Child and Adolescent Psychiatry and Mental Health最新文献

Background: Aripiprazole is the most frequently recommended antipsychotic for the treatment of tics in children and adolescents with Tourette's disorder (TD). However, to date, a randomized controlled trial for aripiprazole oral solution has not been conducted despite being widely preferred by children. Therefore, we examined whether aripiprazole oral solution is effective for treating tics.

Methods: All patients received a flexible dose of aripiprazole oral solution (1 mg/mL, range: 2-20 mg) with a starting dose of 2 mg. The target dose for patients weighing < 50 kg was 2, 5, and 10 mg/day, and that for patients weighing ≥ 50 kg was 5, 10, 15, and 20 mg/day. The primary efficacy endpoint was the mean change in the Yale Global Tic Severity Scale-total tic score (YGTSS-TTS) from baseline to week 8.

Results: Of the 121 patients enrolled, 59 patients (96.7%) in the aripiprazole group and 53 patients (88.3%) in the placebo group completed the study. The aripiprazole group showed significantly greater improvement in the YGTSS-TTS from baseline to week 8 than the placebo group (least squares mean difference [95% confidence interval (CI)] -5.5 [95% CI - 8.4 to - 2.6]). At week 8, the response rate (i.e., percentage of patients with a Tourette's Syndrome Clinical Global Impression-Improvement score of 1 or 2) of the aripiprazole group (86.4%) was significantly higher than that of the placebo group (56.6%; odds ratio: 3.6, p < 0.001). The incidence of treatment-emergent adverse events (TEAEs) reported in at least one patient was 86.9% in the aripiprazole group and 65.5% in the placebo group. All TEAEs were mild or moderate in severity. No serious adverse events or deaths occurred during the study.

Conclusions: Our findings suggest that aripiprazole oral solution is an effective, well-tolerated, and safe treatment for children and adolescents with TD.

Trial registration: ClinicalTrials.gov Identifier: NCT03487783. Registered 4 April 2018.

Background: Mental health and health-related quality of life (HRQoL) in children and adolescents deteriorated during the COVID-19 pandemic. The aim of this population-based longitudinal study was to explore whether distinct mental health trajectories in youths can be identified over the course of the pandemic.

Methods: Mental health problems (MHP), psychosomatic symptoms and HRQoL were assessed at five time points between May 2020 and October 2022 in 744 children and adolescents aged 7 to 20 years using established instruments. We used generalized mixture modeling to identify distinct mental health trajectories and fixed-effects regressions to analyse covariates of the identified profiles of change.

Results: We found five distinct linear latent trajectory classes each for externalising MHP and psychosomatic symptoms and four trajectory classes for internalising MHP. For HRQoL, a single-class solution that indicates a common development process proved to be optimal. The largest groups remained almost stable at a low internalising and externalising symptom level (64 to 74%) and consistently showed moderate psychosomatic symptoms (79%), while 2 to 18% showed improvements across the pandemic. About 10% of the youths had consistently high internalising problems, while externalising problems deteriorated in 18% of youths. Class membership was significantly associated with initial HRQoL, parental and child burden, personal resources, family climate and social support.

Conclusions: The mental health of most children and adolescents remained resilient throughout the pandemic. However, a sizeable number of youths had consistently poor or deteriorating mental health. Those children and adolescents need special attention in schools and mental health care.

Background: Having no or few confidants is found to be associated with more severe mental health problems and a higher prevalence of depression in adults, but research examining this association in adolescents is scarce. Social relationships may be particularly critical during adolescence, as it is an important developmental period during which vulnerability to mental health problems increases. The present study examined the relationship between having no or few confidants and anxiety/depressive symptoms in adolescents.

Methods: Cross-sectional self-report survey targeting 7-12th grade students (age range: 12-18) was conducted in public junior and senior high schools in Mie and Kochi, Japan. Data from 17,829 students (49.7% boys) were analyzed. Associations between anxiety/depressive symptoms (12-item General Health Questionnaire; score range: 0-12) and the number of confidants (None, 1-3, or ≥ 4) were examined using multilevel regression analyses. The analyses were stratified by gender and school level (junior/senior high), and adjusted for experiences of being physically abused and bullied and the interactions of these experiences with the number of confidants.

Results: Having no or 1-3 confidants was associated with more anxiety/depressive symptoms, compared to having ≥ 4 confidants (p < 0.001) in all stratified groups. Having no confidants was associated with more anxiety/depressive symptoms than having 1-3 confidants (p < 0.001); in senior high boys, no difference was observed between having no confidants and having 1-3 confidants. In addition, in senior high boys, victims of bullying who have confidants reported significantly less anxiety/depressive symptoms than the victims who have no confidants (p < 0.01).

Conclusions: Adolescents who had no or few confidants had more anxiety/depressive symptoms. Attention needs to be paid to better identify these adolescents, and avenues to support them need to be established.

Background: The COVID-19-pandemic has had a profound impact on the lives of adolescents worldwide. This study examined the subjective perception of the COVID-19 pandemic measures and its association with mental health and well-being (i.e., loneliness, life satisfaction and multiple health complaints) among 13- and 15-years-old adolescents from 22 countries.

Methods: Data from the cross-national Health Behaviour in School-aged Children (HBSC) 2021/22 study were used from representative samples of 22 countries (N = 67,544; 51.9% girls). The self-perceived impact of COVID-19 measure comprised 10 items asking about the impact on several dimensions of adolescent lives (e.g., relationships with family and friends, health, or eating behaviours). Measures of loneliness, multiple health complaints, and life satisfaction were included as indicators of mental health and well-being. A non-parametric multilevel latent class analysis considering individual and country-levels was conducted to identify classes of self-perceived impact of the COVID-19 measures. Multilevel logistic regression models adjusted by age and socioeconomic status were applied to assess the association between COVID-19 measure impact classes and mental health.

Results: Three classes were identified on individual level encompassing a neutral (51%), positive (31%), or negative (18%) perception of COVID-19 measures. A third of the adolescents reported a positive impact of the pandemic measures. The distribution of classes was heterogeneous within and across countries. Within the positive COVID-19 measure impact class, social relationships were the most important dimension, whereas mental health problems were mostly represented within the negative COVID-19 measure impact class. Girls with a negative perception of pandemic measures showed higher levels of loneliness and multiple health complaints and lower life satisfaction. 15-year-old adolescents and those with a low socioeconomic status reported higher levels of loneliness and lower life satisfaction.

Conclusions: The majority of adolescents perceived the pandemic measures as neutral or positive. Girls, 15-year-old adolescents, and those with low socioeconomic status were at higher risk of suffering from pandemic measures and associated problems of loneliness, multiple health complaints, and low life satisfaction. We conclude that adolescent's mental health and well-being should be considered in the decision-making process by ensuring that the unique challenges of adolescents are adequately addressed in policies.

Background: Adolescent mental health issues are emerging as a significant public health concern across many low- and middle-income countries, particularly in Africa. This study aims to evaluate the aggregated prevalence and contributing risk factors of mental health distress among adolescents in Africa.

Methodology: A comprehensive search of PubMed, PsycINFO, Web of Science, Google Scholar, and HINARI databases was conducted to identify relevant articles on the prevalence and risk factors associated with mental health distress among African adolescents, published up to December 2023. The quality of the selected studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Heterogeneity among the studies was evaluated using the I² statistical test. Potential publication bias was assessed through a funnel plot and Egger's statistical test. This systematic review was registered with PROSPERO under reference number CRD42023494665.

Results: Eighteen studies encompassing data from 37,016 adolescents were included in the analysis. The overall prevalence of mental health distress among adolescents in Africa was found to be 27.34% (95% CI: 23.18-31.50). The occurrence of mental health distress is observed in older adolescents at a prevalence of 29.44% (95% CI: 23.26-35.66) and in younger adolescents at 24.73% (95% CI: 11.96-37.51). Significant risk factors identified included bullying victimization, with an odds ratio (POR) of 1.30 (95% CI: 1.16, 1.46), and experiencing hunger, with an odds ratio (POR) of 2.10 (95% CI: 1.13, 3.91).

Conclusion: The findings indicate a high prevalence of mental health distress among adolescents in Africa, highlighting the widespread impact on this demographic. These results underscore the urgent need for targeted interventions to prevent and address mental health distress among adolescents. Further research on a global scale is essential to develop effective prevention and treatment strategies tailored to this age group.

Background: Mental health problems, such as depression, have a high prevalence in young people. However, the majority of youths suffering from depression do not seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between youthswith different levels of depressive symptoms.

Methods: This cross-sectional study is part of a large-scale, multi-center project. Participants were n = 9509 youths who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, youths were allocated to the following three subgroups: (a) without depressive symptoms, (b) with subclinical symptoms, (c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior, help-seeking intentions and perceived barriers (Barriers questionnaire) between these subgroups. An additional exploratory qualitative content analysis examined text answers on other perceived barriers to help-seeking.

Results: Participants were mostly female (n = 5575, 58.6%) and 12 to 24 years old (M = 15.09, SD 2.37). Participants with different levels of depressive symptoms differed significantly in help-seeking behavior, intentions and perceived barriers. Specifically, participants with clinical depressive symptoms reported more previous help-seeking, but lower intentions to seek help compared to participants without symptoms (all p < 0.05). Participants with subclinical depressive symptoms reported a similar frequency of previous help-seeking, but higher intentions to seek help compared to participants without symptoms (all p < 0.05). Perception of barriers was different across subgroups: participants with clinical and subclinical depressive symptoms perceived the majority of barriers such as stigma, difficulties in accessibility, and family-related barriers as more relevant than participants without depressive symptoms. Across all subgroups, participants frequently mentioned intrapersonal reasons, a high need for autonomy, and a lack of mental health literacy as barriers to help-seeking.

Conclusions: Youths with higher levels of depressive symptoms are more reluctant to seek professional help and perceive higher barriers. This underlines the need for effective and low-threshold interventions to tackle barriers, increase help-seeking, and lower depressive symptoms in adolescents and young adults differing in depression severity.

Trial registration: DRKS00014685.

Background: Past empirical evidence on the longitudinal relations between emotional mental health symptoms and parent-child close relationships has produced mixed and inconclusive results. Some studies suggest a unidirectional relation, whereas other studies point toward a bidirectional association. Additionally, most of the past research has been carried out with adolescent samples, rather than children. Hence, this study aimed to estimate the longitudinal relations between children's trait emotional difficulties and trait parent-child closeness, accounting for the time-invariant and time-varying state components of each factor.

Methods: Participants were 7,507 children (ages 3 years, 5 years, 7 years, and 9 years) from the Growing Up in Ireland cohort. Α bivariate stable trait, autoregressive trait, and state (STARTS) model was estimated using Bayesian structural equation modelling.

Results: The STARTS model revealed that children's emotional difficulties and parent-child closeness were relatively stable across time, and these overarching traits were strongly negatively correlated. Children's earlier trait emotional difficulties predicted later trait parent-child closeness and vice versa between 3 years and 5 years, and between 5 years and 7 years, but these effects disappeared between 7 years and 9 years. At all pairs of time points, state emotional difficulties and state parent-child closeness were weakly negatively correlated.

Conclusions: Overall, the results suggest that early and middle childhood are critical stages for improving parent-child relationships and reducing children's emotional difficulties. Developing close parent-child relationships in childhood appears to be a key factor in reducing children's subsequent emotional difficulties. Children who face greater than usual emotional difficulties tend to be more withdrawn and less receptive to close parent-child relationships and this could serve as an important screening indicator.

Background: While minoritized ethnoracial groups were most likely to be in online learning during the COVID-19 pandemic, the impact of these ethnoracial disparities on adolescent mental health is unclear. Since past studies do not directly examine whether the association between school modality and self-reported mental health outcomes varied by race and ethnicity among U.S. adolescents during the COVID-19 pandemic, this study addresses the gap.

Methods: Adolescents aged 13 to 17 years old (n = 510) were surveyed for self-reports of anxiety and depression symptoms using the 4-item Patient Health Questionnaire during Spring 2021. Seemingly unrelated regressions were used to estimate the differential association between school modality and mental health by respondents' race and ethnicity.

Results: Estimates without interaction between school modality and race and ethnicity suggested that Latino respondents reported a significantly higher frequency of depressive symptoms than their White counterparts (b = 0.459; p < 0.05). Similarly, the estimates without the interaction suggested respondents reporting hybrid learning had a higher frequency of depressive symptoms than in-person learning (b = 0.504; p < 0.05). Estimates with interaction between school modality and race and ethnicity suggested fully online learning was associated with poorer mental health only among White respondents and better mental health among Black respondents. Among adolescents attending school fully online, Black adolescents reported fewer mental health symptoms than their White counterparts (anxiety, b =- 1.364; p < 0.05, and depression, b =- 1.647; p < 0.05).

Conclusions: Fully online learning may have benefitted the mental health of Black adolescents during the COVID-19 pandemic, perhaps because it buffered racial discrimination and social anxiety in schools. Additional interventions should be explored to promote in-person school environments that better support the mental health of Black adolescents. Moreover, prioritizing equitable access to broadband internet will provide better access to online learning and ensure positive mental health, particularly for adolescents from minoritized ethnoracial groups during instances of future pandemics. Future research should continue to consider the race and ethnicity of adolescents to promote mental well-being in schools across learning modalities.

Background: The gut microbiota is believed to influence neurodevelopment through the gut-brain axis, but prior studies have shown inconsistent results regarding early childhood antibiotic exposure and subsequent risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The purpose of this study was to evaluate the hypothesis that exposure to antibacterial agents in the first 2 years of life increases the risk of ASD and/or ADHD.

Methods: This was a retrospective cohort study using 2003-2019 data from the National Health Insurance Research Database in Taiwan. Livebirths born between 2004 and 2016 were identified and separated into singleton, full sibling, and exposure-discordant sibling pair cohorts. The exposure group included children who filled at least one prescription for antibacterial agents between 0 and 2 years old in outpatient settings. The outcome, ASD and/or ADHD, was defined by at least one inpatient or outpatient diagnosis. The maximum follow-up age was 15 years in this study. Potential neonatal, maternal and paternal confounders were adjusted for. Cox proportional hazards models were used to estimate the relative event risk.

Results: The final sample contained 946,581 children in the singleton cohort, 1,142,693 children in the full sibling cohort, and 352,612 children in the exposure-discordant sibling pair cohort. Antibiotic exposure marginally increased the risk of ASD and/or ADHD in the singleton cohort (adjusted hazard ratio [aHR]: 1.06, 95% confidence interval [CI]: 1.04-1.07) and in the full sibling cohort (aHR: 1.03, 95% CI: 1.01-1.04). A slight decrease in the risk of ASD and/or ADHD was observed in the exposure-discordant sibling pair cohort (aHR: 0.92, 95% CI: 0.90-0.94).

Conclusions: The results suggest that early life antibiotic exposure has minimal impact on the risk of ASD and/or ADHD. Given that the estimated effects are marginal and close to null, concerns about ASD and/or ADHD risk increase should not postpone or deter timely and reasonable antibiotic use.

Background: Attention-deficit/hyperactivity disorder (ADHD) has been shown to pose considerable clinical and economic burden; however, research quantifying the excess burden attributable to common psychiatric comorbidities of ADHD among pediatric patients is scarce. This study assessed the impact of anxiety and depression on healthcare resource utilization (HRU) and healthcare costs in pediatric patients with ADHD in the United States.

Methods: Patients with ADHD aged 6-17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions.

Results: The reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001).

Conclusions: Comorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system.