Child and Adolescent Psychiatry and Mental Health最新文献

Background: Of the twelve youth prisons in the German Democratic Republic, known as Jugendhäuser, the one in Halle was notorious for the violence among its inmates. Self-harm in the form of suicides and attempted suicides had been common throughout the prison's existence since 1971, but hunger strikes also became frequent in the 1980s. The aim of this paper is to explain the causes of self-harm in the Jugendhaus Halle, the risks for young people and the chances of achieving their goals, and to discuss a concept of "nonviolent" resistance in this context.

Methods: We analyzed the personal files of juvenile prisoners from the Archive of the Correctional Facility Halle and the Stasi Records Archive Halle concerning the situation and incidents in the Jugendhaus Halle. The historical-critical method was used to analyze these sources.

Results: Most of the youths involved in the hunger strikes were political prisoners who wanted to leave East Germany and felt their sentences were unjust. The hunger strikes usually lasted one or two days, but in persistent cases, the youths were force-fed. Suicide attempts were caused by abuse and humiliation. After medical treatment, those attempting were restrained in "chain beds."

Conclusions: While suicide attempts expressed despair, hunger strikes were frequent among political prisoners protesting their sentences and demanding freedom of movement. Self-harm as a resistance was largely ineffective and met with punitive measures. The idea of "nonviolent" resistance through self-harm is controversial, as it involves harming one's own body and often provokes further violence by prison authorities.

Introduction: Early child-caregiver attachment is foundational to mental health (MH). While prevention efforts often aim to improve attachment quality, clinicians frequently encounter infants and young children already exhibiting clinical symptoms of MH disorders. A comprehensive summary of attachment-based dyadic interventions for this population is lacking. This scoping review aims to address this gap.

Methods: We conducted a scoping review of CINAHL, MEDLINE, PsycINFO, Web of Science, Cochrane CENTRAL and hand-searched articles to identify and characterize dyadic, relationship-based interventions for children aged 0-6 years with clinical symptoms of MH disorders. Studies were screened for eligibility and included if they examined therapeutic modalities used in clinical populations beyond preventive approaches.

Results: Screening identified studies that evaluated several therapeutic modalities, e.g., Parent Child Interaction Therapy (PCIT), Early Pathways (EP), Watch, Wait, and Wonder, Parent-Infant Psychotherapy, and Video Feedback Interventions. PCIT and EP had the most published data, treated the largest number of participants, and demonstrated significant improvements in child or relational outcomes. However, most studies had small sample sizes and methodological limitations. Only a few interventions had been evaluated using rigorous designs such as randomized controlled trials.

Conclusions: Two interventions that had the most evidence were EP and PCIT, particularly for families affected by adverse social determinants of health. Both require further research to explore barriers for implementation (e.g., adaptability in multiple settings and cultures, lessen resources required for service delivery, etc.). Additional research is needed to strengthen the evidence base for dyadic, attachment-based treatments targeting clinical MH concerns in infants and young children.

Background: Trait resilience is a well-established protective factor against diverse social-emotional challenges and stress-associated psychiatric disorders. Its cultivation may thus be exceptionally critical for children exposed to early financial adversity, which has been demonstrated to confer elevated vulnerabilities to psychosocial maladjustment. Grounded in the Family Stress Model with a focus on an understudied Asian population, this longitudinal study investigates how early family socioeconomic disadvantage indirectly shapes children's trait resilience through key parenting dimensions-warmth, rejection, and autonomy support-by both mothers and fathers.

Methods: This longitudinal study was embedded in a multi-ethnic, pre-birth cohort involving Singaporean families (57.3% Chinese, 30.0% Malay, 12.7% Indian), comprising 430 biological mothers (M_Age = 30.5, SD_Age = 5.13), 430 children (47.9% female), and 348 biological fathers (M_Age = 33.9, SD_Age = 6.03). Key family socioeconomic characteristics were measured at baseline during the 11th week of pregnancy via maternal report (maternal education, household income, and housing type), and at 2 or 3 years postnatal via paternal report (paternal education). Children reported on mothers' and fathers' parenting practices (warmth, rejection, and autonomy support) separately at 8.5 years with the Parental Bonding Instrument, and trait resilience at 10.5 years with the Connor-Davidson Resilience Scale-25.

Results: Children from families with lower socioeconomic status during early childhood (indexed by lower levels of mothers' and fathers' educational attainment, and household income) demonstrated lower trait resilience in late childhood. Parallel mediation analyses with 5,000 bootstrapped samples revealed that maternal and paternal educational attainment influenced trait resilience in late childhood via greater maternal and paternal rejection during middle childhood, respectively. Meanwhile, the relationship of household income with children's trait resilience was mediated by lower levels of maternal warmth only. No significant indirect effects of both parents' autonomy support were observed.

Conclusions: Maternal and paternal parenting practices play salient roles in nurturing children's trait resilience, in part substantiating the cultural validity of the Family Stress Model within a Southeast Asian family ecology. Specifically, family interventions could seek to ameliorate both maternal and paternal rejection, as well as enhance maternal warmth behaviors to mitigate the influence of socioeconomic disadvantage on children's trait resilience.

Background: Few studies have examined the point prevalence and incidence of perinatal mental disorders among the general population of pregnant women and no prior studies have investigated these in adolescent mothers. This study aimed to fill this gap by estimating the point prevalence and incidence of depressive and generalized anxiety symptoms, and their associated factors from pregnancy to 3 months post-delivery.

Methods: A longitudinal study was conducted among 533 adolescent pregnant women in their second trimester. A convenience sampling strategy was used to recruit participants from preselected antenatal clinics in Mwanza, Tanzania from 5th August 2023 to 30th June 2024. We used the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms and the Generalized Anxiety Disorder - 7 (GAD-7) scale to screen for generalized anxiety symptoms. The Screening was done in the second trimester of pregnancy (T1), the third trimester (T2), four weeks postpartum (T3) and three months post-delivery (T4).

Results: The point prevalence of both depressive and generalized anxiety symptoms decreased from the second trimester of pregnancy (T1) to 3 months post-delivery (T4). The point prevalence of depressive symptoms fell from 20.64% (95% CI, 0.17-0.24) at T1 to 9.90% (95% CI, 0.07-0.12) at T4, while the point prevalence of generalized anxiety symptoms fell from 22.33% (95% CI, 0.19-0.26) at T1 to 10.48% (95% CI, 0.08-0.13) at T4. In contrast, the incidence of both depressive and anxiety symptoms increased from recruitment (T1) through to 3 months post-delivery. Specifically, the incidence of depressive symptoms rose from 9.00% (95% CI, 0.07-0.12) at T2 to 11.89% (95% CI, 0.07-0.12) at T4, while the incidence of generalized anxiety symptoms rose from 7.20% (95% CI, 0.05-0.10) at T2 to 10.81% (95% CI, 0.06-0.11) at T4. At all-time points, being classified as displaying depressive symptoms was highly associated with being classified as displaying symptoms of anxiety.

Conclusions: There was an increase in incidence in depressive and anxiety symptoms in adolescent women from the second trimester of pregnancy to three months post-delivery, but a decrease in point prevalence. These findings support the importance of integrating mental health services into existing antenatal and postnatal care services for adolescent women.

Background: Adolescence is a sensitive period of social, biological, and cognitive development. Prolonged suffering from psychiatric symptoms during this important phase of development has well-established social, health, and occupational costs in adulthood. The purpose of this study was to identify the barriers to engaging in mental health treatment among symptomatic, community-dwelling adolescents.

Methods: In a cross-sectional study, barriers to mental health service use and psychiatric symptoms, including depressive symptoms, anxiety symptoms, and sleep disturbance, were self-reported by 277 adolescents (age 15.14 ± 2.21 years; 52% female; 93.5% Hispanic or Latino).

Results: Clinically elevated psychiatric symptoms were common in this sample; 26% self-reported clinically significant depressive symptoms, 41% self-reported clinically significant anxiety symptoms, and 46% self-reported clinically significant sleep disturbance. Having clinically elevated symptoms of anxiety was associated with more barriers overall, p < 0.001. Having more exposure to early life adversity (ELA), being in high school or college relative to middle school, and having clinically elevated symptoms of anxiety were each independently associated with more cost concerns, ELA p = 0.02, school p = 0.01, anxiety p = 0.006. Adolescents in this sample with clinically elevated psychiatric symptoms disproportionately reported barriers to seeking mental health treatment pertaining to not wanting to discuss their mental health concerns with a physician, depression p < 0.001 and sleep disturbance p = .005, not knowing how to access a mental health provider, anxiety p < 0.001, and feeling like their symptoms were not pathological given their current circumstances, for both depressive and anxiety symptoms p < 0.001.

Conclusions: Among at-risk youth-predominantly Hispanic/Latino-both intrinsic (normalization, fear/limited knowledge) and extrinsic (cost, transportation, physician referral) barriers shape perceived access to care, with anxiety and sleep problems most strongly tied to overall barriers. Social ecological approaches to addressing these barriers may reduce the time at-risk adolescents delay seeking support or intervention.

Background: Loneliness is currently very prevalent among adolescents, negatively affecting their physical, mental, and social health. Playing videogames is one of the most common leisure activities, which has been associated with multiple negative and positive outcomes for mental health. Depending on their use, they can generate mental and social health benefits or lead to an addiction that disrupts daily life and affects the adolescent's mental health. Community spaces for young people create safe environments where adolescents can gain access to different meaningful leisure activities, but the association of community videogame play with feelings of loneliness has not been researched to this date. Therefore, the purpose of this study is to understand the feelings of loneliness among adolescents aged 14 to 20 who attend community spaces to play videogames.

Methods: This descriptive cross-sectional study included adolescents aged between 14 and 20. A sociodemographic questionnaire, questions related to videogame use, and the Richaud de Minzi and Sacchi Adolescent Loneliness Scale were administered.

Results: A total of 112 adolescents with a mean age of 18.21 years (± 1.52) were included. It was found that adolescents who played alone had a worse perception of their friendships, family ties, themselves, and their social and adaptive skills, compared to adolescents who exclusively played when accompanied.

Conclusions: Participation in meaningful activities, such as shared videogame use within community resources, may decrease the likelihood of developing feelings of loneliness in the adolescent population.

Background: The severity of tics may influence executive function in children and adolescents diagnosed with tic disorders. The underlying mechanism is still inadequately researched. This study investigates the mediating role of premonitory urges in the relationship between tic severity and executive functioning, alongside the moderating effect of comorbidities.

Methods: A total of 154 children and adolescents, aged 6 to 15 years, diagnosed with tic disorders, were recruited from Fujian, China. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urges for Tics Scale (PUTS), and Behavior Rating Inventory of Executive Function (BRIEF) were utilized to evaluate tic severity, premonitory urges, and executive functioning. R software version 4.4.3 was used for descriptive statistics and Pearson correlation studies. The moderated mediator models were tested using Bayesian Structural Equation Modeling (BSEM).

Results: A Bayesian simple mediation model revealed that the premonitory urge fully mediated the association between tic severity and executive functioning. Additionally, comorbidity was found to independently predict both the premonitory urge and executive functioning. In the context of a moderated mediation model, comorbidity intensified the association between tic severity and the premonitory urge, resulting in more pronounced indirect effects on behavioral regulation (BRI) and metacognition (MI). The Index of Moderated Mediation was significant for both BRI and MI, thereby confirming the enhancement of the mediation pathway driven by comorbidity.

Conclusions: This study is the first application of BSEM to clarify the mediating mechanism through which tic severity affects executive functioning via the premonitory urge, while concurrently validating the moderating effect of comorbidities. This finding supports the optimization of clinical assessment and intervention strategies.

Background: Violence and mental health have a large proportion within the global burden of disease for children and youth, especially with the growing magnitude of suicidal behaviour and non-suicidal self-injury. This longitudinal study examined for the effects of physical and psychological family and community violence during childhood, adolescence and youth and the emergence of suicidal behaviour and non-suicidal self-injury among young people.

Methods: 129 participants, from a cohort of 500 students (mean age 8 years, SD 1.2) sampled at schools in a Brazilian metropolis (2005), were followed up for 16 years (2006, 2008, 2012, 2021). Suicidal behaviour/non-suicidal self-injury by the youth was the dependent variable assessed at the fifth wave of the study by Adult Self Report/Achenbach System of Empirically Based Assessment (ASR/ASEBA) and Youth Risk Behavior Survey Scale (YRBSS). The independent variables were 193 questions on violence (Conflict Tactics Scale - CTS - and "Things I have seen and heard"), which were assessed longitudinally. Three groups of violence (physical family violence, psychological family violence and community violence), plus the three stages of development studied (childhood, adolescence and youth), resulted in nine violence events, which were examined descriptively and input to structural equation modelling.

Results: The outcome was found in 37% of the participants, combining all time points. The forms of violence that occurred in childhood, adolescence and youth were, respectively: physical family violence: 84.5%, 14% and 15.5%; psychological family violence: 76.7%, 3.9% and 76.7%; and community violence: 18%, 12.4% and 40.3%. The modelling revealed a network between types of violence: community and psychological (0.348; p < 0.001) in childhood; community and psychological (0.302; p < 0.001) and physical and psychological (0.374; p = 0.001) in youth; and among all types of violence in adolescence. Regarding the outcome, the following factors were prominent: psychological family violence in childhood (0.656; p = 0.006), community violence in adolescence (0.517; p < 0.001) and psychological family violence in youth (0.398; p < 0.001).

Conclusions: The study highlighted the effect of different forms of violence longitudinally with suicidal behaviour and non-suicidal self-injury in youth, underlining the value of preventing violence as an important vector in related intervention.

Background: Adolescents' mental health issues may require psychiatric hospitalization, highlighting the need for effective interventions during hospitalization. This study explored statistical and clinical (through reliable change index; RCI) changes in mental health difficulties across hospitalization and their moderating factors potentially affecting clinical progress and discharge outcomes.

Methods: We examined retrospective socio-demographic and clinical data from 593 adolescents first hospitalized at the Adolescent Psychiatric Hospitalization Unit (UHPA) of the Lausanne University Hospital (CHUV) between 2014 and 2021. Statistical significance (analyzed via t-tests for paired samples) used scores on the Health of the Nation Outcome Scales for Children (HoNOSCA) at admission and discharge, whereas RCI was used to assess clinical significance. Moderating factors were examined through multivariate regression analyses on clinical changes and outcomes at discharge.

Results: Statistically, we observed a significant reduction in mental health issues, as reflected by decreases in the "Total", "Behavioral" and "Symptoms" HoNOSCA scores from admission to discharge. However, clinical improvements (RCI > 1.96) were reached in 20% of patients, while 65% remained stable. Finally, considering moderating factors, while clinical changes during hospitalization remained largely unexplained, moderators such as sex, behavioral and emotional disorders (F9x), antipsychotic intake, voluntary admission, pre-hospitalization occupation, patient-clinician discharge agreement, and length of stay accounted for a significant proportion of clinical outcomes at discharge.

Conclusions: While hospitalization may contribute to stabilizing acute crises, clinically meaningful improvements were limited for many patients. This highlights the importance of integrative and coordinated approaches tailored to adolescents' heterogeneous profiles.

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.