Child and Adolescent Psychiatry and Mental Health最新文献

Introduction: The recent term phubbing is the amalgamation of the words phone and snubbing, and refers to those phone-related behaviors through which we ignore, dismiss, or otherwise eschew social interactions. Little is known about phubbing among child and adolescent psychiatrists (CAPs), a group often called upon to provide direction on how to guide children in their rapidly evolving cybernetic contexts.

Methods: We conducted a mixed methods study of trainees in CAP (n = 73; 68% women), recruited in the US (6 training programs; n = 35) and Türkiye (5 programs; n = 38). For the quantitative component, we administered two standardized tests: the Generic Scale of Phubbing (GSP), and the Generic Scale of Being Phubbed (GSBP). For the qualitative component, we conducted site-specific focus groups. After transcription, translation, and anonymization of the digitally recorded sessions, we analyzed the data using thematic analysis informed by interpretative phenomenology.

Results: Younger participants scored higher on the GSP (r = -0.43, < 0.001), but ratings did not differ between countries (F = 0.65, df = 1, 70, p = 0.42). GSBP scores did not differ across age or country (p > 0.05). Through thematic analysis we arrived at a four-domain model: (1) Perceptions: regarding the role of smartphone use in modern society and their social implications); (2) Explanations: respondents' conceptualization of antecedents to phubbing behaviors; (3) Consequences: specific outcomes, such as normalization or split attention; and (4) Recommendations: strategies to address phubbing and problematic phone use.

Conclusions: Phubbing is a ubiquitous behavior that can have social and emotional consequences. Through a more nuanced understanding of their own phubbing practices, CAPs can modify maladaptive behaviors of their own, have a more empathetic understanding of phubbing by youths under their care, and provide more realistic guidance regarding smartphone use to patients and their families.

Objective: Although empirical evidence of NSSI contagion within adolescent friendships has been documented, the specific mechanisms remain poorly understood. The current study employed a longitudinal design to investigate the influence of NSSI in adolescents' peer groups on their own NSSI behaviors. Additionally, the study examined the mediating role of self-esteem and the specific conditions under which NSSI contagion occurs.

Method: The study involved 326 adolescents (mean age = 13.5, 59.2% female) nested within 163 friendship dyads. NSSI behavior, self-esteem, self-compassion, alexithymia, and personal distress were assessed at baseline (T1), and NSSI behavior was assessed again after three months (T2). A cross-lagged Actor-Partner Interdependence Model (APIM) was used to estimate the NSSI contagion model. In this model, self-esteem served as a mediator in the contagion of NSSI behaviors, while alexithymia, self-compassion, and personal distress acted as moderating factors of this mediating effect.

Results: This study revealed that friends' NSSI status at baseline significantly predicted adolescents' own NSSI status after three months. Self-esteem was found to mediate the NSSI contagion effect exclusively in situations where adolescents exhibited high alexithymia, low self-compassion, and high personal distress.

Conclusions: This research highlights the role of adolescent friendships in NSSI contagion and elucidates the potential mediating role of self-esteem in this contagion. These findings may provide substantial implications for the prevention of the NSSI contagion among adolescents.

Background: Disruptive behavior and emotional problems are common in children and often reduce quality of life. This study aimed to screen for these problems and to examine the effectiveness of child-based indicated prevention.

Methods: N = 3231 children`s disruptive behavior and emotional problems were screened using the Strengths and Difficulties Questionnaire (SDQ) during routine pediatric health check-ups for usually 5- to 10-year old's. We examined the prevalences of disruptive behavior and emotional problems (n = 2825) and its association with quality of life (KINDL; n = 1104). If indicated, children were recommended to participate in the prevention program "Baghira training" (nine 90 min group sessions and one parents' evening) or "Tiger training" (two one-on-one and nine group sessions of 60 min each). To evaluate the training effectiveness of the two indicated prevention programs, SDQ and KINDL scores were followed-up for 6 and 12 months post screening and compared between the Training group (SDQ n = 337; KINDL n = 334; additionally divided into Baghira and Tiger), children not participating despite indication (NoTraining; SDQ n = 595; KINDL n = 146; additionally divided into NoBaghira and NoTiger), healthy children (SDQ n = 1928; KINDL n = 907), and children with clinical symptom levels (SDQ n = 85; KINDL n = 54) using mixed effect models.

Results: 37.0% of the children exhibited disruptive behavior or emotional problems, which were associated with impaired quality of life. The Training group perceived greater symptom reduction in emotional problems than NoTraining, and quality of life increases compared to decreases in NoTraining. The Tiger group showed improvement in symptomatology and quality of life compared to deterioration in NoTiger. The Baghira group also improved, though improvement was similar to NoBaghira apart from symptom reduction in emotional problems in Baghira compared to a symptom increase in NoBaghira. Effects sizes were predominantly small to medium.

Conclusions: Disruptive behavior and emotional problems in children are frequent and impair quality of life. Indicated prevention may improve symptomatology and quality of life. Specifically, the Tiger training is verifiably effective; for the Baghira training, effectiveness is implicated but needs further empirical evaluations.

The COVID-19 pandemic intensified adolescents reliance on social media for connection, education, and entertainment, presenting both opportunities and risks for mental health. This viewpoint explores the dual nature of social media as a lifeline offering peer support and access to resources, especially for marginalized teens and a stressor, linked to anxiety, depression, and cyberbullying. Drawing on global evidence, including WHO and UNICEF data, it shows disparities in impact across socioeconomic, cultural, and gender contexts, with low-resource settings facing unique challenges like digital poverty amidst persistent post-pandemic effects. A multi-stakeholder framework is proposed to balance these dynamics, emphasizing parental and educator empowerment through digital literacy, tech industry accountability via adolescent-specific safeguards, clinical integration of social media screening in healthcare, and robust policy regulation for online safety. The urgency of action is underscored, with specific calls to governments, tech companies, clinicians, and researchers to collaborate on protecting adolescent well-being. This viewpoint argues that transforming social media into a safe space for mental health is a moral imperative, essential to prevent a generational crisis and ensure equity in the digital age.

Background: Although traumatic experiences in childhood have been recognized as contributors to disordered eating behaviors, critical gaps remain in our understanding. There is limited evidence on the individual, cumulative, and distinct patterns of childhood trauma associated with risky restrictive eating and binge/purging behaviors.

Methods: Individuals aged 12-25 years from Xiamen, Fujian Province, China, completed online questionnaires assessing childhood trauma, risky restrictive eating and binge/purging behaviors. Childhood trauma was examined through three analytical approaches: individual types, cumulative trauma scores, and latent class analysis. Logistic regression models were used to investigate the associations between childhood trauma and disordered eating behaviors.

Results: Among the 3424 participants, 7.3% (n = 251) reported disordered eating behaviors occurring two or more times per month over the past year. After adjusting for covariates, our analyses showed that emotional abuse independently associated with increased odds of both risky restrictive eating (OR: 2.11, 95% CI 1.28-3.47) and binge/purging behaviors (OR: 2.20, 95% CI 1.34-3.62). Physical abuse was associated only with increased odds of binge/purging behavior (OR: 2.09, 95% CI 1.20-3.64). Traumatic experiences showed a cumulative effect on disordered eating, significant at two or more incidents. Three trauma patterns were identified: 'low trauma,' 'low neglect,' and 'high trauma.' Youth with the 'high trauma' pattern exhibited the highest odds of both risky restrictive eating (OR: 2.88, 95% CI 1.65-5.02) and binge/purging behaviors (OR: 3.21, 95% CI 1.85-5.54), whereas those in the 'high neglect' pattern showed increased odds only for binge/purging behavior (OR: 1.52, 95% CI 1.01-2.29).

Conclusions: Our findings highlight the need to consider the types, numbers, and patterns of childhood trauma when developing prevention and treatment strategies for disordered eating behaviors.

Background: The National Adolescent Mental Health Surveys (NAMHS) were the result of a six-year collaboration between five organisations from five countries. Nationally representative household surveys of adolescents aged 10-17 years and their primary caregiver were conducted in 2021 in Kenya, Indonesia, and Vietnam.

Compromise and communication: Despite challenges, including the global COVID-19 pandemic, NAMHS was able to produce high-quality data which are featured in this Supplement. The operationalisation of compromise and communication were key factors in navigating the complexity of conducting three parallel surveys while also incorporating the knowledge and expertise of the teams from all five organisations. Compromise was an ongoing feature of NAMHS, including in relation to the choice of measures as well as their administration. Effective communication was realised through a comprehensive system that was implemented from the inception of NAMHS, ensuring meaningful and effective communication between the five teams for the benefit of all three surveys. The approach to compromise and communication was a considerable factor in the ability of NAMHS to not only weather the COVID-19 pandemic but also improve the project during the subsequent delays to data collection.

Conclusion: While factors such as compromise and communication are generally central to successful research collaborations, they are rarely mentioned in survey methodology. Future collaborations undertaking complex cross-national research would greatly benefit from taking a proactive and planned approach to communication and compromise.

Background: Few studies have examined the prevalence of adverse childhood experiences (ACEs) among adolescents living in low- and middle-income countries, and fewer assessed the association with mental disorders.

Methods: We used data from nationally representative household surveys of mental disorders among adolescents aged 10-17 years conducted in Kenya, Indonesia, and Vietnam. The lifetime experience of 13 ACEs was measured using a self-administered questionnaire. Mental disorders were measured using a diagnostic instrument. The proportion of adolescents who endorsed each individual ACE, as well as those who endorsed one or more and four or more ACEs, was calculated. Multivariable logistic regression was used to examine the associations between the number of ACEs endorsed and any mental disorder in the past 12 months, after adjusting for demographic characteristics and primary caregiver mental health.

Results: The prevalence of experiencing at least one ACE was evident among adolescents in all three countries, with Kenya (65.8%, 95% CI: 63.0-68.5) demonstrating significantly higher prevalence than Indonesia (40.2%, 95% CI: 36.4-44.1) and Vietnam (36.9%, 95% CI: 33.1-40.8). Significant differences were seen between all countries in the prevalence of adolescents who experienced four or more ACEs (Kenya: 19.3%, 95% CI: 17.5-21.2; Indonesia: 7.6%, 95% CI: 6.3-9.1; Vietnam: 5.2%, 95% CI: 4.2-6.3). The odds of experiencing a mental disorder in the past 12 months increased as the number of ACEs increased in all three countries. This was most apparent among those experiencing four or more ACEs, who had the highest odds of any mental disorder in the past 12 months as compared to those reporting no ACEs (Kenya: aOR 4.57, 95% CI: 3.35-6.23; Indonesia: aOR 11.10, 95% CI: 6.24-19. 73; Vietnam: aOR 10.30, 95% CI: 5.96-17.82).

Conclusion: The current study demonstrated that ACEs are common among adolescents in Kenya, Indonesia, and Vietnam, and are significantly associated with mental disorders in all three countries. The prevention of ACEs may be a key avenue for reducing the risk of mental disorders in adolescence.

Background: Mental disorders are prevalent and their onset is highest during adolescence. However, there are limited data on adolescent mental health service utilization in low- and middle-income countries.

Methods: Data were from the National Adolescent Mental Health Surveys (NAMHS), nationally representative household surveys of adolescents aged 10-17 years and their primary caregiver conducted in Kenya, Indonesia, and Vietnam. All primary caregivers were asked whether their adolescent used any services providing support or counselling for emotional or behavioural problems in the past 12 months. Mental disorders were assessed using the Diagnostic Interview Schedule for Children, Version 5 (DISC-5). The prevalence of service use was calculated among those with mental disorders, subthreshold mental disorders, and no mental disorder. The prevalence of service use among those with either a diagnostic or subthreshold mental disorder was compared by demographic characteristics and broad mental disorder type. All estimates were weighted using population weights for each country and presented with 95% confidence intervals (CI).

Results: Very few adolescents with a mental disorder (Kenya: 11.9%, 95% CI: 9.3-15.1; Indonesia: 4.7%, 95% CI: 1.9-11.1; Vietnam: 8.2%; 95% CI: 3.9-16.4) or a subthreshold mental disorder (Kenya: 10.8%, 95% CI: 9.1-12.9; Indonesia: 2.2%, 95% CI: 1.1-4.5; Vietnam: 8.5%; 95% CI: 5.0-14.1) accessed services that provide support or counselling for emotional or behavioural problems in the past 12 months. In Kenya, being older (aOR 1.41, 95% CI; 1.07-1.86) and female (aOR 1.77, 95% CI; 1.34-2.34) were associated with increased odds of service use, while having internalising disorders only (aOR 0.45, 95% CI; 0.30-0.65) was associated with decreased odds of service use. No difference by demographic characteristics or mental disorder type was seen in Indonesia and Vietnam.

Conclusions: Only a small proportion of adolescents with a diagnostic or subthreshold mental disorder accessed services for mental health in Kenya, Indonesia, and Vietnam. These findings indicate the need for greater support for adolescents with mental disorders and provide critical context for governments and relevant in-country stakeholders when reviewing the availability and accessibility of adolescent mental health services.

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.