five domains-including sociodemographic factors, academic functioning, extracurricular activities, life experiences, and resilience factors-in predicting adolescent mental health outcomes. A Bayesian machine learning approach is used to identify and rank important factors in predicting adolescent mental health outcomes, including depressive symptoms, anxiety symptoms, and sleep quality.

Results: The machine learning models showed satisfactory predictive performance across outcomes (pseudo-R² = 0.24-0.61; RMSE = 0.65-3.60). Experiences of life stress, benevolent events, environmental sensitivity, and shift-and-persist coping strategies were common top predictors in predicting depressive symptoms, anxiety symptoms, and sleep quality. Stress mindset and expressive suppression strategies were unique predictors of sleep quality and depressive symptoms, respectively.

Conclusions: Our results revealed the importance of life experience and resilience factors in predicting adolescent mental health. Future studies should investigate the causal relationship between these understudied factors and adolescent mental health.

Background/objectives: Off-label psychopharmacologic medication use is widespread in child and adolescent psychiatry, but little is known about its associated factors. This study aimed to assess frequency and determinants of off-label use of antidepressants and antipsychotics in youths in daily clinical practice.

Methods: In a prospective clinical study ('TDM-VIGIL') at 18 centers in three German-speaking countries, child psychiatric patients aged 4-18 years undergoing routine treatment with antidepressants and antipsychotics were systematically followed. Demographic, clinical and pharmacological data were collected in an online-based patient registry; off-label use was categorized by reasons, including age, indication or duration of treatment for each treatment episode. Examined correlates of off-label use included sex, treatment setting, diagnosis and illness severity.

Results: About 67% of all antidepressant and antipsychotic treatment episodes in the 700 included patients (mean age = 14.6 years, girls = 67%) were off-label. For antidepressants, 55.2% were off-label (age = 51.1%, non-licensed indications = 37.4%, age + indication = 11.5%), for antipsychotics 81.7% were off-label (age = 29.4%, non-licensed indications = 33.2%, age + indication = 37.4%). Sex, age (< 12, ≥ 12 years) as well as illness severity were not associated with off-label use. In antidepressant treatment, 'depression' and 'obsessive compulsive disorder' diagnoses were associated with reduced and 'suicidality at admission' with increased off-label prescriptions. In antipsychotics, 'schizophrenia diagnoses' was linked to decreased, university hospital treatment to increased off-label use.

Conclusions: The frequency of off-label use of antidepressants and even more of antipsychotics in youths treated at specialized child psychiatric centers is high. As the clinical efficacy and safety of off-label antidepressant and antipsychotic use in youth is under-researched, our results call for further pharmacovigilance studies and strategies to improve drug safety.

Background: Social anxiety disorder (SAD) in adolescence is associated with significant functional impairment and increased risk of chronic mental health difficulties. Recent research highlights the potential roles of theory of mind, executive functions, and metacognitive beliefs in the onset and maintenance of SAD; however, no study has yet evaluated these three cognitive domains simultaneously in a clinical adolescent sample.

Methods: This was a cross-sectional descriptive study including 40 adolescents aged 12-16 years (SAD group: M = 14.45, SD = 1.48; control group: M = 13.89, SD = 1.32) who were diagnosed with SAD and 40 typically developing controls matched for age and sex. The participants completed the WISC-IV, the Reading the Mind in the Eyes Test (Eyes Test), the Faux Pas Recognition Test (FPRT), and the CNSVS subtests assessing Stroop Test, attention shifting, and continuous performance. The Metacognitions Questionnaire for Children and Adolescents (MCQ-C) was also administered. Parental reports provided sociodemographic data.

Results: Compared to the control group, adolescents with SAD demonstrated lower performance in FPRT total scores, cognitive flexibility, and working memory, and reported higher MCQ-C total scores. Binary logistic regression analysis revealed that both working memory (β = -0.10, p < .05) and MCQ-C scores (β = 0.17, p < .01) were significant predictors of SAD diagnosis.

Conclusions: These findings suggest that impairments in metacognitive beliefs and working memory may help distinguish adolescents with SAD from their typically developing peers. Incorporating these domains into clinical assessment and intervention strategies could enhance early detection and treatment outcomes.

Objective: Autistic children's ability to access mental health services can be challenging due to the limited availability of therapists with autism experience, service ineligibility, and financial strain. This systematic review evaluated and synthesized literature regarding the impact of government policy levers on the access to, and utilization of, mental health services by Autistic children and their families.

Method: Interdisciplinary databases together with gray literature and supplementary searches were used to identify relevant articles. Peer-reviewed, English language studies which reported on the impact of government policy levers on the utilization of, and access to, mental health services by Autistic children and their families were included.

Results: Searches resulted in the identification of 2305 articles (database searches = 744, additional searches = 1531), six of which were included in the final review. All six articles were from the United States of America, published between 2013 and 2020, with a focus on national and state regulatory policy levers targeting insurance companies. Results indicated that most policy levers did not improve service access to, or utilization of, mental health services. Gray literature searches identified that several countries had implemented autism specific policy levers, most however had not been evaluated regarding their impact on mental health service access and utilization by Autistic children or their families.

Conclusion: The majority of identified policy levers have not resulted in greater utilization or access of mental health services for Autistic children or their families. More global research, focusing on datasets that have allowed policies time to impact change, is needed.

Background: The rising prevalence of mental health problems presents economic and social challenges with youth anxiety and depression as major contributors. While strengthening preventive measures is essential to mitigate the impacts of these conditions, limited resources necessitate careful prioritization of interventions. This underscores the need for cost-effectiveness studies to inform resource allocation and decision-making.

Methods: This study utilized data from a trial employing the MOST framework to optimize a targeted group CBT intervention for youths exhibiting anxiety and depressive symptoms. Experimental strategies were evaluated for cost-effectiveness using real-world data examining intervention costs, child mental health outcomes: anxious and depressive symptoms and quality-adjusted life-years (QALYs). Three intervention factors were examined: delivery format (16 sessions vs. 8 sessions + 8 web-based sessions), parental involvement (five sessions vs. parental brochure), and measurement feedback system (MFS) (feedback vs. no feedback), producing eight intervention strategies. The study included 701 children aged 8 to 12, recruited from 52 public schools in 39 municipalities in Norway. Statistical analysis was conducted using R.

Results: For depressive symptoms and QALYs, cost-effective strategies included the long in-person version with low parental involvement and no feedback, and the hybrid format (in-person + web-based sessions) with low parental involvement and no feedback. For depressive symptoms, the hybrid format with parental involvement and no feedback was a feasible strategy. For anxiety symptoms, cost-effective strategies involved the long in-person version with low parental involvement and feedback, and the hybrid format with low parental involvement and feedback.

Discussion: In resource-constrained environments, the least resource-intensive strategies can ensure symptom reduction at minimal cost. Parental involvement is a viable alternative under conditions of intermediate resources, balancing costs, and clinical benefits. When symptom reduction is prioritized, and cost is secondary, the long in-person format with low parental involvement and no feedback may be preferable.

Conclusion: The study highlights trade-offs between cost containment, reach, and intervention effectiveness. Policymakers must weigh costs against desired levels of symptom reduction when making decisions. Trial registration number Clinical Trials NCT04263558 (Feb 11, 20, Jan 25. 21).