Child and Adolescent Psychiatry and Mental Health最新文献

Depression, as a prevalent public health concern, has long been the focus of research attention. However, the magnitude and moderating mechanisms underlying the association between parent-child relationships and childhood depression remain inconclusive. This study employed a meta-analysis to quantitatively assess the associations between two dimensions of parent-child relationships (closeness and conflict) and depressive symptoms in children across diverse global cultures, while investigating potential moderators through subgroup analyses and meta-regression. After systematic Literature search and screening, 63 studies comprising 97 effect sizes were included, with a total sample of 70,687 participants (mean age 13.3 ± 1.12 years; 51% girls). Main effect analysis revealed significant positive correlations between childhood depression and parent-child conflict (r = 0.25) and significant negative correlations with parent-child closeness (r = - 0.24). Moderator analyses identified cultural context, study design, child age, and publication status as significant moderators of these associations. In contrast, child gender, parental gender, and measurement instruments for depression showed no significant moderating effects. This study confirms that parent-child closeness and conflict respectively serve as crucial protective and risk factors for childhood depression. These findings underscore the importance of fostering positive parent-child relationships in preventive interventions, potentially reducing the incidence of childhood depression through improved family dynamics.

Background: Current research lacks comprehensive investigation into the longitudinal relationships among physical exercise (PE), internalizing symptoms (IS), and learning engagement (LE) from an integrated perspective. Particularly scarce are examinations of underlying mediating mechanisms and gender differences within these longitudinal relationships.

Aims: (1) To adopt a comprehensive approach in examining the within-person relationships among PE, IS, and LE, as well as their potential mediating mechanisms; (2) To investigate whether gender differences exist in the relationships among these three variables.

Sample and methods: A one-year longitudinal study with 1,601 Chinese junior high school students assessed PE, IS, and LE at three time points (T1: December 2023, T2: June 2024, T3: December 2024). Random intercept cross-lagged panel models (RI-CLPM) and multi-group analyses were conducted.

Results: RI-CLPM results revealed that: (1) T1 PE positively predicted T2 LE, and T2 PE positively predicted T3 LE; (2) T1 LE negatively predicted T2 IS; (3) T1 IS negatively predicted T2 LE, T2 IS negatively predicted T3 LE, and T2 LE negatively predicted T3 IS, confirming bidirectional relationships; (4) T2 IS longitudinally mediated between T1 PE and T3 LE. The results of gender-based multi-group comparison showed that: (1) autoregressive pathway of T1 PE to T2 PE was only significant in boys; (2) the autoregressive path of T2 IS to T3 IS was only significant in girls; (3) The positive prediction path of T1 PE on T2 LE was only significant in boys, and the positive prediction path of T2 PE on T3 LE was only significant in boys. (4) The negative prediction path of T2 LE on T3 IS was only significant in boys. (5) In both boys and girls, T2 IS plays a longitudinal mediating role between T1 PE and T3 LE.

Conclusions: Among boys in early adolescence, physical exercise habits were more persistent. Physical exercise promoted learning engagement, while higher learning engagement was linked to reduced internalizing symptoms. Among girls in early adolescence, internalizing symptoms showed greater persistence over time. Importantly, for both genders, internalizing symptoms undermine their learning engagement; physical exercise exerts a long-term protective effect against internalizing symptoms. Furthermore, for both genders, physical exercise enhanced learning engagement by mitigating internalizing symptoms.

Background: Understanding the mechanisms of change has recently been emphasized as crucial for advancing research on preventive interventions. This study, embedded within a pilot trial, aimed to explore the mediating effects of resilience for three preventive interventions focusing on reducing the risk of adolescent depression and anxiety in Nepal. We hypothesized that the self-regulation, economic, and combined interventions would differentially increase internal and external resilience, which in turn would reduce adolescent depressive and anxiety symptoms among adolescents in Nepal, supporting to development of a testable, replicable mediation model of prevention intervention pathways.

Methods: Data were collected as part of a feasibility cluster-randomized controlled trial. A total of 229 adolescents aged 13-15, identified as living in poverty and at risk of depression or anxiety, were cluster-randomized by school into three intervention arms (self-regulation, economic, combined) and a control group. Assessments for depression and anxiety symptoms, and external and internal resilience were performed at three timepoints, with a six-month interval between each. Twenty school-based group intervention sessions were conducted weekly post-baseline. Linear mixed modeling explored changes in resilience within groups. Exploratory mediation analyses were performed to examine the association between interventions (as predictors), resilience at 6 months (as mediator), and symptoms of depression and anxiety at 12 months as outcomes, through two separate parallel mediation models.

Results: While no significant sensitivity to change effects for resilience was found, hypothesized directional time-related improvements were observed in external resilience for males in self-regulation and economic arms, and for females in the self-regulation arm; internal resilience showed positive trends for males in economic and combined arms, and for both males and females in the self-regulation arm. No significant effects of the interventions through resilience on mental health outcomes were detected, though internal resilience at 6 months predicted lower anxiety at 12 months, and for males in all intervention arms, higher internal resilience was significantly associated with lower depression.

Conclusions: The findings warrant the testable conceptual mediation model with resilience as a mechanism in larger, fully powered prevention trials for adolescents.

Trial registration: ISRCTN14601588 https//doi.org/10.1186/ISRCTN14601588.

Background: Brief Admission by self-referral (BA) was implemented in 2018 in Swedish child and adolescent psychiatric (CAP) inpatient care. This intervention empowers adolescents to self-admit at their own request for brief periods to prevent self-harm and suicidal crisis. As BA enhances healthcare user autonomy, it is a timely intervention to consider with the emerging human rights discourse and rising imperatives for person-centered care in psychiatry. The present study explores talk about adolescents access to BA specifically in terms of involvement and responsibilities of parents and other significant adults in CAP.

Methods: In this qualitative study, we interviewed 26 significant adults (the majority being biological parents) of children with access to BA. Interviews were semi-structured, asking broadly about participants' experiences with BA. We used reflexive thematic analysis from a social constructionist framework to explore how participants' narratives drew on existing psychiatric discourses.

Results: We constructed four themes around narratives of involvement and responsibilities in BA specifically and CAP generally: there's no need to be involved in BA, selflessly supporting child involvement, being insufficiently involved, and being left to shoulder everything. These themes illustrate a sliding scale from perceiving little responsibility nor need for involvement, to perceiving shared responsibility for children's well-being but limited personal rights, to being under-involved and even perceptions of being left with sole responsibility as CAP refused to provide care.

Conclusions: Participants' narratives could generally be mapped onto rights-based discourse, emphasizing that adolescents should have access to BA as it helped them care for themselves. As participants took various positions regarding the responsibility of parents versus CAP to protect and help adolescents, the risk of perpetually downplaying the needs of parents and other significant adults became apparent, along with the pitfalls of neoliberal healthcare management and responsibilization of child mental health. CAP ought to systematically inform both adolescents and significant adults about BA, strengthening mental health literacy among the target population. It also ought to be emphasized that supporting significant others is considered part of the purpose with BA.

Background: Previous studies have reported eating and sleep issues in children with attention deficit hyperactivity disorder (ADHD), but few have focused on those comorbid with overweight/obesity. This study aimed to investigate eating behavior and sleep habit problems in children with ADHD and comorbid overweight/obesity, and their relationship with ADHD core symptoms in such children.

Methods: The study included 124 children with ADHD and overweight/obesity and 145 children with ADHD and normal weight. The Children's Eating Behavior Questionnaire, Children's Sleep Habit Questionnaire, and Vanderbilt ADHD Diagnostic Parent Rating Scale were used to assess eating behavior problems, sleep habit problems, and core ADHD symptoms, respectively.

Results: Compared to the normal-weight children with ADHD, those with overweight/obesity scored higher in food responsiveness, enjoyment of food, night waking, sleep-disordered breathing, and daytime sleepiness, while lower in satiety responsiveness, slowness in eating, and emotional undereating. Lower scores of satiety responsiveness and slowness in eating were associated with the presence of overweight or obesity among children with ADHD. In the ADHD overweight/obesity group, shorter sleep duration was correlated with higher body mass index (BMI), and higher food responsiveness was associated with more severe attention deficit symptoms.

Conclusions: Children with ADHD and overweight/obesity reported more eating and sleep problems than those with normal weight. Lower satiety response and faster eating rate may be potential risk factors for overweight/obesity in children with ADHD. Among those with comorbid overweight/obesity, shorter sleep duration associates with higher BMI, and greater food responsiveness relates to more severe attention deficit symptoms. These findings suggest eating and sleep behaviors should be considered in ADHD management, with further research needed on targeted interventions.

Background: This study investigates the current mental health status among children and adolescents in Jiangsu Province by analyzing symptoms of depression, anxiety, and stress using standardized psychological scales. Machine learning models were utilized to identify key influencing variables and predict mental health outcomes, aiming to establish a rapid psychological well-being assessment framework for this population.

Objective: A cross-sectional survey was conducted via random cluster sampling across 98 counties (cities/districts) in Jiangsu Province, enrolling 141,725 students (47,502 primary, 47,274 junior high, 11,619 vocational high school students, and 35,330 senior high ). The study focused on prevalent mental health disorders and associated risk factors.

Methods: Depression, anxiety, and stress scores served as dependent variables, with 57 socio-demographic and behavioral factors as independent variables. Five supervised machine learning models (Decision Tree, Naive Bayes, Random Forest, K-Nearest Neighbors (KNN), and XGBoost) were implemented using R software. Model performance was evaluated using accuracy, precision, recall, F1 Score and Area Under the ROC Curve (AUC). Feature importance analysis was conducted to identify key predictors.

Results: The study revealed significant mental health disparities: depression (14.9%), anxiety (25.5%), and stress (10.9%) prevalences showed clear gender and regional gradients. Females exhibited higher rates across all conditions (p < 0.05), and urban areas had elevated risks compared to suburban regions. Mental health deterioration escalated with educational stages (e.g., depression from 9.2% in primary to 21.2% in senior high; χ²_trend = 2274.55, p < 0.05). The XGBoost model demonstrated optimal predictive performance (AUC: depression = 0.799, anxiety = 0.770, stress = 0.762), outperforming other models. Feature importance analysis consistently identified bullying duration, age, and drinking history as top risk factors across both Gain and SHAP methods, while SHAP values additionally emphasized modifiable lifestyle factors (e.g., breakfast frequency) and demographic variables (e.g., gender).

Conclusions: This study identifies bullying, age, and alcohol consumption history as key mental health risk factors among Jiangsu's children and adolescents. These findings emphasize the need for school-based anti-bullying programs, age-specific mental health counseling, and healthy lifestyle education (including alcohol refusal). Lifestyle behaviors like daily breakfast intake should be integrated into dietary interventions for mental health promotion. Urban-rural and gender disparities necessitate targeted support for urban adolescent females, while educational stage differences highlight the criticality of early prevention.

Background: Internalizing symptoms are highly prevalent in childhood and adolescence. Several studies have demonstrated heterogeneity in symptom trajectories and examined their predictors. However, little is known about their outcomes in late adolescence. Building on a previous study that identified a stable low, an increasing and an (early high) decreasing trajectory of internalizing symptoms in childhood, this follow-up study examines their outcomes, including mental health-related measures and self-regulation facets.

Methods: Trajectories of internalizing symptoms were identified using parent reports at three measurement points in a community sample of N = 1453 children aged 6-13 years, based on the Emotional Problems Scale of the Strengths and Difficulties Questionnaire. At the 8-year follow-up, n = 556 adolescents aged 16-21 years participated, providing self-reports on mental health-related measures and self-regulation facets (emotional reactivity, emotion regulation, planning behavior, risk taking, impulsiveness, delay discounting). Additionally, three self-regulation facets (working memory updating, inhibition, risk taking) were assessed behaviorally.

Results: Adolescents in the increasing trajectory reported significantly greater internalizing symptoms, more specific anxiety symptoms, greater distress and social impairment, and more impaired personality functioning than those in the stable low trajectory, and more specific depressive symptoms than those in the stable low and decreasing trajectories. Regarding SR facets, they reported lower planning behavior and less use of the emotion regulation strategies reappraisal and positive reappraisal than those in the stable low trajectory, and greater use of the emotion regulation strategy catastrophizing than those in the stable low and decreasing trajectories.

Conclusions: Children with increasing internalizing symptoms in childhood present internalizing symptoms and self-regulation deficits in late adolescence that can hinder further development. In contrast, the differences observed in childhood between the decreasing and the stable low trajectories are no longer detectable. Promoting self-regulation could be a promising prevention and intervention target. Future research should investigate protective factors contributing to symptom remission.

Background: School absenteeism is a significant issue affecting children and adolescents worldwide. This study aimed to examine the mediating role of depression in the association between social capital and school absenteeism among students in Japanese elementary and junior high schools.

Methods: A cross-sectional study was conducted using data from 7765 students (aged 9-15 years, 49.7% female) in Hirosaki, Japan. Social capital was measured using the Japanese version of the Social Capital Questionnaire for Adolescent Students (SCQ-AS), depression was assessed via the Patient Health Questionnaire for Adolescents (PHQ-A), and school absence was reported by parents/guardians. Multilevel mediation analysis was employed to examine the associations at both the student and school levels.

Results: At the student level, depression fully mediated the relationship between social capital (school social capital, perceived safety, and neighborhood social capital) and school absence. At the school level, perceived safety had a direct effect on school absence (β = - 0.70, p < 0.01), whereas school social capital was negatively associated with depression (β = - 0.57, p < 0.001). However, no significant indirect effects were observed at the school level.

Conclusion: Depression mediates the association between social capital and school absence at the student level, whereras school-level perceived safety is directly associated with school absence. These findings suggest a multitiered approach to addressing school absenteeism, focusing on enhancing individual social capital and mental health support, as well as improving school-wide safety perceptions.

Background: School-based cognitive behavioral therapy (CBT) programs delivered by teachers are effective in preventing anxiety among children. Internet-based CBT has emerged as an efficient method for delivering such interventions. Our previous research demonstrated the feasibility of the e-learning version of Journey of the Brave in reducing anxiety among Japanese elementary school students in a home-based learning environment. This study aimed to evaluate the feasibility and acceptability of the e-learning version in school settings and to identify any practical implementation issues.

Methods: We conducted a single-arm study with 204 elementary school students aged 10-12 years. Participants completed the e-learning program during regular classroom hours. Of these, 180 students who completed more than 80% of the program and agreed to participate in the study were included in the analysis. We evaluated changes in anxiety symptoms using the Spence Children's Anxiety Scale (SCAS), alongside learning logs and a post-program satisfaction questionnaire.

Results: The estimated mean SCAS score, analyzed using a generalized linear mixed model, showed a significant decrease of 2.6 points from pre-intervention to follow-up (p = .04, 95% CI [-5.08, -0.09]). Subgroup analysis revealed a 6.4-point reduction in boys compared to a 0.5-point decrease in girls. In School A, the SCAS score slightly increased by 0.4 points, while in School B, it decreased by 3.1 points. Significant interaction effects were observed between time and gender (p = .03) and between time and school (p = .04). The mean comprehension test score (true/false) was 13.2 out of 16 (SD = 2.2).

Conclusion: The Journey of the Brave e-learning version was feasible and well-accepted in school settings. Student self-reports suggested that they may have applied the CBT knowledge and skills in their daily lives. Future studies should explore the contextual factors influencing program effectiveness and determine optimal conditions for its implementation.

Trial registration:  UMIN, UMIN000057115, Registered February 21, 2025.

Background: The relationship between the parent-child relationship and adolescent depression is much discussed, but still not fully understood. Based on ecological systems theory, this study examined the potential mediating role of psychological resilience and the moderating role of school climate between the association of parent-child relationship and adolescent depression.

Methods: This study employed a three-wave longitudinal design with six months between each time point, involving 549 elementary and middle school students in southeastern China (50.82% males; mean age at Time 1 = 11.43). Measurements included the parent-child relationship (T1), psychological resilience (T2), school climate (T3), depression (T1 and T3), and demographic information.

Results: The moderated mediation model demonstrated that after controlling for baseline adolescent depression (T1), the parent-child relationship (T1) was longitudinally and negatively associated with adolescent depression (T3) through the mediating effect of psychological resilience (T2). Additionally, the analysis revealed that a positive school climate moderated this mediation by mitigating the adverse impact of low psychological resilience on adolescent depression, thus reducing the indirect effect of the parent-child relationship on adolescent depression.

Conclusions: Our findings offer a nuanced understanding of the underlying mechanisms linking parent-child relationship to adolescent depression among Chinese adolescents. Theoretical contributions and practical applications of these findings are further elaborated.