Child and Adolescent Psychiatry and Mental Health最新文献

Background: Few studies report the prevalence of both bullying victimisation and perpetration at the national level in low- and middle-income countries, with fewer still reporting the association with mental disorders assessed diagnostically.

Methods: Nationally representative household surveys of adolescents aged 10-17 years and their primary caregiver were conducted in Kenya, Indonesia, and Vietnam as part of the National Adolescent Mental Health Surveys (NAMHS). Adolescents were asked about bullying victimisation and perpetration in the past three months. The prevalence of mental disorders in the past 12 months was assessed using a diagnostic instrument. The prevalence of bullying involvement was calculated, along with bullying victimisation and perpetration which were further disaggregated by sex and age. Types of victimisation and perpetration were assessed among those who endorsed bullying involvement. Adjusted odds ratios quantified the association between any mental disorder and bullying victimisation and perpetration. All findings were weighted to the respective country's population and presented with 95% confidence intervals (CIs).

Results: The prevalence of any bullying involvement was highest in Kenya (6.3%, CI 5.3-7.4), followed by Indonesia (3.4%, 95% CI 2.4-4.8), then Vietnam (1.9%, 95% CI 1.3-2.7). For bullying victimisation, both Kenya (4.1%, 95% CI 3.4-5.0) and Indonesia (2.6%, 95% CI 1.9-3.6) had significantly higher prevalence than Vietnam (1.2%, 95% CI 0.9-1.67). Kenya had significantly higher prevalence of bullying perpetration (3.1%, 95% CI 2.5-3.8) compared to Indonesia (1.1%, 95% CI 0.6-2.1) and Vietnam (0.8%, 95% CI 0.5-1.2). Adolescents experiencing bullying victimisation were significantly more likely to have a mental disorder than those who had not been bullied in all three countries (Kenya: aOR 2.17, 95% CI 1.50-3.15; Indonesia: aOR 3.55, 95% CI 1.47-8.59; Vietnam: aOR 4.71, 95% CI 1.82-12.21). The same was seen for bullying perpetration although only in Kenya (aOR 4.38, 95% CI 2.77-6.93) and Indonesia (aOR 4.32, 95% CI 1.62-11.51).

Conclusions: NAMHS is the first study to report national prevalence estimates of bullying victimisation and perpetration among adolescents in Kenya, Indonesia, and Vietnam. Bullying was strongly associated with adolescent mental disorders and is consequently an important consideration for strategies aimed at improving adolescent mental health.

Background: There is a lack of country-level evidence for the association between social support and adolescent mental health while existing studies vary greatly in how they account for the interplay of multiple sources of social support.

Methods: This study utilised data from the National Adolescent Mental Health Surveys, nationally representative surveys of adolescents aged 10-17 years and their primary caregiver in Kenya, Indonesia, and Vietnam. Patterns of social support among adolescents in each country were assessed using a latent class analysis. The association between the identified social support classes and any mental disorder, suicidal ideation, and self-harm in the past 12 months was assessed using the Bolck-Croon-Hagenaars method, adjusted for demographic characteristics and caregiver mental health. All estimates were weighted to the respective country's population and presented with 95% confidence intervals (CIs).

Results: Three latent social support classes were consistently identified in Kenya, Indonesia, and Vietnam: Caregiver-focussed support, Other support, and Limited support. The Caregiver-focussed support class had the highest proportion of adolescents in all three countries (Kenya: 65.3%, 95% CI: 63.0-67.5; Indonesia: 54.0%, 95% CI: 50.4-57.6; Vietnam: 81.6%, 95% CI: 79.0-84.1), although the proportions varied significantly by country. Adolescents in the Caregiver-focussed support class had significantly lower odds of any mental disorder (Kenya: adjusted odds ratio [aOR]: 0.31, 95% CI: 0.25-0.38; Indonesia: aOR: 0.23, 95% CI: 0.17-0.31; Vietnam: aOR: 0.39, 95 CI%: 0.26-0.57), suicidal ideation (Kenya: aOR: 0.14, 95% CI: 0.10-0.19; Indonesia: aOR: 0.17, 95% CI: 0.10-0.29; Vietnam: aOR: 0.42, 95% CI: 0.24-0.76) and self-harm (Kenya aOR: 0.07, 95% CI: 0.04-0.13; Indonesia aOR: 0.23, 95% CI: 0.11-0.47 and Vietnam aOR: 0.16, 95% CI: 0.09-0.27) compared to the Limited support class. Adolescents belonging to the Other support class also demonstrated lower odds of these outcomes than those in the Limited support class.

Conclusions: The association between social support and poor mental health indicates the critical role of primary caregivers, other family members, and peers in adolescent mental health. These findings highlight the need to develop interventions that leverage an adolescent's existing support networks.

Background: There are limited prevalence data available for mental disorders in adolescents living in low- and middle-income countries (LMICs). The National Adolescent Mental Health Surveys (NAMHS) measured the prevalence of six common mental disorders, along with self-harm and suicidal behaviours, associated risk and protective factors, and service use in adolescents aged 10-17 years in Kenya, Indonesia, and Vietnam. The challenges and opportunities arising from large scale epidemiological mental health research in low resource settings are discussed. MEASUREMENT OF MENTAL DISORDERS IN LOW- AND MIDDLE-INCOME COUNTRIES: Diagnostic criteria for mental disorders are largely informed by evidence and experiences from high-income countries. NAMHS reports a low prevalence of adolescent mental disorders in Indonesia and Vietnam, suggesting there is much that the Global North can learn from the Global South in relation to population mental health. Improving population mental health requires a public health approach which focuses on promotion of wellbeing, increased community cohesion, and prevention of exposure to risk factors in early life.

Conclusion: NAMHS significantly advances knowledge of adolescent mental health in LMICs. These data provide a baseline from which future trends of mental health in these countries can be compared. This will be increasingly important as the world faces ongoing challenges, such as conflict and climate change, which will inevitably affect global mental health.

Background: Adolescent depression has become a pressing public health concern in China, with recent estimates indicating a prevalence rate of 26.17%. This mental health issue poses significant risks to adolescents' psychological development and long-term well-being. The present study investigates how multiple resilience-related factors across emotional, familial, school, and social domains interact with depressive symptoms over time, with particular attention to gender differences.

Methods: A cross-lagged network analysis was conducted using longitudinal data from 770 adolescents recruited from two middle schools in northern China. Participants completed various validated questionnaires measuring depression, emotional resilience, family resilience, teacher support, friendship quality, and social support at two time points.

Results: Network analysis revealed that teacher support had the highest out-expected influence for the overall sample, while friend support was central to in-expected influence. Gender differences were pronounced; male adolescents primarily relied on friendship quality, whereas female adolescents benefitted more from teacher support. Additionally, depression had a greater weakening effect on social support in males and on family support in females.

Discussions: This study highlights gender-specific pathways in the interaction between depressive symptoms and resilience factors among adolescents. The findings suggest that both teacher and peer support are critical in shaping these dynamics, with implications for developing targeted interventions aimed at enhancing emotional resilience and addressing depressive symptoms in a gender-sensitive manner.

Background: Childhood loneliness is a significant public health concern, particularly in China due to distinct sociocultural contexts. Prior research often overlooks symptom-level interactions, limiting the precision of targeted interventions. This study applied network-based methodologies to clarify the structure of loneliness, identify intervention targets, and examine the roles of psychological factors and family socioeconomic status (SES).

Methods: A total of 2,593 school-age children from Shantou, China, were assessed for loneliness, depressive symptoms, anxiety symptoms, ADHD symptoms, perceived social support, hope, and family SES. In silico interventions using the NodeIdentifyR algorithm (NIRA) within an Ising model identified effective targets for prevention and intervention. A Graphical Gaussian Model (GGM) mapped loneliness within a broader psychological context, and a Moderated Network Model (MNM) tested SES influences.

Results: Lack of friendship and peer acceptance emerged as key targets for prevention and intervention, respectively. Loneliness functioned as both a central and bridging symptom in the psychological network, closely connected to other psychological variables. Higher SES buffered its associations with depressive symptoms and hope.

Conclusions: Early, peer-focused, and context-sensitive strategies may more effectively support children's well-being. This study is the first to apply network analysis and in silico intervention methods, providing novel perspectives and strategies for the prevention and intervention of childhood loneliness among Chinese children.

Background: In the recent years, global and regional adversities (e.g., strict COVID-19 restrictions, prolonged social isolation, rising academic stress, and increasing digital dependence) have placed youth at heightened risk for ongoing interpersonal, behavioral, and mental health challenges. Examining the relevant trends during this period could yield insight into the persistence of these difficulties and inform targeted intervention strategies. Guided by the theoretical models including developmental system theories and developmental cascade model, the present study focused on three forms of attachment (i.e., child-father attachment, child-mother attachment, and peer attachment) and four types of maladaptive behaviors (i.e., depression, social anxiety, problematic internet use, and academic procrastination) among Chinese adolescents. It aims to uncover their trajectories spanning 2021 to 2023 and the correlations between the trajectories.

Methods: The research draws on data collected at three-time points (i.e., November 2021, May 2022, and May 2023), with a sample of 701 Chinese adolescents (Mage = 14.0 years, SD = 1.44, Range = 13-17 years; 52% girls). A latent growth modeling approach was employed. Specifically, latent growth curve modeling was conducted to estimate the trajectories of the seven key constructs, with Wald tests assessing differences in growth factors across constructs. Slope correlations between attachment and maladaptive behaviors were examined, and Fisher's z-transformation was applied to compare the strength of these slope-level associations.

Results: (1) All three types of attachment showed declining trajectories, with their slopes positively correlated. (2) Child-father and child-mother attachment declined more steeply than peer attachment. (3) All four maladaptive behaviors demonstrated increasing trends, with their slopes positively correlated. (4) Problematic internet use increased more rapidly than depression and academic procrastination, and social anxiety rose faster than academic procrastination. (5) The slopes of all three types of attachment were negatively correlated with the slopes of all four types of maladaptive behaviors. Notably, child-father and child-mother attachment demonstrated stronger associations with maladjustment trajectories than peer attachment.

Conclusions: In addition to providing longitudinal evidence that adolescents' interpersonal relationships and maladjustment have been worsening during a time of instability, the study highlights the pivotal role of parent-child relationships and the dynamic interplay between the trajectories of adolescents' social relationships and behavioral problems. Interventions may need to leverage these trajectory-related characteristics to better enhance adolescents' psychosocial functioning.

Purpose: Through a meta-analysis, this study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing stress among parents of children with special needs. This study aimed to quantify the intervention effect and identify moderating variables, such as cultural differences and intervention parameters, to provide evidence for clinical practice.

Methods: Systematic searches were conducted across the ​​PsycINFO​​, PubMed, Web of Science, and Cochrane Library databases. The inclusion criteria were as follows: (1) peer-reviewed English publications; (2) randomized controlled trials; (3) the use of ACT as the core intervention; (4) study participants being parents of children with special needs; and (5) reporting standardized effect sizes for stress symptoms. A total of 10 studies (n = 700) met the inclusion criteria. A random effects model was employed for the meta-analysis, and subgroup analyses were performed based on geographic distribution, intervention duration, intervention parameters, and types of children's illnesses (neurodevelopmental disorders, chronic diseases, and critical conditions).

Results: ACT significantly reduced stress symptoms among parents of special children, with a standardized mean difference (SMD =- 0.42, 95% CI- 0.72 to- 0.12, P = 0.0068). Subgroup analyses and meta-regression indicated a notable non-linear dose-response relationship concerning the intervention parameters. Key factors contributing to the heterogeneity of intervention outcomes included the frequency of the intervention, duration per session, overall intervention period, modalities employed, types of parental groups, and categories of children's illnesses.

Conclusion: ACT demonstrated moderate efficacy in alleviating stress among parents of exceptional children. The most significant stress reduction was observed when interventions were conducted for a minimum of 120 min per session, at least twice weekly, and over a total duration exceeding 8 weeks, particularly when ACT was integrated with other interventions for parents of children suffering from chronic and critical illnesses. Additionally, the effectiveness of the intervention in mixed-gender parent groups was significantly greater than in groups where mothers constituted over 90% of participants (P < 0.05). Implementing high-intensity ACT courses for populations experiencing acute stress is recommended to facilitate the rapid alleviation of stress symptoms. Concurrently, mobile health-assisted, low-density, long-term interventions are suggested for individuals dealing with chronic stress. Future research should investigate the efficacy disparities in predominantly mother-led groups and strive to develop gender-adapted ACT protocols.

Background: The paucity of research examining the long-term self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice system-placed juveniles) and potential influencing factors is a matter of concern. Since psychopathic traits tend to be associated with an earlier onset of delinquent behavior, higher levels of delinquent behavior, and higher rates of recidivism, it is important to study this phenomenon in more detail. The present study aims to examine the long-term stability of psychopathic traits, including its underlying dimensions, in young adults with a history of residential care.

Method: A 10-year follow-up study was conducted, in which a subset of participants who had previously consented to be re-contacted (n = 511) were re-contacted (data collection between 2018 and 2020). A total of n = 203 subjects (average age at follow-up of 25.7, SD = 1.8) completed the questionnaires online, including the Youth Psychopathic Traits Inventory (YPI) (mean time interval between baseline and follow-up; 121 months, SD = 11.7).

Results: At the group level, a significant decrease in psychopathic traits was observed, encompassing the underlying dimensions (i.e., Grandiose-Manipulative [GM], Callous-Unemotional [CU], and Impulsive-Irresponsible [II]).The Reliable Change Index revealed that approximately one-third of adolescents demonstrated a substantial decrease in psychopathic trait symptoms, as well as in GM, CU, and II symptoms. The strongest predictor of psychopathic traits in young adulthood was found to be psychopathic traits at baseline (approximately 10 years earlier).

Discussion: The results of this study suggest a lower long-term stability of self-reported psychopathic traits over a time period of 10 years than was previously assumed in institutionalised youths over a shorter period of time. Research is needed to control for the influence of different aspects of caregiving on outcomes regarding psychopathic traits in order to better interpret these results.

Objectives: Suicide is the second leading cause of mortality among Canadian youth. As wait times for mental health (MH) support have increased, adolescents with mild-to-moderate suicidal ideation (SI) are waiting longer for support compared to those with more acute SI. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a 6-week virtual group intervention designed to provide support to adolescents with mild to moderate SI and their caregivers. We conducted a randomized controlled trial to assess the efficacy of BRAVA in reducing symptoms of SI, depression, and anxiety in adolescents, and improving life stress in caregivers.

Design/methods: Outcome measures were administered to both groups [BRAVA, Enhanced Treatment-as-Usual (ETU)] at intake and exit, and at 3-month follow-up (BRAVA only) for SI (primary outcome), anxiety and depression (adolescent), perceived stress (youth and caregiver), attachment and family functioning (caregiver). SI was measured using Suicidal Ideation Questionnaire Junior. Intention to treat (ITT) analysis was performed for youth and caregiver cohorts.

Results: Ninety-nine eligible youth presenting with mild-to-moderate SI and their caregivers were recruited from hospital and community MH services. Families were randomized to BRAVA (n = 50) or ETU (n = 49). Adolescents were on average 14.6 years old, mostly female (64%), and of European racial heritage (44%). In ITT analysis, both BRAVA and ETU groups improved in youth SI from intake to exit, with no statistically significant differences between groups at exit. Sensitivity analysis without multiple imputations demonstrated a significant difference in SI scores at exit between the groups, where improvements in the BRAVA group were maintained at 3-month follow-up. Significant differences between groups on youth perceived stress, and depression and anxiety scores were also observed in BRAVA participants at post-treatment compared to the ETU control group. No statistically significant differences were observed for any caregiver outcomes measured except a trend for improved perceived caregiver stress in the BRAVA group post-treatment.

Conclusions: BRAVA was associated with significantly greater improvements in anxiety/depression and adolescent perceived stress compared to ETU. Although the intervention did not result in significant caregiver reported improvements, group cohesion and treatment satisfaction were high for both youth and caregivers.

Clinical trial registration: BRAVA: Building Resilience and Attachment in Vulnerable Adolescents (BRAVA); https://clinicaltrials.gov/ : NCT04751968.

Background: Burnout symptoms and secondary traumatic stress are especially high among Child Welfare Workers (CWWs) and psychotherapists and might have increased since the recent increase in refugee numbers. Little is known about the wellbeing of CWW and psychotherapists working with unaccompanied young refugees (UYR), especially in German child and youth welfare facilities where they work closely together. This study aims to assess levels of compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in German CWWs and psychotherapists, examining connections to demographic variables and group differences.

Methods: N = 198 CWW and N = 97 psychotherapists were assessed via the Professional Quality of Life Scale (ProQOL). Descriptive statistics, t-test for independent samples, correlations between the ProQOL scales and hierarchical regression analyses with demographic variables as predictors were computed.

Results: Both samples showed average to high levels of CS, and low to average levels of BO and STS. CWWs scored significantly higher than psychotherapists on BO and STS. In CWW, demographic variables were not associated with CS, BO or STS. Among psychotherapists, previous experiences in working with UYR (β = 0.38; p <.001) were positively associated with CS. Factors such as weekly therapy sessions (β = - 0.35, p =.001) and the psychotherapist's migration background (β = - 0.20, p =.048) were negatively associated with STS. The number of PTSD cases treated (β = 0.27, p =.018) and additional training (β = 0.31, p =.006) were positively associated with STS.

Conclusion: Among psychotherapists, prior experience in working with UYRs may contribute to elevated levels of CS, whereas a higher number of previously treated PTSD cases appears to be associated with increased STS. Further research on the influence of sociodemographic variables is needed for CWWs to identify protective and risk factors. Supporting and training CWWs and psychotherapists is crucial for quality treatment of traumatized UYRs.