Neuromodulation technologies improve functional recovery after brain injury: From bench to bedside

Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited. This limited plasticity serves as a primary barrier to functional recovery after brain injury. Neuromodulation technologies represent one of the fastest-growing fields in medicine. These techniques utilize electricity, magnetism, sound, and light to restore or optimize brain functions by promoting reorganization or long-term changes that support functional recovery in patients with brain injury. Therefore, this review aims to provide a comprehensive overview of the effects and underlying mechanisms of neuromodulation technologies in supporting motor function recovery after brain injury. Many of these technologies are widely used in clinical practice and show significant improvements in motor function across various types of brain injury. However, studies report negative findings, potentially due to variations in stimulation protocols, differences in observation periods, and the severity of functional impairments among participants across different clinical trials. Additionally, we observed that different neuromodulation techniques share remarkably similar mechanisms, including promoting neuroplasticity, enhancing neurotrophic factor release, improving cerebral blood flow, suppressing neuroinflammation, and providing neuroprotection. Finally, considering the advantages and disadvantages of various neuromodulation techniques, we propose that future development should focus on closed-loop neural circuit stimulation, personalized treatment, interdisciplinary collaboration, and precision stimulation.

Emerging role of microglia in the developing dopaminergic system: Perturbation by early life stress

Early life stress correlates with a higher prevalence of neurological disorders, including autism, attention-deficit/hyperactivity disorder, schizophrenia, depression, and Parkinson's disease. These conditions, primarily involving abnormal development and damage of the dopaminergic system, pose significant public health challenges. Microglia, as the primary immune cells in the brain, are crucial in regulating neuronal circuit development and survival. From the embryonic stage to adulthood, microglia exhibit stage-specific gene expression profiles, transcriptome characteristics, and functional phenotypes, enhancing the susceptibility to early life stress. However, the role of microglia in mediating dopaminergic system disorders under early life stress conditions remains poorly understood. This review presents an up-to-date overview of preclinical studies elucidating the impact of early life stress on microglia, leading to dopaminergic system disorders, along with the underlying mechanisms and therapeutic potential for neurodegenerative and neurodevelopmental conditions. Impaired microglial activity damages dopaminergic neurons by diminishing neurotrophic support (e.g., insulin-like growth factor-1) and hinders dopaminergic axon growth through defective phagocytosis and synaptic pruning. Furthermore, blunted microglial immunoreactivity suppresses striatal dopaminergic circuit development and reduces neuronal transmission. Furthermore, inflammation and oxidative stress induced by activated microglia can directly damage dopaminergic neurons, inhibiting dopamine synthesis, reuptake, and receptor activity. Enhanced microglial phagocytosis inhibits dopamine axon extension. These long-lasting effects of microglial perturbations may be driven by early life stress-induced epigenetic reprogramming of microglia. Indirectly, early life stress may influence microglial function through various pathways, such as astrocytic activation, the hypothalamic-pituitary-adrenal axis, the gut-brain axis, and maternal immune signaling. Finally, various therapeutic strategies and molecular mechanisms for targeting microglia to restore the dopaminergic system were summarized and discussed. These strategies include classical antidepressants and antipsychotics, antibiotics and anti-inflammatory agents, and herbal-derived medicine. Further investigations combining pharmacological interventions and genetic strategies are essential to elucidate the causal role of microglial phenotypic and functional perturbations in the dopaminergic system disrupted by early life stress.

Acetaldehyde-driven mRNA methylation and expression changes in ethanol-metabolizing enzyme genes

This study examines how the alcohol metabolite acetaldehyde modulates mRNA methylation and expression of ethanol-metabolizing genes, uncovering its epigenetic role in ethanol metabolism. Using neuron-like (SH-SY5Y) and non-neuronal (SW620) cellular models, we examined the effects of chronic intermittent acetaldehyde (CIA) exposure and subsequent withdrawal (CIA+WD) on global RNA m6A modifications and the methylation and expression of three brain ethanol-metabolizing genes: CAT (catalase), CYP2E1 (cytochrome P450 2E1), and ALDH2 (aldehyde dehydrogenase 2). A 3-week CIA exposure, with or without 24-hour withdrawal, did not significantly alter global m6A methylation levels in either cell line. However, acetaldehyde exposure/withdrawal induced hypermethylation at the mRNA stop codon regions of ALDH2 (CIA: p = 0.002; CIA+WD: p = 0.055) and CAT (CIA: p = 0.077; CIA+WD: p = 0.036) in SH-SY5Y cells, but not in SW620 cells. Furthermore, ALDH2 mRNA expression was significantly upregulated in both cell types following exposure (SH-SY5Y: p = 0.073 [CIA] and 0.00002 [CIA+WD]; SW620: p = 0.0009 [CIA] and 0.00008 [CIA+WD]). In contrast, CYP2E1 mRNA methylation and the expression of CYP2E1 and CAT remained unchanged. These findings highlight the cell-specific epigenetic effects of acetaldehyde, particularly its role in modulating mRNA methylation and expression of ALDH2, a key enzyme in alcohol metabolism.

Psychometric properties of the revised Ukrainian version of the Continuous Traumatic Stress Response scale (CTSR) in the context of the Russo-Ukrainian war

Background: The Continuous Traumatic Stress Response scale (CTSR) was designed to measure symptoms associated with multiple ongoing security threats in the context of Israeli-Palestinian conflict. Since 2014, Ukraine has faced armed invasion and war, with nationwide insecurity since February 2022.Objective: This study aimed to adapt the CTSR scale into Ukrainian and evaluate its psychometric properties within a Ukrainian sample during the ongoing war.Method: The Ukrainian adaptation of the CTSR followed the procedure used in creating the original instrument (Goral, A., Feder-Bubis, P., Lahad, M., Galea, S., O'Rourke, N., & Aharonson-Daniel, L. (2021). Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats. PLoS One, 16(5), e0251724). To identify a unique context-specific factor structure relevant to the Ukrainian experience, the initial 25 items were tested in a sample of 584 Ukrainians using exploratory and confirmatory factor analyses. Subsequently, the established scale structure was assessed for homogeneity, and convergent validity using measures of depression (PHQ-9), anxiety (GAD-7), perceived stress (PSS-4), resilience (BRS), and PTSD symptoms (PCL-5).Results: A three-factor, 9-item solution, representing the constructs of exhaustion, alienation, and helplessness, demonstrated the most acceptable fit among all the alternative CTSR models, including the original: χ2 = 72.84, df = 24, p < .001, χ2/ (df) = 3.04, CFI = 0.94, TLI = 0.91, SRMR = 0.05, RMSEA = 0.08. Cronbach's α for internal consistency ranged from 0.68 to 0.84 for total score, and subscales. Significant positive correlations ranging from 0.41 to 0.67 with symptom severity of depression, anxiety, perceived stress, and PTSD established the convergent validity of the Ukrainian CTSR, indicating that it measures related yet distinctive psychological phenomena of reactions to continuous traumatic stress.Conclusions: The revised Ukrainian version of the CTSR scale is a reliable and valid measure of continuous traumatic stress response, accurately reflecting its manifestation in the Ukrainian context. These findings are crucial for guiding clinical interventions and research in prolonged war environments, where understanding the nuances of ongoing trauma is essential.

Prevalence of attention deficit hyperactivity disorder in homeless children and adolescents: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to examine the prevalence of Attention deficit hyperactivity disorder (ADHD) in homeless children and adolescents, and the factors that may influence its prevalence.

METHODS

Relevant publications in Medline, Web of Science, Scopus and PsycINFO were systematically searched to identify studies on the prevalence of ADHD in homeless children and adolescents (≤19 years). The extracted data were pooled using a random-effects model.

RESULTS

Thirteen studies involving 2878 homeless children and adolescents were included (mean age: 12.0 years, sex F/M: 0.43). The prevalence rates of ADHD vary considerably across studies, ranging from 1.6% to 64.5%. The pooled prevalence of ADHD was 22.8% (95% CI 12.9-34.4%, I2 =98%). Meta-regression analyses indicated that age (slope = 0.046; p = .042) significantly increased ADHD prevalence. The prevalence of ADHD in studies with a mean age ≥ 12 years (43.1%, 95% CI 26.5-60.4%) was higher than those with a mean age < 12 years (13.1%, 95%CI 4.3-25.6).

CONCLUSION

Despite the high heterogeneity of the studies, we observed that ADHD could affect almost a quarter of homeless children and adolescents. Reintegrating them into care systems and ensuring access to public health interventions tailored for homeless families and youth is imperative for breaking the cycle of homelessness and improving long-term trajectories.

Protocol MelatoSom-Kids-PTSD: sleep disturbances in children and adolescents with post-traumatic stress disorder (PTSD) - a randomized double-blind placebo-controlled trial to investigate the efficacy of paediatric prolonged-release melatonin

Introduction: Sleep disorders in the insomnia spectrum, as well as nightmares, are among the most sensitive and persistent symptoms in children with post-traumatic stress disorder (PTSD). There is currently no reference treatment or specific pharmacological treatment recommendation on the management of sleep disturbances in children and adolescents suffering from PTSD, despite the fact that they have a significant effect on daytime functioning and overall mental health of children as well as on family's health and quality of life. In this respect, paediatric prolonged-release melatonin (PedPRM) has shown significant beneficial effects on insomnia disorders in children with autism spectrum disorders and positive effects on anxiety and depressive symptomatology. Our study will be the first randomized controlled trial to examine the efficacy of PedPRM melatonin on sleep disorders in children and adolescents with PTSD, as well as on PTSD symptoms, associated daytime functioning and overall mental health in these children and their caregivers.Methods/design: The MelatoSOM-Kids-PTSD study (French national hospital-based clinical research programme) will be a multi-centre prospective double-blind placebo-controlled parallel group clinical trial investigating the efficacy of paediatric prolonged-release melatonin to alleviate sleep disturbances in children and adolescents with PTSD (120 participants recruited over a 24-month period). The experimental group will be treated with active prolonged-release melatonin over 13 weeks (PedPRM). The control group will receive a placebo. The primary endpoint will be the difference in sleep diary derived total sleep time after 13 weeks of treatment in the PedPRM group versus placebo group. Secondary endpoints will be the differences in objective sleep quality parameters and daytime functioning before and after treatment, in children with PTSD and their caregivers.Discussion: This paper describes the MelatoSOM-Kids-PTSD protocol, which will evaluate the effectiveness of melatonin, a treatment that has already demonstrated an excellent benefit-risk ratio in the paediatric population over 4 years.

Psychometric evaluation of the UCLA PTSD Reaction Index (PTSD RI-5) in a Turkish Clinical sample of trauma-exposed children

Objective: Trauma victimization is common among children, however, a significant proportion of trauma victims go unrecognized unless they are thoroughly assessed, even in child psychiatry clinics. The aim of this study was to evaluate the psychometric properties and diagnostic accuracy of the Turkish version of the UCLA PTSD Reaction Index for DSM-5 (PTSD RI-5) in a clinical sample of trauma-exposed children and adolescents.Method: A total of 208 children and adolescents admitted to the child psychiatry clinic, each of whom had a history of at least one traumatic event, were evaluated with the PTSD RI-5 to investigate trauma history and PTSD symptoms. All participants also completed the Revised Child Anxiety and Depression Scale (RCADS) and 64 participants were assessed with a semi-structured diagnostic interview for PTSD and depression.Results: Internal consistency for the total scale was high (Cronbach's α = 0.91) and the confirmatory factor analysis (CFA) supported the four-factor structure of the PTSD RI-5 (CFI =  0.915, TLI = 0.902, RMSEA =0.062). ROC analysis showed strong diagnostic accuracy (AUC = 0.94).Conclusion: The Turkish version of the PTSD RI-5 may a reliable and valid tool for diagnosing PTSD in clinical samples and may improve diagnosis and treatment outcomes by identifying unrecognized trauma-related symptoms.

A polyepigenetic glucocorticoid exposure score and HPA axis-related DNA methylation are associated with gestational epigenetic aging

Gestational epigenetic aging (GEA) is a novel approach for characterizing associations between prenatal exposures and postnatal risks. Psychosocial adversity in pregnancy may influence GEA, but the molecular mechanisms are not well understood. DNA methylation to glucocorticoid regulation and hypothalamic-pituitary-adrenal (HPA) axis genes are implicated but have not been fully examined in association with GEA. This study investigated whether a polyepigenetic glucocorticoid exposure score (PGES) and HPA axis gene (NR3C1, HSD11B2, FKBP5) methylation were associated with GEA, and whether associations were sex-specific. Participants were from a prospective cohort of racial/ethnic diverse and socially disadvantaged pregnant women and infants (n = 200). DNA methylation variables were estimated using umbilical cord blood. PGES was derived with CpGs shown to be sensitive to synthetic dexamethasone exposure. NR3C1, HSD11B2, and FKBP5 methylation was summarized via factor analysis. We found that PGES (β = -1.12, SE = 0.47, p = 0.02) and several NR3C1 and FKBP5 factor scores were associated with decelerated GEA (all p < 0.05). A significant sex interaction was observed for FKBP5 factor score 3 (β = -0.34, SE = 0.15, p = 0.02) suggesting decelerated GEA for males but not females. This study showed that glucocorticoid regulation-related DNA methylation was associated with a decelerated aging phenotype at birth that might indicate a neonatal risk.

Factors working against suicidal attempts in nursing home residents under COVID-19

This study examines the protective and risk factors for suicide among nursing home residents as well as strategies to prevent suicide. In this study, semi-structured interviews are used to interpret the experiences and perceptions of nursing home residents regarding suicide attempts. The research is conducted using the technique of content analysis with Nvivo. Researchers have assessed this study for clarity. The experiences of nursing home residents with suicidal ideation were divided into three categories, nine sub-themes, and relevant theme clusters. The three categories were: (a) protective factors for suicide prevention; (b) risk factors for suicide attempts; and (c) suicide prevention strategies. These factors and strategies were found to be associated with suicide ideation and attempts. Factors and strategies influencing suicidal ideation and attempts among nursing home residents revealed some new issues and problems during COVID-19, allowing healthcare providers to better understand nursing home residents and improve intervention strategies in practice.

Psychometric accuracy of the Dutch Child and Adolescent Trauma Screener

Objective: The aim of this study is to investigate the psychometrics of the Dutch version of the Child and Adolescent Trauma Screener (CATS-2). By this, an international recognized instrument to screen symptoms of post-traumatic stress (PTSS) in children and adolescents according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) becomes available for Dutch youth.Procedure and Method: Based on the validated CATS-2 we established the Dutch version, named the KJTS. A total of 587 children and adolescent, age 7-21, and 658 caregivers referred to mental health care services in Amsterdam was included in the study to examine psychometric properties. The construct was tested by confirmatory factor analysis (CFA). Furthermore reliability, convergent-divergent patterns and diagnostic test accuracy were examined.Results: The underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported by CFA showing a good fit for the selfreport (CFI = .95, TLI = .94), and an acceptable fit for the caregiver report (CFI = .90, TLI = .89). The KJTS showed excellent reliability (alpha = .92) on both selfreport and caregiver report. The convergent-discriminant validity pattern showed medium to strong correlations with measures of internalization problems, such as anxiety and affective problems (r = .44-.72) and low to medium correlations with externalizing symptoms (r = .21-.36). The ROC-curve analysis has proven a good accuracy (AUC = .81; n = 106).Discussion and conclusion: This study demonstrates the psychometric accuracy of the KJTS in a Dutch clinical population. The KJTS reflects adequately the dimensionality of PTSD as described in the DSM-5, with a good fit for selfreports, an acceptable fit for caregiver reports, excellent reliability and sufficient validity. Limitations are described. The outcomes support the use of the KJTS in research and clinical practice for screening and monitoring of PTSS.

Childhood maltreatment and non-suicidal self-injury: the mediating role of mentalization and depression

Background: Childhood maltreatment (CM) is recognized as one of the primary factors increasing the risk of non-suicidal self-injury (NSSI).Objectives: This study aims to further understand the impact of different types of CM on the mechanisms underlying NSSI risk by examining the potential mediating roles of mentalization and depression.Method: A self-report survey was conducted with 1645 Chinese youths (933 males, 712 females; mean age = 18.25, SD = 0.64) to evaluate their experiences of CM, depression, mentalization, and NSSI frequency over the past year. Structural equation modelling was utilized to examine the direct and indirect pathways linking CM to NSSI risk via mentalization and depression.Results: The study found that emotional abuse, physical abuse, mentalization, and depression had significant direct effects on NSSI risk. Moreover, mentalization and depression mediated the relationship between emotional abuse and NSSI risk, while emotional neglect and physical neglect indirectly influenced NSSI risk only through depression. Physical abuse had a significant direct effect on NSSI risk, whereas sexual abuse did not show any direct or indirect effects.Conclusions: The findings suggest that childhood emotional abuse has a markedly different impact compared to other forms of CM. Interventions focused on improving mentalization may be particularly effective in addressing the effects of emotional abuse, mitigating depression, and reducing the risk of NSSI.

Understanding and supporting parenting in parents seeking PTSD treatment: a qualitative study

Background: Parental post-traumatic stress disorder (PTSD) can impact parenting and child psychosocial wellbeing. Complementing trauma-focused psychotherapy with parenting interventions can thus have important preventive value. Understanding parents' lived experiences is necessary to tailor such interventions to their needs.Objective: This study addressed the question: how can preventive parenting support be shaped to the needs of parents entering specialized psychotherapy for PTSD? To answer this question, we investigated parenting challenges, parent-child communication about PTSD, strengths, and social support experiences of parents with PTSD.Method: The sample included 14 parents seeking PTSD treatment at a tertiary mental healthcare institution, while parenting children aged 4-17. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.Results: On the one hand, parental dysregulation (e.g. exploding or shutting down) was an important challenge. On the other hand, parents' attempts to remain regulated (e.g. through overcontrol and overprotectiveness) also affected family life. When talking to their child about PTSD, parents were guided by what they considered beneficial for the child to know. An important strength was that parents tried to remain attuned to the child's needs, regardless of their own struggles. Parents also described experiences that could be understood as post-traumatic growth through parenting. Generally, parents experienced a lack of social support.Conclusion: Our findings illustrate that parents entering PTSD treatment are highly motivated to do what is best for their child. Based on parents' lived experiences, preventive parenting interventions should address the impacts of both dysregulation and overcontrolling regulation attempts. Another important goal is reducing feelings of incompetence. Integrating the parenting role in psychotherapy for PTSD could also be beneficial. For example, setting parenting-related therapy goals can be motivating. Furthermore, parent-child interactions can be a mirror that reflects the parents' inner state: considering these interactions can help recognize changes in symptomatology.

"Living their best life": PhotoVoice insights on well-being, inclusion, and access to public spaces among adolescent refugee girls in urban resettlement

PURPOSE

Newcomer adolescent girls from the Middle East and North Africa region face intersectional challenges and opportunities upon resettlement. This study employs PhotoVoice participatory research methodology to explore perspectives on well-being and belonging shared by six students who resettled to Chicago from Iraq and Syria.

METHODS

Two programme sessions consisted of participants reflecting on their photographic responses to four prompts in focus group discussions. The subsequent four sessions included qualitative analysis skill building, participant-led generation of thematic codes and diagrams using their data, and the creation of action plan posters to share back with the community. The research team then analysed all data using a grounded theory approach with constant comparative analysis.

RESULTS

Four major themes emerged: 1) public spaces served as a vehicle for exploring well-being and belonging; 2) intersectional inclusion in public spaces was deemed a vital priority; 3) schools held an important role in facilitating belonging and access to public spaces; and 4) language was a critical barrier and facilitator to access and inclusion.

CONCLUSIONS

Findings highlight the need for holistic approaches to support refugee youth in urban contexts and emphasize the role of schools in facilitating inclusive access to public spaces to strengthen newcomer students' well-being and belonging.

Prevalence of war-related posttraumatic stress disorder in adolescents: a systematic review and meta-analysis

Background: Posttraumatic stress disorder is common in civilians who are currently experiencing, or who have experienced, war. Most previous studies have focused on adult populations and, despite the recognised detrimental effect of war trauma on adolescent mental health, there remains a paucity of evidence on the prevalence of war-related PTSD in adolescents.Objective: This pre-registered (https://osf.io/dqg2z) systematic review and meta-analysis aims to understand the prevalence of PTSD, as well as both risk and protective factors for developing PTSD, in adolescents aged 10-24 years from across the world who are experiencing, or have experienced, war-related traumatic events, described in papers published in a 10 year period (2013-2023). We also examine how the choice of PTSD diagnostic assessment tool influences prevalence rates.Method: Medline (PubMed), PsycINFO (EBSCOhost), and PTSDpubs (ProQuest) were searched, which resulted in 21 papers eligible for inclusion. Data was searched, extracted and synthesised using the software tool Covidence.Results: The age range of adolescents in the included papers was 11-19 years. The average prevalence of PTSD was 29.4% (95% CI [18.7%, 43.0%]), although prevalence rates across studies were highly inconsistent (I2 = 99.4%). Prevalence rates were significantly higher in studies conducted longer after war exposure, and the PTSD diagnostic assessment tool used influenced prevalence.Conclusions: There is high prevalence of PTSD in adolescents during and after war. The prevalence of war-related PTSD increases with time in the post-war period, highlighting the need for access to psychological services following war. This study underscores the importance of defining age ranges and using validated and culturally sensitive assessment tools when interpreting prevalence rates of PTSD in adolescents.

Gut microbiome changes with micronutrient supplementation in children with attention-deficit/hyperactivity disorder: the MADDY study

Micronutrients have demonstrated promise in managing inattention and emotional dysregulation in children with attention-deficit/hyperactivity disorder (ADHD). One plausible pathway by which micronutrients improve symptoms is the gut microbiome. This study examines changes in fecal microbial composition and diversity after micronutrient supplementation in children with ADHD (N = 44) and highlights potential mechanisms responsible for the behavioral improvement, as determined by blinded clinician-rated global improvement response to micronutrients. Participants represent a sub-group of the Micronutrients for ADHD in Youth (MADDY) study, a double blind randomized controlled trial in which participants received micronutrients or placebo for 8 weeks, followed by an 8-week open extension. Stool samples collected at baseline, week 8, and week 16 were analyzed using 16S rRNA amplicon sequencing targeting the V4 hypervariable region. Pairwise compositional analyses investigated changes in fecal microbial composition between micronutrients versus placebo and responders versus non-responders. A significant change in microbial evenness, as measured by alpha diversity, and beta-diversity, as measured by Bray-Curtis, was observed following micronutrients supplementation. The phylum Actinobacteriota decreased in the micronutrients group compared to placebo. Two butyrate-producing bacterial families: Rikenellaceae and Oscillospiraceae, exhibited a significant increase in change following micronutrients between responders versus non-responders. These findings suggest that micronutrients modulated the composition of the fecal microbiota and identified specific bacterial changes associated with micronutrient responders.

"They are just as different as the rest of us" - a focus group study of primary teachers' perceptions of children with ADHD who struggle socially

PURPOSE

Difficulties in peer interactions are common among children with ADHD and associated with severe consequences. Prevailing interventions have been criticized for not accounting for the significance of context and for limited effect on important social outcomes. Given the importance of the school environment and the teacher for children's social development, we wanted to explore how teachers perceive their own role and responsibilities when children are struggling socially, and how they intervene in their daily practice.

METHODS

We conducted semi-structured interviews in five focus groups of primary school teachers in Bergen, Norway and analysed the data through reflexive thematic analysis.

RESULTS

We discerned two overarching themes, each with several subthemes. The first theme, "Monitoring and Attending to Individual Needs in a Context", represents teachers' perceptions of their role and responsibilities. The second theme, "Tailoring Interventions Through Continuous Assessments", represents the teachers' strive to fulfil this role in their everyday practice.

CONCLUSION

Our findings reflect a complex, contextual understanding of social difficulties, acknowledging the uniqueness of each child, regardless of diagnosis. The teachers' practice was characterized by continuous tailoring to accommodate the specific, contextualized needs of each child, both "behind the scenes" and trough participating in children's everyday social interactions.

Methods for integrating public datasets: insights from youth disaster mental health research

Introduction: Weather-related disasters pose significant risks to youth mental health. Exposure to multiple disasters is becoming more common; however, the effects of such exposure remain understudied. This study demonstrates the application of integrative data approaches and FAIR (Findable, Accessible, Interoperable, Reusable) data principles to evaluate the relationship between cumulative disaster exposure and youth depression and suicidality in the United States, taking into account contextual factors across levels of social ecology.Methods: We combined data from five public sources, including the Youth Risk Behavior Surveillance System (YRBS), Federal Emergency Management Agency (FEMA), United States Census Bureau, Center for Homeland Defense and Security School Shooting Safety Compendium, and Global Terrorism Database. The integrative dataset included 415,701 youth from 37 districts across the United States who completed the YRBS between 1999 and 2021. The YRBS served as the core dataset.Results: This data note highlights strategies for harmonizing diverse data formats, addressing geographic and temporal inconsistencies, and validating integrated datasets. Automated data cleaning and visualization techniques enhance accuracy and efficiency. Planning for sensitivity analyses before data cleaning is recommended to improve the data integration process and enhance the robustness of findings.Discussion: This integrative approach demonstrates how leveraging FAIR principles can advance trauma research by facilitating large-scale analyses of complex public health questions. The methods provide a replicable framework for examining population-level impacts of phenomena and highlight opportunities for expanding trauma research.

The perceived burden of working with traumatized youth: construction and psychometric investigation of the Trauma Professionals' Burden Scale (TPBS)

Background: It is assumed that providing trauma-informed care for children and adolescents is a major challenge for professionals in child and youth welfare, psychiatric clinics and psychotherapy practices, yet studies are scarce. This is partly due to the fact that valid instruments that capture the specific stress caused by working with traumatized youths are missing. Our study aims to present the construction and results of the psychometric investigation of a scale that addresses the concerns, strains and needs of professionals, the Trauma Professionals' Burden Scale (TPBS).Methods: In our cross-sectional survey with youth psychotherapists, welfare professionals and psychiatric care staff (N = 834), the psychometric properties of the TPBS were examined using standard item and reliability analyses, exploratory factor analysis and confirmatory factor analysis (CFA). Convergent validity was assessed by testing the hypothesis that two TPBS subscales show high positive correlations with two established scales.Results: After deletion of eleven items, the remaining items of the TPBS show good discriminatory power, allowing to discriminate between participants with high or low scores, and high factor loadings. CFA results indicate fair model fit (RMSEA = .081, CFI = .81). Internal consistencies of the subscales range from ω = .76 to ω = .89. The expected correlations with the established scales are confirmed. A six-item short scale was created, showing excellent model fit (RMSEA = .047, CFI = .99) and good internal consistency (ω = .88).Conclusions: Although further validating research is required, the present study supports the psychometric validity of the TPBS enabling to assess professionals' stress associated with providing trauma-informed care for youth.

Accuracy of the Pediatric Emotional Distress Scale - Early Screener to predict the risk for developing PTSD in young children after accidental injury

Early identification of posttraumatic stress disorder (PTSD) in children is important to prevent chronic symptoms and long-term negative consequences. However, PTSD often goes unrecognized in the emergency setting of hospitals and screening methods for young children are lacking.

To evaluate the accuracy of an early screening tool for PTSD in a sample of young children (0-7 years) after unintentional injury.

The Pediatric Emotional Distress Scale - Early Screener (PEDS-ES) was administered to parents of children referred to the Emergency Department within 7 days post-accident (n = 82), and a validated interview for PTSD was administered 3 months after the accident as criterion measure: the Diagnostic Infant and Preschool Assessment (DIPA). Diagnostic accuracy of the PEDS-ES was inspected using area under the curve analyses including sensitivity, specificity, Positive and Negative Predictive Value.

After three months PTSD diagnosis was established in 21% of the children. Use of the PEDS-ES within 7 days after the injury showed fair accuracy with AUC = .727. Sensitivity (0.65) and specificity (0.73) for the suggested cutoff of 8 were moderate for predicting PTSD diagnosis 3 months after the injury. The examination of cutoff values that achieve enhanced sensitivity in a screening context - where sensitivity is prioritized - while maintaining a high level of specificity suggests that a lower cutoff of around 6 points may serve as a more sensitive (sensitivity: 0.82; specificity: 0.56) valid alternative cutoff score.

The PEDS-ES allows for successful early screening of risk for traumatic stress symptoms in young children after single accidental injury. It enables early identification of individuals who are at risk for developing PTSD and need further monitoring of symptoms, diagnostic assessment and treatment.

Identifying traumatization in young children through structured play: validation of the Odense Child Trauma Screening (OCTS) in Lithuania

Background: There is a need for valid methods to evaluate young children's (4-8 years) psychological difficulties related to traumatic experiences. The Odense Child Trauma Screening (OCTS), developed by Danish researchers, is a play-based story stem assessment tool developed to screen for indicators of traumatization in young children. Just a few studies of the OCTS have been published so far.Objective: The current study aimed to test the reliability and convergent validity of the OCTS in the Lithuanian community and risk subsamples of young children aged 4-8 years.Method: The total sample consisted of 209 participants (58.9% girls) from the community (47.4%) and risk (52.6%) subsamples, Mage = 6.29 (SD = 1.48). All children were screened with the OCTS, and caregivers completed self-report questionnaires: demographics, the Child and Adolescent Trauma Screen-Caregiver (CATS-C), and the Strengths and Difficulties Questionnaire (SDQ).Results: The data suggests that the OCTS has good inter-rater reliability. The OCTS, SDQ, and CATS-C scores were significantly higher in the risk subsample, with small to large effect sizes. Boys and younger children (3-4-year-olds) scored higher on the OCTS. Out of all the OCTS stories, the Burnt hand story had significant correlation coefficients with all the CATS-C PTSD symptoms.Conclusions: The study provides initial information about the reliability and the validity of the OCTS and calls for further exploration of this instrument. There were also variations in scores between the Lithuanian data and an earlier study of the Danish sample. Future studies on the OCTS would benefit from further cross-cultural, reliability and the validity examination.

Patterns of mental health problems and resilience among immigrant and refugee adolescents: a latent profile analysis

Background: Immigrant and refugee adolescents often face traumatic experiences and are vulnerable to mental health problems, such as post-traumatic stress disorder (PTSD), anxiety and depression. Yet, they also show remarkable resilience in the face of these stressors. Research is still scarce on how both mental health problems and resilience dynamically interplay in immigrant and refugee adolescents' development.Objective: We aimed to identify latent profiles of immigrant and refugee adolescents' wellbeing, consisting of externalizing and internalizing symptoms, PTSD (intrusion and avoidance), and resilience, and analyse the demographic and contextual determinants of these profiles.Method: We employed cross-sectional survey data from the RefugeesWellSchool project for 1607 immigrant and refugee adolescents (mean age 15.3 years, SD 2.15, 42.3% girls) from six European countries: Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom. Latent profile analysis and three-step procedure with BCH weights were used to identify the wellbeing profiles and their determinants.Results: Results identified four adolescent wellbeing profiles: (1) Low symptoms (49.7%, n = 791); (2) High symptoms with intrusion (10.6%, n = 169); (3) Moderate symptoms (26.9%, n = 428); and (4) Resilient avoidant (12.8%, n = 203). Older participants, those with refugee background, shorter residence in the host country, more experiences of daily stressors or discrimination, or low family support were less likely to belong to the Low symptoms or Resilient avoidant groups (p ≤ .001).Conclusions: The profiles reflected distinct differentiation of intrusive and avoidance dimensions of the PTSD-symptoms. Intrusion clustered with high level of other mental health problems, whereas avoidance co-occurred with high resilience. Experiences related to immigration, stressors, and family support were crucial determinants of the wellbeing profile membership. Future interventions should utilize information obtained by person-centered studies to create better targeted and tailored support for immigrant and refugee adolescents.

'At the heart of the community' - a Somali woman's experience of 'alignment' of support to escape social isolation in pregnancy and early motherhood

PURPOSE

Stresses in pregnancy and early motherhood can affect women's health and wellbeing, and babies' development. Migrant women face compounding stressors from the intersection of gender, race, social class, migration, and language. We explored one Somali woman's experience of pregnancy and the transition to motherhood, following migration to an urban environment in the Global North, aiming to understand resilience in this specific socio-cultural context.

METHODS

This case study used interpretative phenomenological analysis of a single two-hour semi-structured interview with a Somali woman in the UK to explore how this experience may have relevance for communities and practitioners in the Global North.

RESULTS

We identified two overarching themes in this woman's experience: "vicious" and "virtuous" circles, attempting to make sense of her experience of isolation and lack of wellbeing, and subsequent confidence, engagement, and community-building.

CONCLUSIONS

An experience of "alignment" in social relationships appeared to make possible the shift from "vicious" to "virtuous" circle, which enabled escape from social isolation. This account of transformation-from social isolation to community contribution-underlines the role of community organizations facilitating positive social networks and peer support during pregnancy and early motherhood.

"The wind does not go the way the ship wants!": stress and social support in Syrian migrant adolescents

PURPOSE

Previous studies reveal the importance of proximal context and social environment in the adaptation and resilience of immigrant adolescents. Syrian immigrant youth in Turkey face stressors such as acculturation, discrimination, and economic problems. However, more qualitative research is needed to examine the unique stressors and coping processes of Syrian immigrant youth and the social networks that support them. This study aimed to uncover the relevant unique relationships.

METHOD

The study involved 24 Syrian migrant adolescents aged 12-18, with four focus group interviews conducted from April to May 2024. Data were analyzed using Interpretative Phenomenological Analysis (IPA).

CONCLUSIONS

The themes related to sources of stress were (a) life struggle, (b) peer relationships, (c) future anxiety, (d) social barriers, and the social support mechanisms in times of stress were discovered as (a) family (b) clergy and religious rituals (c) non-governmental organizations (d) school counselors. The results of our study shed light on the fact that Syrian migrant youth experience significant socioeconomic difficulties and are forced to leave formal education and work in unequal conditions. Our study also revealed that youths have difficulties in accessing education, health, and professional psychological support services due to perceived discrimination in public institutions such as schools and hospitals.

Maladaptive appraisals and posttraumatic stress reactions in young terror survivors across 8 years: a random intercepts cross-lagged analysis

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Preliminary efficacy of eye movement desensitization and reprocessing for children aged 1.5-8 years with PTSD: a multiple baseline experimental design (N = 19)

Background: Trauma exposure is common in (pre) school-aged children and around one-fifth of exposed children meet the criteria for post-traumatic stress disorder (PTSD). These symptoms can cause severe impairment to a child's functioning and, if left untreated, have negative long-term consequences. Therefore, there is an urgent need for effective treatment to reduce the acute and long-term effects of trauma. However, currently, there are no established empirically validated treatments for PTSD in young children.Objective: To assess the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for improving PTSD symptoms, behavioural and emotional problems in young children aged 1.5-8 years, and parenting stress in their parents.Method: A non-concurrent, multiple baseline experimental design was combined with standardized measures across 19 mostly chronically trauma-exposed children fulfilling DSM-5 PTSD diagnosis. Primary outcomes included effects on the severity of PTSD symptoms and the rate of diagnostic remission from PTSD. Secondary outcomes included emotional and behavioural problems and parenting stress at each assessment point (baseline, pre-treatment, post-treatment, and three-month follow-up). Participants received six 1-hour EMDR sessions.Results: At post-treatment 79% of the children no longer met the diagnostic criteria for PTSD. Further, a significant decline in the severity of PTSD symptoms, emotional and behavioural problems in children was found post-treatment (all effect sizes > 1.20), as well as a significant reduction of parenting stress in their parents (Cohen's d effect size 0.45). All gains were maintained at the three-month follow-up, including a 79% loss of PTSD diagnosis. There was no dropout (0%) and no adverse events were reported.Conclusions: The findings provide preliminary evidence of the safety, feasibility, and efficacy of six sessions of EMDR therapy for reducing paediatric PTSD and comorbidity in young children aged 1.5-8 years and, at the same time, decreasing parenting stress. Further trials are warranted.Trial Registration: International Clinical Trial Registry Platform (before National Trial Register, trial search/who/int: identifier: NL8426, EMDR for young children with PTSD).

Neuroenhancement by repetitive transcranial magnetic stimulation (rTMS) on DLPFC in healthy adults

The term "neuroenhancement" describes the enhancement of cognitive function associated with deficiencies resulting from a specific condition. Nevertheless, there is currently no agreed-upon definition for the term "neuroenhancement", and its meaning can change based on the specific research being discussed. As humans, our continual pursuit of expanding our capabilities, encompassing both cognitive and motor skills, has led us to explore various tools. Among these, repetitive Transcranial Magnetic Stimulation (rTMS) stands out, yet its potential remains underestimated. Historically, rTMS was predominantly employed in studies focused on rehabilitation objectives. A small amount of research has examined its use on healthy subjects with the goal of improving cognitive abilities like risk-seeking, working memory, attention, cognitive control, learning, computing speed, and decision-making. It appears that the insights gained in this domain largely stem from indirect outcomes of rehabilitation research. This review aims to scrutinize these studies, assessing the effectiveness of rTMS in enhancing cognitive skills in healthy subjects. Given that the dorsolateral prefrontal cortex (DLPFC) has become a popular focus for rTMS in treating psychiatric disorders, corresponding anatomically to Brodmann areas 9 and 46, and considering the documented success of rTMS stimulation on the DLPFC for cognitive improvement, our focus in this review article centers on the DLPFC as the focal point and region of interest. Additionally, recognizing the significance of theta burst magnetic stimulation protocols (TBS) in mimicking the natural firing patterns of the brain to modulate excitability in specific cortical areas with precision, we have incorporated Theta Burst Stimulation (TBS) wave patterns. This inclusion, mirroring brain patterns, is intended to enhance the efficacy of the rTMS method. To ascertain if brain magnetic stimulation consistently improves cognition, a thorough meta-analysis of the existing literature has been conducted. The findings indicate that, after excluding outlier studies, rTMS may improve cognition when compared to appropriate control circumstances. However, there is also a considerable degree of variation among the researches. The navigation strategy used to reach the stimulation site and the stimulation location are important factors that contribute to the variation between studies. The results of this study can provide professional athletes, firefighters, bodyguards, and therapists-among others in high-risk professions-with insightful information that can help them perform better on the job.

Effectiveness of trauma-focused treatments for refugee children: a systematic review and meta-analyses

ABSTRACTBackground: Prevalence of posttraumatic stress disorder (PTSD) in refugees is higher compared to the general population, and barriers in accessing mental health care are often experienced. With staggering numbers of people seeking refuge around the world, and 40% being 18 years or younger, effective trauma-focused therapies for refugee children with PTSD are highly needed.Objective: A systematic review and meta-analyses were conducted to provide an overview of, and to analyse, intervention studies using PTSD measures in young refugees, assessing treatment effectiveness and addressing efforts to mitigate barriers to mental health care.Method: Eleven databases were searched for studies evaluating trauma-focused treatments (TFT) for refugee children (0-18). Meta-analyses were conducted for all included studies grouped together; and second, per intervention type, using posttreatment measures and follow-up measures. Pooled between-group effect sizes (ESs) and pre-post ESs, using a random-effects model were calculated.Results: A total of 47 studies was retrieved, with 32 included in the meta-analyses. The narrative review highlighted positive outcomes in reducing posttraumatic stress symptoms for CBT-based interventions, EMDR therapy, KIDNET, and other treatments such as art therapy. Meta-analyses revealed medium pooled pre-post ESs for CBT-based interventions (ES = -.55) and large for EMDR therapy (ES = -1.63). RCT and CT studies using follow-up measures showed promising outcomes for KIDNET (ES = -.49). High heterogeneity of the included studies limited interpretation of several other combined effects. Results should be interpreted with caution due to the generally low quality of the included studies. All studies addressed efforts to minimize treatment barriers.Conclusion: More high-quality studies are urgently needed to inform treatment recommendations. Evidence-based therapies, such as CBT-based interventions, EMDR therapy, and KIDNET, demonstrate promising findings but need further replication. Strategies to overcome barriers to treatment may be necessary to reach this population.

Bidirectional association between atopic dermatitis and attention deficit hyperactivity disorder: a systematic review and meta-analysis

BACKGROUND

Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

MATERIALS AND METHODS

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger's test.

RESULTS

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25-1.44, p < 0.01; HRs = 1.42, 95% CI 1.20-1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21-1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76-3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18-7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14-2.76, p < 0.01) simultaneously.

CONCLUSION

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.

Individuals with high autistic traits exhibit altered interhemispheric brain functional connectivity patterns

Individuals with high autistic traits (AT) encounter challenges in social interaction, similar to autistic persons. Precise screening and focused interventions positively contribute to improving this situation. Functional connectivity analyses can measure information transmission and integration between brain regions, providing neurophysiological insights into these challenges. This study aimed to investigate the patterns of brain networks in high AT individuals to offer theoretical support for screening and intervention decisions. EEG data were collected during a 4-min resting state session with eyes open and closed from 48 participants. Using the Autism Spectrum Quotient (AQ) scale, participants were categorized into the high AT group (HAT, n = 15) and low AT groups (LAT, n = 15). We computed the interhemispheric and intrahemispheric alpha coherence in two groups. The correlation between physiological indices and AQ scores was also examined. Results revealed that HAT exhibited significantly lower alpha coherence in the homologous hemispheres of the occipital cortex compared to LAT during the eyes-closed resting state. Additionally, significant negative correlations were observed between the degree of AT (AQ scores) and the alpha coherence in the occipital cortex, as well as in the right frontal and left occipital regions. The findings indicated that high AT individuals exhibit decreased connectivity in the occipital region, potentially resulting in diminished ability to process social information from visual inputs. Our discovery contributes to a deeper comprehension of the neural underpinnings of social challenges in high AT individuals, providing neurophysiological signatures for screening and intervention strategies for this population.

Construction and initial validation of the International Trauma Questionnaire - Caregiver Version (ITQ-CG): assessing ICD-11 PTSD and CPTSD in children from caregiver perspective

ABSTRACTObjective: The 11th version of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. The International Trauma Questionnaire (ITQ) is the most widely used measure of assessment and has been adapted for use in children and adolescents (ITQ-CA), but a corresponding caregiver version is still missing. We aimed to close this gap by adapting the ITQ-CA and provide an initial validation of the ITQ - Caregiver Version (ITQ-CG). A corresponding measure of assessment from caregiver-perspective is integral for the use in child psychology, psychiatry and research.Method: Altogether, 326 children and adolescents who attended the department of child and adolescent psychiatry were rated by their caregivers using a set of standardized measures. Excluding patients due to missing data or no trauma exposure, a final sample of 223 patients was analysed. Factorial structure of the ITQ-CG and multiple forms of validity were examined using confirmatory factor, latent class and correlation analysis.Results: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD as the factorial structure of the ITQ-CG. Convergent-divergent validity of main- and subscales of the ITQ-CG was evidenced by respective correlations with criterion variables. Latent class analysis supported the discriminant validity of the ITQ-CG, identifying a CPTSD-, PTSD-, DSO- and low symptoms-class. The CPTSD-class was associated with highest rates of comorbid psychopathology and functional impairment. Concurrent validity was evidenced by satisfactory concordance between caregiver- and child-reports.Conclusion: This study provides the construction and initial validation of the ITQ-CG to assess ICD-11 PTSD and CPTSD in children and adolescents from caregiver-perspective. We found compelling evidence for the ITQ-CGs validity, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD from caregiver-perspective. The ITQ-CG is freely available for clinicians and researchers.

Children's experiences of living with their mental ill-health - a scoping review

PURPOSE

This study aims to identify and summarize existing qualitative empirical research on children's experiences of living with their mental ill-health.

METHODS

A scoping review with a systematic search of the databases PubMed, CINAHL, and PsychINFO was conducted. The search generated 9,864 studies, which were screened by title, abstract, and full text.

RESULTS

Forty articles were included comprising 826 children aged 8-19 years. The key findings were described in four themes: Identifying oneself with mental ill-health, Managing suffering and daily challenges, Seeking supportive and caring relationships and Navigating a complex school environment. Being identified with mental ill-health brought challenges for children's everyday struggles. Their own coping strategies as well as supportive relationships with friends and adults were important. However, the balance between support and stress was complex.

CONCLUSIONS

Children have a desire to manage and comprehend their complex everyday lives of living with mental ill-health and wish for supported yet independent decision-making. Attitudes of friends, adults and professionals are important in providing understanding and non-judgemental support, valuable for children's well-being. Open conversations about mental health and providing accessible, child-centred interventions based on the needs expressed by children are necessary. This study contributes to the literature by emphasizing the central role of children's voices in matters of mental ill-health.

Potentially traumatising events and post-traumatic stress symptoms of adolescents in out-of-home care

Background: Children and adolescents in out-of-home care are particularly vulnerable to potentially traumatising events (PTEs) and trauma-related mental health disorders. In Germany, there is limited evidence on trauma exposure and posttraumatic stress symptoms (PTSS) among youth in child welfare facilities. Better understanding their psychopathology could support the development of tailored trauma-focused interventions.Objective: This study investigates PTEs and PTSS (DSM-5 criteria) in adolescents living in residential care. It also examines risk factors for PTSS and compares self-reports with proxy-reports from institutional staff.Method: A total of N = 126 adolescents (mean age = 14.98 years, SD = 1.62, range = 11-19) from 17 residential care facilities in southern Germany and their institutional caregivers completed questionnaires assessing demographics, PTEs, and PTSS.Results: Participants reported an average of M = 4.51 PTEs (SD = 3.08, range = 0-12). High rates of online victimisation were found, with 19.8% reporting cyberbullying and 22.2% reporting being coerced online into sexual acts - the latter showing a strong correlation with PTSS (r = 0.33). Adolescents scored an average of M = 21.24 (SD = 11.01, range = 2-50) on the CATS-2, with scores above the clinical cut-off (≥21) indicating high symptom burden. Significant predictors of PTSS included the number of PTEs (β = .55, p < .001), female gender (β = .27, p < .01), and interpersonal trauma (β = .55, p < .001). Correlations between self- and staff-reports were low (r = .06-.19), with staff reporting fewer symptoms.Conclusion: The findings underline the high vulnerability of youth in care to trauma and stress-related symptoms and support the need for trauma-sensitive care. The prominence of online victimisation highlights the need for routine clinical screening. Low agreement between self- and caregiver reports reinforces the importance of directly assessing adolescents' experiences.

The role of prenatal stress and maternal trauma responses in predicting children's mental health during war

Background: The negative effects of prenatal stress on children's development and the buffering effects of maternal behaviour are well documented. However, specific maternal responses to trauma, particularly among families experiencing cumulative stressors during pregnancy and early childhood, remain less understood.Objective: This study investigated the interplay between prenatal stress in the context of the coronavirus disease 2019 (COVID-19) pandemic and consequent maternal trauma responses and children's difficulties in the context of war-related trauma.Methods: We recruited 318 pregnant women in Israel during the first wave of the COVID-19 pandemic (Time 1). Prenatal depression, anxiety, and COVID-related stress symptoms were assessed. When children were approximately 3.5 years old (SD = 0.02), the mothers were asked to report on parental responses related to the ongoing war and their child's emotional and behavioural difficulties (Time 2). Structural equation modelling was used to examine how maternal trauma responses mediate the association between prenatal stress-related mental health symptoms and children's difficulties during war.Results: Maternal prenatal depressive, anxious, and COVID-19-related stress symptoms predicted maladaptive maternal trauma responses during the war, which in turn were associated with increased emotional and behavioural problems in their children. Among the specific maternal trauma-related responses examined, cognitive avoidance and overprotectiveness were the only behavioural responses during the war significantly associated with children's difficulties.Conclusions: Our study highlights the impact of pandemic-related prenatal stress on maternal responses and children's difficulties during war, emphasizing the importance of identifying at-risk families as well as developing targeted interventions that mitigate negative parenting responses, particularly avoidance and overprotection.

Differences in hair cortisol to cortisone ratio between depressed and non-depressed adolescent women

Research on stress has demonstrated that the hypothalamic-pituitary-adrenal (HPA) axis contributes to major depressive disorder in youth. Hair glucocorticoids are key biological markers of chronic stress. We assessed group differences in hair cortisol and cortisone concentrations, and the cortisol/cortisone ratio between depressed adolescent women and a non-depressed comparison group. Further, within the depression group, we explored the contribution of symptom severity and clinical correlates of depression in relation to glucocorticoid concentrations. Hair samples of three centimeters for 74 adolescent women (41 in the depression group and 33 in the comparison group), aged between 12 and 19 years old, were analyzed. Depressive and anxiety symptoms were measured using the Beck Youth Inventory II and clinical correlates of depression were measured using the Childhood Trauma Questionnaire-Short Form and the Borderline Personality Features Scale for Children. No significant differences emerged between the depression group and the comparison group on hair cortisol or hair cortisone concentrations. However, groups differed significantly on the cortisol/cortisone ratio, a proposed proxy of 11-beta-hydroxysteroid dehydrogenase activity, with a higher ratio for the depression group. Within the depression group, neither symptom severity nor clinical correlates were associated with glucocorticoid concentrations. Although cross-sectional, our findings highlight the importance of future studies to test whether the group difference found in cortisol/cortisone ratio is the result of alterations in 11-beta-hydroxysteroid dehydrogenase enzymes (type 1 or 2) activity. Further research is thus needed to clarify the role of these enzymes in major depressive disorder in youth and to develop more targeted intervention strategies.

Autism spectrum disorder: difficulties in diagnosis and microRNA biomarkers

We performed a PubMed search for microRNAs in autism spectrum disorder that could serve as diagnostic biomarkers in patients and selected 17 articles published from January 2008 to December 2023, of which 4 studies were performed with whole blood, 4 with blood plasma, 5 with blood serum, 1 with serum neural cell adhesion molecule L1-captured extracellular vesicles, 1 with blood cells, and 2 with peripheral blood mononuclear cells. Most of the studies involved children and the study cohorts were largely males. Many of the studies had performed microRNA sequencing or quantitative polymerase chain reaction assays to measure microRNA expression. Only five studies had used real-time polymerase chain reaction assay to validate microRNA expression in autism spectrum disorder subjects compared to controls. The microRNAs that were validated in these studies may be considered as potential candidate biomarkers for autism spectrum disorder and include miR-500a-5p, -197-5p, -424-5p, -664a-3p, -365a-3p, -619-5p, -664a-3p, -3135a, -328-3p, and -500a-5p in blood plasma and miR-151a-3p, -181b-5p, -320a, -328, -433, -489, -572, -663a, -101-3p, -106b-5p, -19b-3p, -195-5p, and -130a-3p in blood serum of children, and miR-15b-5p and -6126 in whole blood of adults. Several important limitations were identified in the studies reviewed, and need to be taken into account in future studies. Further studies are warranted with children and adults having different levels of autism spectrum disorder severity and consideration should be given to using animal models of autism spectrum disorder to investigate the effects of suppressing or overexpressing specific microRNAs as a novel therapy.

Associations between adherence to 24-hour movement guidelines with depression, anxiety, and loneliness among Chinese adolescents

PURPOSE

While growing evidence suggests a link between meeting 24-hour movement guidelines and adolescent mental health, further investigation is needed to clarify this association. This cross-sectional study aimed to examine how adherence to single and combined 24-hour movement guidelines relates to depression, anxiety, and loneliness in adolescents, while exploring variations across sex and age.

METHODS

A total of 15,344 adolescents aged 10-18 years in Shanghai were selected using multi-stage stratified cluster random sampling in 2021. Data on movement behavior and mental health problems were collected through self-reported questionnaires. Logistic regression was used to assess the associations and stratified analyses were performed for sex and age groups. The STROBE checklist for observational research was adopted for reporting.

RESULTS

Only 2.7 % of our sample of Chinese adolescents met all three 24-hour movement behavior recommendations. Compared to not meeting any recommendations, meeting one or more recommendations was significantly associated with a lower risk of depression, anxiety, and loneliness (p < 0.001 for all), showing a dose-response gradient (p < 0.001 for all). Meeting both screen time and sleep recommendations showed near-equivalent protection against depression (OR = 0.47, 95%CI 0.37-0.61) to meeting all three recommendations (OR = 0.46, 95%CI 0.32-0.64). Meeting the guidelines appeared to have a stronger protective effect on the mental health of girls and younger adolescents than boys and older adolescents.

CONCLUSIONS

Meeting 24-hour movement guidelines, particularly screen time and sleep recommendations, was associated with a reduced risk of depression, anxiety, and loneliness in adolescents. These findings highlight the importance of integrating 24-hour movement guidelines into public health initiatives, such as school-based policies promoting balanced schedules and parental guidance on recreational screen use.

Machine learning-based predictive modeling of depressive symptoms in Chinese adolescents

BACKGROUND

The aim is to develop prediction models by lifestyles indicators as well as socioeconomic status to predict the risk of depressive symptoms in adolescents, and to rank and explain these predictors.

METHOD

A cross-sectional study was conducted in 32389 school students grade 4-12. A self-rating depression scale was used to define depressive symptoms (CES-D score ≥ 16), and lifestyle survey was used to investigate risk factors of depressive symptoms. Boruta-RF algorithm was used for feature selection and to rank variable importance. Random forest model was constructed to predict the risk of depressive symptom, and partial dependence plot (PDP) was used to explain the relationship between each variable and predicted outcome.

RESULTS

Boruta-RF algorithm showed that self-rated health, sleep duration, parental support for physical exercise, breakfast intake, screen time, skipping physical education classes, egg intake, grade, milk/soy product intake, and parental exercise habits were the top ten most important factors for depressive symptoms. The AUC of the random forest model was 0.829 (95% CI: 0.820 - 0.837), suggesting good accuracy for predicting depressive symptoms. Additionally, we demonstrated the nonlinear effect of each predictor for predicting risk of depressive symptoms by PDP.

CONCLUSIONS

The prediction model, using lifestyle indicators routinely collected in schools, can effectively screen for high-risk individuals needing further mental health evaluations, and facilitate early detection of depressive symptoms in adolescents. The study is limited by its cross-sectional design implying causality, use of CES-D for depressive symptoms rather than clinical diagnosis, and omission of neuroimaging biomarkers for improved accuracy.

Global prevalence and psychological impact of bullying among children and adolescents: a meta-analysis

OBJECTIVE

Bullying is a significant public health concern with negative consequences. Therefore, we conducted this meta-analysis to estimate the pooled prevalence and psychological impact of bullying among children and adolescents.

METHODS

A comprehensive search of CINAHL, Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science was conducted until April 2024. Data were analyzed using the Generalized Linear Mixed Model adopted random-effect model in R software. We assessed heterogeneity using I2 test and Cochran's Q-statistic and study quality using Joanna Briggs Institute (JBI) critical appraisal tools. Moreover, meta-regression and subgroup analyses identified factors contributing to prevalence of bullying.

RESULTS

A total of 116 studies involving 603,231 participants were identified. The pooled prevalence of bullying victims was 25 % (95%CI: 22 %-28 %), followed by 16 % (13 %-20 %) for bullying perpetrators, and 16 % (11 %-21 %) for bully-victims (individuals who experience both roles). We found that bullying has psychological impacts for all groups, including emotional distress, loneliness, anxiety, depression, self-harming behavior, suicidal ideation, and suicidal attempts.

LIMITATIONS

The results showed high heterogeneity; however, meta-regression and sub-group analyses were performed to identify potential moderating factors.

CONCLUSIONS

This study highlights that one-quarter of children and adolescents are bullying victims, while perpetrators and bully-victims share a prevalence of one-sixth. Addressing bullying requires collaboration among schools, parents, and healthcare professionals. Educational programs focused on prevention and targeted interventions for all groups are essential to mitigate the long-term mental health consequences of bullying. A comprehensive approach is crucial, considering the interconnected roles of victims, perpetrators, and bully-victims in the bullying dynamic.

Food selectivity and autism: A systematic review

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests in the first years of life, with a complex pathogenesis influenced by biological, genetic and epigenetic factors. Many children with ASD display marked food selectivity, often restricting themselves to a narrow range of foods. The problems associated with feeding children with ASD can vary widely, from mild cases that pose no immediate health risks, to more severe situations with a risk of malnutrition or, conversely, overeating. This scoping review aims to provide an in-depth overview of the frequency, nature and factors related to food selectivity in children with autism.

AIM

To comprehensively review the literature on food selectivity in ASD.

METHODS

A systematic review of the literature was conducted using the PubMed, Web of Science and EBSCO databases, to identify articles published in English from 2014 until 2024. Studies on a sample diagnosed with ASD and food selectivity were included. The selected databases were chosen for their broad coverage of the scientific literature. These databases represent reliable sources of high-quality articles, ensuring a comprehensive and up-to-date search.

RESULTS

We evaluated 222 studies on food selectivity in autism, from which duplicates were removed and unrelated titles were filtered out. Finally, 9 articles were included in the review. Five articles provide a general overview of the phenomenon, analysing its nature and factors. Two studies delve into sensory sensitivity, in particular the impact of food textures, tastes and smells. Finally, two studies focus on problem behaviour during mealtimes.

CONCLUSION

Children with ASD have greater food selectivity than the neurotypical population. The diet should contain a greater variety of fruit, vegetables, yoghurt, while reducing the consumption of rice and pasta.

Lying behavior in adolescents with conduct disorder: An experimental study of the role of executive functioning

Children with conduct disorder (CD) are often reported to engage in higher rates of lying compared to their typically developing (TD) peers. However, there is a paucity of experimental evidence exploring the specific characteristics and underlying mechanisms driving the propensity for lying in this population. To address these gaps, this study aimed to investigate the relationship between executive functioning (EF) and lying behavior in adolescents with CD compared to TD adolescents. To assess spontaneous lying for personal gain, we used a spot-the-differences task with adolescents aged 13 to 16 (N = 115). EF abilities-including cognitive flexibility, inhibitory control, and working memory-were measured using the Trail Making Test, Color-Word Stroop Task, and Digit Span Test, respectively. We hypothesized that CD adolescents would lie more frequently for personal gain than TD adolescents. Additionally, we expected EF to negatively correlate with lying frequency in TD adolescents but positively correlate with lying frequency in CD adolescents. The results partially supported these hypotheses. While adolescents with CD did not lie significantly more often than TD adolescents, EF was differently related to lying frequency. Specifically, cognitive flexibility was positively associated with lying frequency in CD adolescents but was not significantly related to lying frequency in TD adolescents. Additionally, better inhibitory control was associated with less frequent lying across both groups. These findings provide new insights into the role of EF in adolescent dishonesty and suggest that EF may influence lying behavior differently in CD and TD populations.

Can attentional biases predict outcome of CBT in children with social anxiety disorder?

BACKGROUND

Many studies have investigated differences in attention allocation to threat between socially anxious individuals and healthy controls in adult and child samples. The extent to which differences exist within the group of socially anxious individuals and whether these have a predictive value for the extent of symptom reduction after cognitive-behavioral therapy (CBT) has been studied less until to date and yielded inconsistent findings, particularly in child samples.

METHODS

The present study investigated whether three different indices of biased attention, measured at pretreatment by eye-tracking, were associated with differences in response to a 12-session exposure-based group CBT in a sample of 41 children with social anxiety disorder (SAD).

RESULTS

In linear regression analyses neither initial vigilance nor initial maintenance nor attentional avoidance predicted symptom reductions after CBT. Children who no longer met diagnostic criteria after treatment did not differ from those who did not fully remit in terms of initial vigilance and attentional avoidance (d < .36). With regard to initial maintenance of attention to threat, the analysis revealed a large but statistically non-significant effect between both groups (d = .81).

CONCLUSION

Initial maintenance of attention to threat may be beneficial for the treatment of social anxiety. However, the evidence in our study is only weak and further research is needed before clear implications can be drawn.

Amphetamine increases timing variability by degrading prefrontal temporal encoding

Amphetamine is a commonly abused psychostimulant that increases synaptic catecholamine levels and impairs executive functions. However, it is unknown how acute amphetamine affects brain areas involved in executive control, such as the prefrontal cortex. We studied this problem in mice using interval timing, which requires participants to estimate an interval of several seconds with a motor response. Rodent prefrontal cortex ensembles are required for interval timing. We tested the hypothesis that amphetamine disrupts interval timing by degrading prefrontal cortex temporal encoding. We first quantified the effects of amphetamine on interval timing performance by conducting a meta-analysis of 15 prior rodent studies. We also implanted multielectrode recording arrays in the dorsomedial prefrontal cortex of 7 mice and then examined the effects of 1.5 mg/kg D-amphetamine injected intraperitoneally on interval timing behavior and prefrontal neuronal ensemble activity. A meta-analysis of previous literature revealed that amphetamine produces a large effect size on interval timing variability across studies but only a medium effect size on central tendencies of interval timing. We found a similar effect on interval timing variability in our task, which was accompanied by greater trial-to-trial variability in prefrontal ramping, attenuated interactions between pairs of ramping neurons, and dampened low-frequency oscillations. These findings suggest that amphetamine alters prefrontal temporal processing by increasing the variability of prefrontal temporal encoding. Our work provides insight into how amphetamine affects prefrontal activity, which may be useful in developing new neurophysiological markers for amphetamine use and novel treatments targeting the prefrontal cortex.

The relationship between parenting behavior, suicidal ideation, and suicide attempt across two population-based samples of adolescents

We examined the relationship between parenting, suicidal ideation (SI), and the transition from SI to suicide attempt (SA), and whether parenting behaviors moderate the associations of genetic liability for SA and/or painful and provocative events (PPEs) with SA risk. Participants included 6153 adolescents (48.3 % female, Mage at baseline = 9.47 years, followed over 3 years) from the Adolescent Brain Cognitive Development Study (ABCD) and 5942 adolescents (52.1 % female, Mage at baseline = 15.55 years, followed over 1 year) from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used logistic regression to test associations between parenting and SI/SA. Genetic liability and PPEs were included as potential predictors of SA. In ABCD, higher parental acceptance and monitoring were associated with lower risk for SI (odds ratios [ORs] = 0.7-0.9, ps < .01) but not SA (ORs = 0.9, ps > .05). Non-suicidal self-injury and parental knowledge of child SI were associated with elevated risk for SA (ORs = 2.6-2.8, ps < .01), but their interaction was non-significant (OR = 0.9, p = .85). In Add Health, maternal support was related to reduced SI risk (OR = 0.8, p < .01), but paternal support, and both parents' involvement and presence at home, were not (ORs = 0.9-1.0, ps > .05). Several PPEs were associated with higher SA risk (ORs = 1.3-2.0, ps < .05). These findings suggest that the parent-adolescent relationship may be more relevant to SI, rather than the transition from SI to SA.

Repetitive transcranial magnetic stimulation frequency effects on suicidal ideation in adolescents with major depressive disorder

Previous research has explored Transcranial Magnetic Stimulation (TMS) interventions for suicidal thoughts and behaviors. However, the optimal dose parameters for TMS interventions targeting suicidal ideation in adolescents remain unknown. This exploratory study examined the impact of 1 Hz and 10 Hz TMS treatment on suicidal ideation in adolescents with major depressive disorder. Participants (N = 41) aged 12-18 years were randomized to TMS treatments with 1 Hz or 10 Hz frequency over 6 weeks and included in the exploratory analyses. The change in the intensity of suicidal ideation throughout treatment was estimated with ordinal logistic regression models with and without adjustments for the change in depressive symptom severity. The predicted odds of intensity of suicidal ideation significantly decreased over six-weeks of acute TMS treatment for both the 10 Hz TMS group (OR = 0.754, 95 % CI = 0.634 to 0.897, p = 0.0015) and the 1 Hz TMS group (OR = 0.780, 95 % CI = 0.668 to 0.909, p = 0.0016). However, after adjustment for the change in depression severity as a time-varying covariate in the ordinal logistic regression model, the magnitude of the decrease (or predicted odds) in intensity of suicidal ideation was attenuated and rendered non-significant for both the 10 Hz and 1 Hz TMS groups. TMS treatment suicidal ideation outcomes were not significantly different between the 10 Hz and 1 Hz TMS groups. Low-frequency TMS may be as effective as high-frequency TMS in treating suicidal ideation in adolescents with depression. Notably, 1 Hz TMS may have a favorable tolerability and safety profile for adolescents.

An exploratory psychometric network analysis of depression scales in a sample of adolescents

BACKGROUND

There is heterogeneity in existing depression scales, which may lead to measurement bias. This study aimed to investigate the clustering of depressive symptoms in adolescents, including central symptoms as well as similarities and differences among four commonly used depression scales. Additionally, the study examined gender differences in network structures to explore the suitability of these scales.

METHODS

This study performed an exploratory psychometric network analysis of depression in 620 Chinese adolescents aged 15-17 years using R, which included four depression scales. The mean age of the adolescents was 15.95 ± 0.66 years. Among them, 279 (45.0 %) were boys, 316 (51.0 %) were girls, and 25 (4.0 %) did not report gender.

RESULTS

The network analysis revealed seven distinct symptom clusters among adolescents with depressive symptoms, including "Negative Emotions and Pessimism", "Loss of Positive Emotions", "Interpersonal Issues", "Retardation and Attention Issues", "Fear and Decision-making Difficulties", "Irritability or Stress" and "Low Self-esteem and Self-efficacy". These clusters varied in item distribution across the different scales. Moreover, network comparisons indicated notable gender differences in the structure of depressive symptom networks. Girls exhibited stronger associations between depressive symptoms, particularly concentrating core symptoms in clusters related to "Interpersonal Issues" and "Low Self-esteem and Self-efficacy".

CONCLUSION

Heterogeneity among depression scales may bias detection and identification in adolescents. Selecting appropriate scales based on participant characteristics and symptom clusters is essential. Furthermore, future screening and interventions should account for gender differences.

Relationship between facial emotion recognition and non-suicidal self injury in adolescents with depression: A multicenter cross-sectional study from China

OBJECT

Adolescent depression is highly co-occurring with non-suicidal self-injury (NSSI). Exploring the relationship between NSSI and facial emotion recognition is crucial for early intervention in adolescents with depression.

METHODS

This study used a multi-center cross-sectional design (14 psychiatric hospitals in 9 provinces of China). The Patient Health Questionnaire-9 (PHQ-9) and Functional Assessment of Self-Mutilation (FASM) were used to evaluate depression and NSSI respectively. Six emotions including neutral, angry, disgusted, fearful, happy, sad and surprised were used for testing. Spearman correlation analysis and binary logistic regression analysis were used to explore the relationship between NSSI and emotion recognition.

RESULTS

This study recruited 1644 adolescent depression patients, of whom 76.2 % (1252/1644) reported NSSI behavior and had significantly higher PHQ-9 scores than adolescents without NSSI behavior (p < 0.001). "Cut or carved on your skin" was more common in the choice of method (87.6 %). The age curve showed that girls have more NSSI in each age group, and the peak incidence of NSSI in girls was higher than that in boys. Compared with the non-NSSI group, the NSSI group exhibited higher accuracy in recognizing aversive emotions. In addition, PHQ-9 scores were significantly correlated with the recognition of neutral(P < 0.001), angry(P = 0.011), and happy(P = 0.008). Furthermore, PHQ-9 scores (P < 0.001) and Surprised facial emotion recognition scores (P = 0.026) showed significant correlations with NSSI behavior.

CONCLUSION

NSSI is common in adolescents with depression, and the emotional recognition ability of NSSI patients has decreased, especially in identifying neutral, happy, and angry emotions. Similarly, depression further exacerbates the risk of NSSI.

Influence of lifestyle and family environment factors on mental health problems in Hong Kong preschoolers

BACKGROUND AND AIMS

Existing studies that simultaneously consider the effects of lifestyle and family environment factors on mental health problems (MHPs), particularly in preschoolers, are limited. This study aims to explore lifestyle and family environment factors associated with MHPs, externalising problems (EPs) and internalising problems (IPs) in preschoolers.

METHODS

This territory-wide, school-based study conducted from 2020 to 2022 involved 1926 preschoolers. MHPs, EPs, and IPs and factors such as sleep duration, sleep latency, entertainment screen time, educational screen time, parent-child recreation and learning activities were assessed. Linear and logistic regression analyses were used to explore the relationships between these factors and MHPs, EPs, and IPs.

RESULTS

The average sleep duration was 9.94 h per day, average screen time of 2.53 h per day, and 42.6 % experienced sleep latency exceeding 20 min per day among preschoolers (mean age: 4.39 years, 49.1 % female). Adjusted analyses showed that decreased parent-child recreation activities, prolonged sleep latency and excessive entertainment screen time were associated with increased MHPs, EPs, and IPs (β: 0.05 to 0.20, all p < 0.05). Weekend sleep duration of <10 h per day, sleep latency of >20 min per day, and educational screen time of >30 min per day were identified as risk factors for MHPs, EPs, and IPs, with an adjusted odds ratio ranging from 1.32 to 2.32 (all p < 0.05).

CONCLUSIONS

Preschoolers' lifestyle and family environment factors are associated with MHPs, EPs, and IPs respectively. Ensuring adequate sleep duration, avoiding sleep latency exceeding 20 min per day, reducing entertainment screen time, limiting educational screen time to 30 min per day, and increasing parent-child interactions may help to minimise mental health problems.

Twins and virtual twins: Comparative analysis of problem behaviors

A study of factors affecting children's problem behaviors using two unique sibships, monozygotic twins adopted together from China (MZ-CTT twins) and virtual twins (same-age unrelated siblings reared together; VTs), is presented. MZ-CTT twins share genes and environments, whereas VTs share environments only, allowing assessment of how these factors influence behavioral difficulties. Participants (MZ-CTT: n = 43 pairs; VT: n = 41 pairs) were in ongoing studies of behavioral development at the Twin Studies Center at California State University, Fullerton. Mean ages were 7.00 years (SD = 2.59) for MZ-CTT pairs and 6.24 years (SD = 2.26) for VT pairs; MZ-CTT pairs were significantly (albeit only slightly) older. Parents completed demographic surveys and the Child Behavior Checklist for each child. The greater resemblance of age- and sex-corrected t scores of MZ-CTT pairs across Internalizing, Externalizing, and Total problem behavior scales (ris = .72, .71, and .77, respectively) compared with VT pair scores (ris = .25, .40, and .63, respectively) demonstrates genetic influence on these measures. VT pairs with a biological child and an adoptee showed greater resemblance than those with two adoptees. This probably reflects the correlation of biological children's genotype with the adoptees' environment. Regression analyses revealed that for MZ-CTT pairs less variance in problem behaviors was explained by parental variables, such as maternal education, relative to VT pairs. This result may speak to the greater heterogeneity of the backgrounds of VT participants. In summary, this study of two unique kinships shows that both genetic and environmental factors influence child behavioral problems. Future studies using novel and informative kinships are warranted.

Cumulative risk for comorbidity of depression and anxiety in young people

BACKGROUND

Depression and anxiety often co-occur, resulting in a more severe prognosis than either condition alone. Identifying the impact of risk factors on this comorbidity is essential for guiding early interventions.

METHOD

Data from 4563 young participants in the Growing Up in New Zealand (GUiNZ) longitudinal study were analysed to identify risk factors associated with comorbid depression and anxiety. Scores for depression and anxiety symptoms were converted into binary variables using the cut-off of 10 and 60, respectively, and then combined to create the comorbidity outcome. A Cumulative Risk (CR) score was used to measure the impact of multiple risk factors from prenatal to childhood on the likelihood of this comorbidity. CR scores were further grouped into three levels of risk, and their association with comorbidity was examined using univariable and multivariable logistic regression analyses.

RESULTS

The prevalence of comorbidity at age 12 years was 8.9% (406/4563). Among young people, 14.2% (647/ 4563) had no risk factors, 64.7% (2953/4563) had one to three (low CR score level), and 21.1% (963/4563) had four or more risk factors (high CR score level). In the adjusted analyses, young people in the low and high CR levels had 2.6 times and 4.6 times higher odds, respectively, of experiencing comorbidity compared to those with no risk factors.

DISCUSSION

The risk of comorbid depression and anxiety symptoms increases with the number of risk factors experienced from prenatal to childhood. Multi-faceted interventions targeting several risk factors are recommended to improve youth mental health.