Child and adolescent mental disorders: the magnitude of the problem across the globe

Drama Therapy for Children and Adolescents with Psychosocial Problems: A Systemic Review on Effects, Means, Therapeutic Attitude, and Supposed Mechanisms of Change

Drama therapy is applied to children and adolescents with psychosocial problems. Drama therapy is an experimental form of treatment which methodologically uses drama and theatre processes to achieve psychological growth. Although in clinical practice, drama therapy has been applied successfully, little is known about how and why drama therapy contributes to a decrease in psychosocial problems. A systematic narrative review was performed to obtain more insight into this issue. Eight databases were systematically searched. Ten out of 3742 studies were included, of which there were four random controlled trails, three non-controlled trials, and three pre-and post-test design studies. We identified the results, drama therapeutic means, attitude, and mechanism of change. Positive effects were found on overall psychosocial problems, internalizing and externalizing problems, social functioning, coping and regulation processes, social identity, and cognitive development. An adaptive approach was mentioned as the therapeutic attitude. The means established contribute to a dramatic reality, which triggers the mechanisms of change. These are processes that arise during treatment and which facilitate therapeutic change. We found ten supposed mechanisms of change to be frequently used in all studies. No direct relations were found between the results, drama therapeutic attitude, means, and mechanisms of change.

Exploring mental health interventions for youth in Southern Africa: A rapid review

A significant mental health treatment gap prevails in Southern Africa. Whilst some treatments exist for adults and school children, treatment options for young adults, at a particularly vulnerable time of life, are scarce. Understanding success mechanisms of existing youth mental health interventions is vital for informed development and scaling of interventions to address this critical gap. This rapid review identifies 27 recent health interventions addressing common youth mental disorders in Southern Africa. Eight studies that quantitatively measured success found significant mental health improvements as an intervention result. Studies that identified success via non-statistical means also found, albeit self-reported, generally favourable outcomes. No single best-practice intervention was identified to replicate throughout the region. Our review instead highlights three important mechanisms for intervention success: including youth in intervention design and delivery; indirectly addressing mental health; and developing multi-modal interventions. We recommend collaborative, ecological approaches to youth mental health interventions in Southern Africa.

The Short-Term Impact of a Combination Intervention on Depressive Symptoms Among School-Going Adolescent Girls in Southwestern Uganda: The Suubi4Her Cluster Randomized Trial

PURPOSE

This study aims to examine the short-term impact of a combined intervention consisting of evidence-based family economic empowerment (FEE) and multiple family group (MFG) interventions on depressive symptoms among school-going adolescent girls in southwestern Uganda.

METHODS

We analyzed longitudinal data from a cluster randomized trial. The sample consisted of 1,260 adolescent girls (aged 14-17 years at enrollment) recruited from senior one and senior two classes across 47 secondary schools in the southwestern region of Uganda. Participants were randomized at the school level to either the control condition receiving bolstered standard of care or one of the two treatment conditions-the treatment one condition receiving the FEE intervention or the treatment two conditions receiving both the FEE plus MFG interventions. Descriptive statistics and a three-level mixed-effects model were conducted to examine the effect of a combination intervention on depressive symptoms.

RESULTS

At baseline, there were no significant differences between the control condition and both treatment conditions. While all three groups experienced a substantial reduction in depressive symptoms from baseline to 12 months, the reductions were stronger for the two intervention groups. However, FEE + MFG was not significantly different from FEE at 12 months.

DISCUSSION

Results imply that the FEE intervention may be a promising tool in addressing depressive symptoms among adolescent girls. Therefore, to reduce the long-term implications of adverse psychosocial health during adolescence, policymakers and program implementers should explore scaling up economic empowerment interventions in similar settings to bridge the mental health treatment gap for adolescent girls.

Association between Physical Fitness Index and Psychological Symptoms in Chinese Children and Adolescents

The aim of this study was to determine the relationship between different physical fitness indices (PFIs) and psychological symptoms and each dimension (emotional symptoms, behavioral symptoms, social adaptation difficulties) of Chinese children and adolescents. Methods: A total of 7199 children and adolescents aged 13−18 in Jiangxi Province, China, were tested for grip strength, standing long jump, sit-ups, sit and reach, repeated straddling, 50 m run, 20 m shuttle run test (20 m SRT) items. The physical fitness indicators were standardized, converted to Z score and added up to obtain the PFI, and the self-assessment of the psychological section of the multidimensional sub-health questionnaire of adolescents (MSQA) to test the psychological symptoms, using the chi-square test to determine the psychological symptoms of different types of children and adolescents and binary logistic regression analysis to determine the association between psychological symptoms and different PFI grades. Results: The higher the PFI of Chinese children and adolescents, the lower the detection rate of psychological symptoms, emotional symptoms and social adaptation difficulties, from 25.0% to 18.4%, 31.3% to 25.7% and 20.1% to 14.4%, respectively. These results were statistically significant (χ2 = 14.073, 9.332, 12.183, p < 0.05). Taking the high-grade PFI as a reference, binary logistic regression analysis was performed. Generally, compared with the high-grade PFI, children and adolescents with a low-grade PFI (OR = 1.476, 95% CI: 1.200−1.814) or medium-grade PFI (OR = 1.195, 95% CI: 1.010−1.413) had a higher risk of psychological symptoms (p < 0.05). Conclusions: The lower the PFI of Chinese children and adolescents, the higher the detection rate of psychological symptoms, showing a negative correlation. In the future, measures should be taken to improve the physical fitness level of children and adolescents in order to reduce the incidence of psychological symptoms and promote the healthy development of children and adolescents.

Systematic Review of Mindfulness-Based Interventions in Child-Adolescent Population: A Developmental Perspective

Human development implies deep changes in cognitive, attentional, emotional, and behavioral skills. Therefore, Mindfulness-Based Interventions (MBIs) should be adapted in terms of dose, frequency, kind of exercises, assessment methods, and expected effects regarding the abilities and limitations of each developmental period. The present review seeks to describe and compare MBIs characteristics, assessment methods, and effects in youth between 3 and 18 years old considering four developmental periods. A systematic review was carried out including experimental primary studies published during the last five years. Results show that the frequency of the sessions and program duration varies widely. Differences were observed in instructors’ training and in assessment strategies. Discrepancies were observed regarding the effects of MBIs both within and between periods in cognitive, socio-emotional, symptoms, and mindfulness variables. Consistency was observed in prosocial behaviors for preschoolers, and in emotional and behavioral problems and hyperactivity in ages between preschool and early adolescence. Nevertheless, it was impossible to compare most results and determine consistency or discrepancy due to the lack of studies. Regarding mindfulness, it is defined and assessed in different ways in each period. Orientations are suggested to move from a compartmentalized view of isolated MBIs, towards an integrative perspective that allows tracing developmental trajectories for mindfulness and other key cognitive and socioemotional skills for children and adolescents.

A Longitudinal Process Model Evaluating the Effects of Cooperative Learning on Victimization, Stress, Mental Health, and Academic Engagement in Middle School

Mental health is a significant concern among young people, particularly during the COVID-19 pandemic. Notably, mental health problems can significantly reduce student performance in school, including both engagement and achievement. Both mental health problems and reduced student performance often arise due to peer victimization, which can include teasing, racial- or gender-based discrimination, and/or physical assault. Stress has been proposed as one mechanism through which victimization influences mental health, and stress can also interfere with academic performance at school, including engagement and achievement. To date, however, no research has evaluated longitudinal associations between victimization and stress, and how these longitudinal patterns may impact adolescent behavior and mental health. In this study, we used data from a 2-year cluster randomized trial of cooperative learning to evaluate an etiological process model that includes (1) longitudinal reciprocal effects between victimization and stress, and (2) the effects of both victimization and stress on student mental health and academic engagement. We hypothesized that victimization and stress would have significant reciprocal effects, and that both would predict greater mental health problems and lower academic engagement. We further hypothesized that cooperative learning would have significant effects on all constructs. We found partial support for this model, whereby stress predicted greater victimization, but victimization did not predict increased stress. While both factors were linked to student outcomes, stress was a more powerful predictor. We also found significant salutary effects of cooperative learning on all constructs. The implications of these results for student behavioral and mental health are discussed.

Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress

Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.

Analysis of Attempted Suicide in a Pediatric Setting: Extracted Notes for Clinical Practice and Complexity of Help

Background and Objectives: Suicidality among adolescents is a global mental health issue. However, the post-suicidal care of minors is insufficient and lacks complexity, as repeated attempts occur. Further, little is known about the social (i.e., family setting) and psychological (for example, exposure to bullying, suicidality, or addiction within a close environment) backgrounds of minors who engage in suicidal behavior in Lithuania. Thus, the aim of our study was to evaluate and compare psychosocial factors that may influence minors’ decisions to attempt suicide for the first time and then repeatedly and to extract notes for future clinical practice. Materials and Methods: Data from 187 cases of suicide attempts by minors treated at the Children’s Hospital of Vilnius University Santara Clinics from January 2011 to January 2018 was obtained and analyzed. Results: The data showed that 48.7% of minors hospitalized because of a suicide attempt had a history of previous suicide attempts. Minors who attempted suicide repeatedly were more often engaged in non-suicidal self-injurious behavior (p = 0.033). Further, a small number had experienced suicide within their close surroundings (p = 0.045). The comparative analysis did not reveal any significant differences in psychosocial backgrounds between first-time attempters and those who attempted suicide for at least a second time. Conclusions: Social and psychological support after a suicide attempt in a pediatric setting is lacking efficiency, as minors who repeatedly attempt suicide suffer from similar psychosocial burdens. Complex and targeted follow-up care is needed.

Community Mental Health Services in Egypt

As far back as the 14th Century, Egypt had already developed mental health care in a community-based sense in Kalaoon Hospital in Cairo, 600 years before similar institutions were founded across the globe. By 2001, an Egyptian-Finnish bilateral comprehensive reform program was incorporated. A few years later, in 2007, the Minister of Health and Population initiated a proper appraisal of the mental health services in Egypt, which was aimed at achieving better integration and coordination in the mental health sector, as well as supervision and training on the national, governmental, and primary care levels. By 2009, the Mental Health Act of 2009 (Law 71) brought basic conceptual changes to the care of people with a mental illness in Egyptian institutions, replacing the outdated 1944 law that had been used in Egypt for decades. However, despite all of the important steps Egypt is taking to move toward more integrated mental health services, more effort and resources are still needed to fight against stigma and to develop a comprehensive multidisciplinary approach that is approachable and effective to all those who need it.

Adolescent perspectives on depression as a disease of loneliness: a qualitative study with youth and other stakeholders in urban Nepal

BACKGROUND

There is a lack of research on the adolescent experience of depression in low- and middle-income countries. Criteria derived from research conducted primarily among adult Western populations inform current diagnostic standards for depression. These clinical categories are often used without exploration of their relevance to adolescent experience. Also, reliance on these categories may overlook other symptoms of depression that manifest in non-western settings. Cross-cultural qualitative work with adults in non-Western settings has suggested some differences with experience of depression and symptoms that are most relevant to service users. Research into adolescent experiences of depression is warranted to inform the development of effective interventions.

METHODS

Qualitative interviews were conducted in Nepal with adolescents with depressive symptoms (n = 9), healthy adolescents (n = 3), parents (n = 6), teachers (n = 10), social workers (n = 14), primary (n = 6) and mental (n = 6) healthcare providers, and policymakers (n = 6). Two focus groups were conducted with parents (n = 12) of depressed and non-depressed adolescents. Data were analyzed according to the framework approach methodology.

RESULTS

Loneliness was the hallmark experience that stood out for all adolescents. This was connected with 5 other clusters of symptoms: low mood and anhedonia; disturbances in sleep and appetite, accompanied by fatigue; irritability and anger; negative self-appraisals including hopelessness and self-doubt; and suicidality. Adolescents distinguished depression from other forms of stress, locally referred to as tension, and described depression to involve having "deep tension." Perceived causes of depression included (1) Family issues: neglectful or absent parents, relationship problems, and family discord; (2) Peer relationships: romantic problems, bullying, and friendship problems; and (3) Social media: social comparison, popularity metrics, cyberbullying, and leaking of personal information.

CONCLUSIONS

Consistent with other cross-cultural studies, loneliness was a core element of the adolescent experience of depression, despite its absence as a primary symptom in current psychiatric diagnostic classifications. It is important to note that among youth, symptoms were clustered together and interrelated (e.g., sleep and appetite changes were connected with fatigue). This calls for the need for more cross-cultural qualitative research on experience of depression among adolescents, and potential for modification of diagnostic criteria and prevention and treatments to focus on the experience of loneliness.

Impairment of spatial memory and dorsal hippocampal synaptic plasticity in adulthood due to adolescent morphine exposure

Opioid exposure during adolescence, a crucial period of neurodevelopment, has lasting neurological and behavioral consequences and affects the cognitive functions in adulthood. This study investigated the effects of adolescent morphine exposure in spatial learning and memory and synaptic plasticity of the CA1 area of the dorsal hippocampus. Adolescent Wistar rats received increasing doses of morphine for 1, 5, and 10 days. Acute morphine group was injected 2.5 mg/kg morphine for 1 day, subchronic morphine group for 5 days, with an increasing dose of 2.5 mg/kg and reached to the dose of 12.5 mg/kg and chronic morphine group for 10 days that began with an increasing dose of 2.5 mg/kg and reached to the dose of 25 mg/kg. Then after 25 days and reaching adulthood, spatial learning and memory were evaluated via the Morris water maze (MWM) test. Moreover, we test the electrophysiological properties of dorsal hippocampal plasticity in adult rats by in vitro field potential recordings. Subchronic and chronic adolescent morphine exposure impaired spatial learning and memory in the MWM test. Baseline synaptic responses in the chronic morphine group were increased and long-term potentiation (LTP) impaired in the CA1 area in subchronic and chronic morphine groups. In adulthood, the slope of the field excitatory postsynaptic potential (fEPSP) required to elicit a half-maximal population spike (PS) amplitude was significantly larger in subchronic and chronic adolescent morphine exposure compared to the saline group. Therefore, subchronic and chronic adolescent morphine exposure altered synaptic transmission and plasticity in addition to learning and memory. Long-term morphine exposure during adolescence can interfere with neurodevelopment, making a persistent impression on plasticity and cognitive capability in adulthood.

Effect of COVID-19 infection on psychological aspects of pre-schooler children: a cross-sectional study

Background

Coronavirus disease 2019 (COVID-19) had a tremendous effect on individual’s lives worldwide. The pandemic’s significant socioecological impact is one of the many burdens children confront in the current crises. As a result, this study was designed to determine the psychological impacts of the COVID-19 pandemic on preschoolers, particularly the consequences of COVID-19 infection. This study involved 138 children aged 2–5.11 years old who were classified into two groups based on their COVID-19 infection history, which was documented via a PCR test. All participants were assessed by the Socioeconomic Scale and The Children’s Behavior Checklist (CBCL).

Results

COVID-19 infection was found in 21.7% of the children who participated in this study. Furthermore, children with COVID-19 had a higher percentage of clinical rating on the CBCL Profile of DSM-5 scales for affective problems (13.3 vs. 7.4%), anxiety problems (13.3 vs. 9.3%), pervasive developmental problems (20 vs. 13%), and oppositional defiant problems (6.7 vs. 5.6%) than children without COVID-19. Anxiety and somatic problems had a positive correlation with the impact of the COVID-19 pandemic on the lives of children.

Conclusions

Children infected with COVID-19 were more likely to have psychological issues, such as affective disorders, anxiety problems, pervasive developmental problems, and oppositional defiant problems. These psychological issues had a relationship with the impact of the COVID-19 pandemic on the lives of children.

Access to and Quality of Neighbourhood Public Open Space and Children’s Mental Health Outcomes: Evidence from Population Linked Data across Eight Australian Capital Cities

Neighbourhood-level interventions offer a promising opportunity to promote child mental health at a population level; however, neighbourhood effects are still regarded as a ‘black box’ and a better understanding of the specific design elements, such as public open space, is needed to inform actionable policy interventions. Methods: This study leveraged data from a population linked dataset (Australian Early Development Census—Built Environment) combining information from a national census of children’s developmental outcomes with individualised geospatial data. Associations between access to (within 400 m and 800 m from home), and quality of, public open space and child mental health outcomes across eight capital cities were estimated using multilevel logistic regression models, adjusting for demographic and contextual factors. Access was defined based on proximity of public open space to children’s home addresses, within distance thresholds (400 m, 800 m) measured along the road network. Effect modification was tested across maternal education groups. Results: Across the eight capital cities, inequities in access to child friendly public open spaces were observed across maternal education groups and neighbourhood disadvantage quintiles. Children with access to any type of public open space within 800 m of home had lower odds of demonstrating difficulties and higher odds of competence. Children with access to child friendly public open spaces within 800 m of home had the highest likelihood of demonstrating competence. Conclusion: Improving access to neighbourhood public open space appears to be a promising strategy for preventing mental health difficulties and promoting competence in early childhood. Action is needed to redress socio-spatial inequities in access to child friendly public open space.

Comparative effectiveness of in-person vs. remote delivery of the Common Elements Treatment Approach for addressing mental and behavioral health problems among adolescents and young adults in Zambia: protocol of a three-arm randomized controlled trial

BACKGROUND

In low- and middle-income countries (LMIC), there is a substantial gap in the treatment of mental and behavioral health problems, which is particularly detrimental to adolescents and young adults (AYA). The Common Elements Treatment Approach (CETA) is an evidence-based, flexible, transdiagnostic intervention delivered by lay counselors to address comorbid mental and behavioral health conditions, though its effectiveness has not yet been tested among AYA. This paper describes the protocol for a randomized controlled trial that will test the effectiveness of traditional in-person delivered CETA and a telehealth-adapted version of CETA (T-CETA) in reducing mental and behavioral health problems among AYA in Zambia. Non-inferiority of T-CETA will also be assessed.

METHODS

This study is a hybrid type 1 three-arm randomized trial to be conducted in Lusaka, Zambia. Following an apprenticeship model, experienced non-professional counselors in Zambia will be trained as CETA trainers using a remote, technology-delivered training method. The new CETA trainers will subsequently facilitate technology-delivered trainings for a new cohort of counselors recruited from community-based partner organizations throughout Lusaka. AYA with mental and behavioral health problems seeking services at these same organizations will then be identified and randomized to (1) in-person CETA delivery, (2) telehealth-delivered CETA (T-CETA), or (3) treatment as usual (TAU). In the superiority design, CETA and T-CETA will be compared to TAU, and using a non-inferiority design, T-CETA will be compared to CETA, which is already evidence-based in other populations. At baseline, post-treatment (approximately 3-4 months post-baseline), and 6 months post-treatment (approximately 9 months post-baseline), we will assess the primary outcomes such as client trauma symptoms, internalizing symptoms, and externalizing behaviors and secondary outcomes such as client substance use, aggression, violence, and health utility. CETA trainer and counselor competency and cost-effectiveness will also be measured as secondary outcomes. Mixed methods interviews will be conducted with trainers, counselors, and AYA participants to explore the feasibility, acceptability, and sustainability of technology-delivered training and T-CETA provision in the Zambian context.

DISCUSSION

Adolescents and young adults in LMIC are a priority population for the treatment of mental and behavioral health problems. Technology-delivered approaches to training and intervention delivery can expand the reach of evidence-based interventions. If found effective, CETA and T-CETA would help address a major barrier to the scale-up and sustainability of mental and behavioral treatments among AYA in LMIC.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03458039 . Prospectively registered on May 10, 2021.

High temperatures trigger suicide mortality in Brussels, Belgium: A case-crossover study (2002-2011)

BACKGROUND

Temperature may trigger the risk of suicide, however, the extent and shape of the associations show geographical variation. Here, we investigate the short-term effects of temperature on suicide deaths occurring in Brussels between January 1st, 2002 and December 31st, 2011.

METHODS

We conducted a bidirectional time-stratified case-crossover study with cases being suicide deaths occurring among Brussels residents aged 5 years or older. Cases were matched by day of the week with control days from the same month and year. The exposure was the daily average temperature measured at the Uccle station (Brussels) and obtained from the Belgian Royal Meteorological Institute. We combined conditional logistic regression with distributed lag non-linear models (DLNM) to obtain one week (lag 0-6) cumulative risk ratios (RR) and their 95% confidence intervals (CI) for the effects of moderate and extreme cold (5th and 1st percentiles of temperature, respectively) and moderate and extreme heat (95th and 99th percentiles of temperature, respectively), relative to the median temperature.

RESULTS

In total, 1891 suicide deaths were included. The median temperature was 11.6 °C, moderate and extreme cold temperatures were 0 and -3.1 °C, respectively, and moderate and extreme high temperatures were 20.9 and 24.4 °C, respectively. The cumulative risk of suicide mortality was almost twice higher among lags 0 to 6 for both moderate and extreme heat, relative to the period median temperature (e.g. moderate heat RR = 1.80 CI:1.27-2.54). No statistically significant associations were observed for cold temperatures.

CONCLUSIONS

In Brussels, a western European city with temperate climate, high temperatures may trigger suicide deaths up to one week later. In the context of climate change, adaptation strategies must take into consideration the effects of temperature on mental health.

The Roles of Adherence and Usage Activity in Adolescents' Intervention Gains During Brief Guided Online Acceptance and Commitment Therapy

OBJECTIVE

This study investigated the roles of adherence and usage activity in adolescents' (n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT).

METHOD

Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention.

RESULTS

First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K-means cluster analysis in regard to adherence, usage activity and intervention gains: (1) "Adhered, committed users with relatively large intervention gains" (35%), (2) "Less committed users with no intervention gains" (42%), and (3) "Non-committed users with no intervention gains" (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion.

CONCLUSIONS

The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.

Does exposure to greenness improve children's neuropsychological development and mental health? A Navigation Guide systematic review of observational evidence for associations

BACKGROUND

Contact with nature may have a key role in child brain development. Recent observational studies have reported improvements in children's neuropsychological development and mental health associated with greenness exposure. In a rapidly urbanizing word, researchers, policymakers, healthcare workers and urban planners need to work together to elaborate evidence-based policies and interventions to increase the availability of quality green space with the potential to enhance childhood development.

OBJECTIVE

To review the observational evidence assessing the effect of exposure to greenness on children's neuropsychological development and mental health.

METHODS

The protocol for the review was preregistered at PROSPERO (CRD42020213838). The Navigation Guide systematic review methodology was followed. Search strategies were formulated and adapted to each database. Searches were performed in PubMed, Scopus, Web of Science and EBSCO's GreenFILE on October 5, 2021. Additional articles were further identified by hand-searching reference lists of included papers.

RESULTS

A systematic search of 4 databases identified 621 studies, of which 34 were included in the review. The studies included investigated diverse domains within neuropsychological development and mental health, such as attention, working memory, intelligence, cognitive development, academic performance, well-being, attention-deficit/hyperactivity disorder symptoms, and behavior. Most of the studies were rated as having high or probably high risk of bias in the assessment.

DISCUSSION

Although nearly all studies showed a positive association between greenness exposure and the outcomes studied, the heterogeneity in the methods used to assess exposure and the diversity of domains within each main outcome has made it difficult to draw clear conclusions. Future studies should adopt a longitudinal design to confirm the causality of the associations and include measures to determine which characteristics of greenness have the greatest influence on each domain. Researchers should also try to explore pathways linking exposure to greenness with the neuropsychological development and mental health, by implementing mechanistic studies.

A Protective Factor for Emotional and Behavioral Problems in Children: The Parental Humor

In order to prevent the development of emotional and behavioral problems, risk and protective factors must be identified. This study aims to establish a link between perceived parental humor and children mental health. The sample comprises 762 pupils aged 10 to 15 (M = 12.23; SD = 1.12), who completed self-reports evaluating perceived parental humor (EEE-H) and their own emotional and behavioral strengths and difficulties (SDQ). The results indicate that parental humor is negatively associated with internalizing problems in children; no association with externalizing problems is observed. According to the study, girls who perceive low parental humor are the most likely to display internalizing problems, while girls perceiving high parental humor are the least likely to do so. Parental humor, characterized by calmness, cheerfulness, and optimism, is a protective factor against internalizing problems in children, especially girls. We recommend training for parents and training and intervention programs for families to encourage activities that boost parental humor.

Validation of the coping self-efficacy scale: Vietnamese version for adolescents

BACKGROUND

This study aimed to examine the construct validity of the Coping Self-Efficacy Scale-Vietnamese Version (CSES-V) among Vietnamese adolescents.

METHODS

This study selected Grade 10 students from eight schools in Hanoi using a multiple-stage sampling method. Multiple aspects of the construct validity were examined including: factorial structure (evaluated using exploratory factor analysis); internal consistency (tested using Cronbach's alpha coefficient); measurement invariance between male and female participants and longitudinal measurement invariance (tested by employing multiple group confirmatory factor analysis) and external aspect (tested using Pearson's correlation coefficients between CSES-V and the Depression Anxiety and Stress Subscales of Depression (DASS21-D), Anxiety (DASS21-A), and Stress (DASS21-S) and a measure of mental well-being, Mental Health Continuum Short Form (MHC-SF)).

RESULTS

A total of 1082 adolescents (aged 14-16 years) was included in this study. Data supported a three-factor structure (comprising 24 items) that explained 97.6% of the total variance of the CSES-V. Cronbach's alpha coefficients of all three factors were acceptable. All levels of measurement invariance between male and female participants and longitudinal measurement invariance were well-supported. The three factors of the CSES-V were positively correlated with MHC-SF and were negatively correlated with the DASS21 subscales at a low or moderate level, supporting the external aspect of the construct validity.

CONCLUSIONS

CSES-V is recommended to assess coping self-efficacy among Vietnamese adolescents who are attending school.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions

The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.

Features of Psychomotor Coordination in Adolescents with Neuropsychiatric Pathology Enrolled in a Standard Educational Program

The imbalance between the speed and accuracy of cognitive-motor operations can lead to the formation of abnormal behavioral programs fraught with serious negative consequences for the individual. For successful correction and prevention of social disadaptation in adolescents with nervous and mental diseases and functional disorders in mental sphere in general education schools, the peculiarities of their psychomotor activity should be taken into account. We measured some parameters of visual-motor coordination and sensorimotor reaction in adolescents with mental disorders with (n = 36) or without (n = 27) organic brain damage. Adolescents from both groups showed higher speed, but poorer accuracy and smoothness, of movements than typically developing students (n = 70). The visual and acoustic reaction times were longer in adolescents with mental disorders without organic brain damage than in reference groups.

Prevalence of Mental Health Disorders Among Immigrant, Refugee, and Nonimmigrant Children and Youth in British Columbia, Canada

Importance

There remains limited understanding of population-level patterns of mental disorder prevalence for first- and second-generation immigrant and refugee children and youth and how such patterns may vary across mental disorders.

Objective

To examine the diagnostic prevalence of conduct, attention-deficit/hyperactivity disorder (ADHD), and mood/anxiety disorders in immigrant, refugee, and nonimmigrant children and youth in British Columbia, Canada.

Design, Setting, and Participants

This retrospective, population-level cohort study examined linked health administrative records of children and youth in British Columbia (birth to age 19 years) spanning 2 decades (1996-2016). Physician billings, hospitalizations, and drug dispensations were linked to immigration records to estimate time-in-British Columbia-adjusted prevalence of mental disorder diagnosis among children and youth from immigrant or refugee backgrounds compared with those from nonimmigrant backgrounds. Analyses were conducted from August 2020 to November 2021.

Main Outcomes and Measures

The diagnostic prevalence of conduct, ADHD, and mood/anxiety disorders were the main outcomes. Results were stratified by migration category (immigrant, refugee, nonimmigrant), generation status (first- and second-generation), age, and sex.

Results

A total of 470 464 children and youth in British Columbia were included in the study (227 217 [48.3%] female). Nonimmigrant children and youth represented 65.5% of the total study population (307 902 individuals). Among those who migrated, 142 011 (87.8%) were first- or second-generation immigrants, and 19 686 (12.2%) were first- or second-generation refugees. Diagnostic prevalence of mental disorders varied by migration category, generation status, age, and sex. Children and youth from immigrant and refugee backgrounds (both first- and second-generation), compared with nonimmigrant youth, generally had a lower prevalence of conduct disorder (eg, age 6-12 years: first-generation immigrant, 2.72% [95% CI, 2.56%-2.90%] vs nonimmigrant, 7.03% [95% CI, 6.93%-7.13%]), ADHD (eg, age 6-12 years: first-generation immigrant, 4.30% [95% CI, 4.10%-4.51%] vs nonimmigrant, 9.20% [95% CI, 9.08%-9.31%]), and mood/anxiety disorders (eg, age 13-19 years: first-generation immigrant, 11.07% [95% CI, 10.80%-11.36%] vs nonimmigrant, 24.54% [95% CI, 24.34%-24.76%]). Among immigrant children and youth, second-generation children and youth generally showed higher prevalence of conduct, ADHD, and mood/anxiety disorders than first-generation children and youth (eg, ADHD among second-generation immigrants aged 6-12 years, 5.94% [95% CI, 5.75%-6.14%]; among first-generation immigrants aged 6-12 years, 4.30% [95% CI, 4.10%-4.51%]). Second-generation refugee children had the highest diagnostic prevalence estimates for mood/anxiety in the 3-to-5-year age range relative to first- and second-generation immigrant and nonimmigrant children (eg, second-generation refugee, 2.58% [95% CI, 2.27%-2.94%] vs second-generation immigrant, 1.78% [95% CI, 1.67%-1.89%]). Mental disorder diagnoses also varied by age and sex within immigrant, refugee, and nonimmigrant groups.

Conclusions and Relevance

These findings show differences in diagnostic mental disorder prevalence among first- and second-generation immigrant and refugee children and youth relative to nonimmigrant children and youth. Further investigation is required into how cultural differences and barriers in accessing health services may be contributing to these differences.

Self-control, Mental Health Problems, and Family Functioning in Adolescence and Young Adulthood: Between-person Differences and Within-person Effects

Adolescents' self-control develops in the context of mental health and family functioning, but it is unclear how the interplay of self-control, mental health, and family functioning unfolds across time within individuals. Separating within-person from between-person effects, random-intercept cross-lagged panel models were applied to adolescents (from ages 11 to 26) from a Dutch cohort (n = 2228, 51% female). Adolescents with low self-control were likely to have mental health problems and poorly functioning families. Although within-person changes in the study variables were not meaningfully associated in a reciprocal manner, changes in self-control and mental health were concurrently associated. This suggests that besides stable connections between self-control, mental health, and family functioning in adolescence and young adulthood, changes in self-control and mental health are developmentally linked as well.

Schulische Prädiktoren für psychische Auffälligkeiten bei Kindern und Jugendlichen anhand einer Befragung von Schülerinnen und Schülern an Klinik- und Regelschulen

Zusammenfassung. Ungefähr ein Fünftel aller Kinder und Jugendlichen zeigt psychische Auffälligkeiten, doch nur ein geringer Teil der Betroffenen erhält professionelle Hilfe. Häufig gehen mit psychischen Beeinträchtigungen auch gravierende schulische Probleme einher. In dieser Studie untersuchten wir, ob es schulische Merkmale von Schülerinnen und Schülern gibt, die Hinweise auf eine psychische Auffälligkeit liefern können. Dazu wurden 185 Klinikschülerinnen und -schüler und 387 Schülerinnen und Schüler an Regelschulen zu ihrer schulischen Situation befragt. Außerdem wurde der Strengths and Difficulties Questionnaire (SDQ) genutzt, um eine Vergleichsgruppe mit ausschließlich psychisch unauffälligen Schülerinnen und Schülern bilden zu können. Wir verwendeten ein logistisches Regressionsmodell, um herauszufinden, welche Antwortitems eine gute Vorhersage auf psychische Auffälligkeiten ermöglichten. Der Klassifikator war in der Lage, psychisch auffällige und unauffällige Schülerinnen und Schüler mit hoher Genauigkeit zu unterscheiden (Genauigkeit .83, Sensitivität: .76; Spezifität: .87). Die Klassifikation basierte dabei – anders als vermutet werden könnte – nicht primär auf Aussagen zum Lern- und Leistungsverhalten der Schülerinnen und Schüler, sondern auf Aussagen zu schulvermeidendem Verhalten und ihrer sozialen Integration. Diese schulischen Prädiktoren waren auch unter Kontrolle von Alter und Geschlecht sehr stabil. Die Ergebnisse deuten darauf hin, dass Lehrkräfte eine bedeutsame Rolle bei der Früherkennung von psychischen Auffälligkeiten einnehmen können.

Quantile regression analysis of the association between parental rearing and interpersonal sensitivity in Chinese adolescents

BACKGROUND

Parental rearing is well documented as an important influencing factor of interpersonal sensitivity (IS). However, little research has focused on the extent by which various aspects of parental rearing in fluence IS. This study aimed to analyze the effects of parental rearing on IS, using quantile regression. We analyzed the extent of the influence of parental rearing on IS by quantile regression to provide definitive evidence on the family education of adolescents with IS problems.

METHODS

The multiple cross-sectional studies were conducted among 3345 adolescents from Harbin, China, in 1999, 2006, 2009 and 2016. Furthermore, a multistage sampling method (stratified random cluster) was used to select participants. IS was assessed using a subscale of the Symptom Checklist-90-Revision. Perceived parental rearing was assessed using the Egna Minnen av. Barndoms Uppfostran. The ordinary least squares (OLS) linear regression was used to determine the average effect of parental rearing on IS. The quantile regression was conducted to examine the established associations and to further explain the association.

RESULTS

Paternal emotional warmth was found to be associated with IS across the quantile, especially after the 0.6 quantiles; however, this association was not found for maternal emotional warmth. Paternal punishment was associated with IS at the 0.22-0.27 and 0.60 quantile; however, maternal punishment had no significant effect on IS. QR method found that paternal overinvolvement was associated with IS at the 0.48-0.65 quantiles, but paternal overprotection was associated with IS across the quantile; however, maternal overinvolvement and overprotection was positively correlated with IS at the 0.07-0.95 quantiles. The correlation between paternal rejection and IS was found at the 0.40-0.75 and > 0.90 quantiles; maternal rejection was associated with IS within the 0.05-0.92 quantiles.

CONCLUSIONS

Parental rearing practices predict different magnitudes of IS at varying levels. This study provides suggestions for parents to assess purposefully and systematically, intervene, and ameliorate adolescent IS problems. We also highlight the role of paternal rearing in children's IS problems, providing new ideas for family education.

Selection of Pediatric Mental Health Quality Measures for Health System Improvement in British Columbia Based on a Modified Delphi Approach

BACKGROUND

The COVID-19 pandemic has highlighted the importance of mental wellbeing. The identification and implementation of quality measures can improve health outcomes and patient experience. The objective was to identify and define a core set of valid and relevant pediatric mental health quality measures that will support health system evaluation and quality improvement in British Columbia, Canada.

METHODS

The study consisted of four phases. First, a comprehensive database search identified valid pediatric quality measures focused on mental health and substance use (MH/SU). Second, the identified quality measures were mapped to focus areas, which were then prioritized by two stakeholder groups consisting of 26 members. Third, up to two representative measures for each prioritized focus area were pre-selected by an expert panel (n = 9). And fourth, a three-step modified Delphi approach was employed to (1) assess each quality measure on a 7-point Likert scale against three relevance criteria (representative of a quality problem, value to intended audience and actionable), (2) discuss the results, and (3) select and rank the most relevant measures. Forty-eight stakeholders were invited to participate; of those 24 completed the round 1 survey, 21 participated in the round 2 discussion and 18 voted in the round 3 selection and ranking survey. For round 1, consensus was determined when at least 70% of the response rates were within the range of five to seven. For round 3, Kendall's coefficient of concordance W was used as an estimator of inter-rater reliability.

RESULTS

One-hundred pediatric mental health quality measures were identified in the database search. Of those, 37 were mapped to ten focus areas. Pre-selection resulted in 19 representative measures moving forward to the Delphi study. Eleven measures met the consensus thresholds and were brought forward to the round 2 discussion. Round 3 ranking showed moderate to strong raters' agreement (Kendall's W = 0.595; p < 0.01) and resulted in the following five highest-ranked measures: level of satisfaction after discharge from inpatient admission due to MH/SU, number of patients experiencing seclusion or restraint, length of time from eating disorder referral to assessment, number of ED visits due to MH/SU, and number of readmissions to ED.

CONCLUSION

The selected core set of valid and relevant pediatric quality measures will support sustainable system change in British Columbia. The five top-ranked measures will be refined and tested for data collection feasibility before being implemented in the province.

Designing a Tool to Address the Depression of Children During Online Education

Advances in communication and information technology have changed the way humans interact. During the COVID-19 pandemic, the technology for communication has caused depression and anxiety, including among children and teens. Depression among children and teens may go unrecognized and untreated, as parents and teachers may have difficulty recognizing the symptoms. COVID-19 has changed traditional learning methods, forcing children to stay home and connect through online education. Although some children may function reasonably well in less-structured environments, many children with significant depression suffer a noticeable change in social activities, loss of interest in an online school, poor online academic performance, or changes in appearance. Home quarantine has affected children's mental health, and it has become challenging for school counselors to predict depression in many children participating in online education. This study aims to design and develop a tool for predicting depression among children aged 7 to 9 years old by recording students' online classes and sending a note to the child's academic file. The idea of needing this tool arose as an output for applying the design thinking approach to the online education website during COVID-19. This inspired the authors to combine the lecture recordings and the prediction of depression into one tool. Image processing techniques are applied to generate the results predicted by the model on the collected videos. The overall accuracy for classifying depressed and not depressed videos is 89%.

Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder

PURPOSE

Nightmare is common and is also independently implicated in suicide risk among the adolescent population. Adolescents with major depressive disorder (MDD) are at an increased risk of suicide. Therefore, comorbid nightmares may amplify suicide risk among this clinical population. This study aimed to explore the effects of nightmares on suicide risk among adolescents with MDD.

PATIENTS AND METHODS

Subjects were 499 outpatients aged 12-18 in four large psychiatric hospitals clinic of China, from January 1 to October 31, 2021. Simultaneously, we matched 499 healthy controls according to gender and age. All participants underwent affective state (depressive and anxiety symptoms) and sleep variable (nightmare frequency/distress, insomnia symptoms, and daytime sleepiness) evaluation as well as MDD diagnoses and determination of suicide risk by a fully structured diagnostic clinical interview.

RESULTS

Adolescents with MDD reported a higher incidence of frequent nightmares (at least one night per week) and level of nightmare distress than healthy controls (22.0% vs 6.1%; 28.85 ± 11.92 vs 17.30 ± 5.61). Over half of the patients with suicide risk (51.6%) experienced frequent nightmares compared with approximately one-third of those at a risk for suicide (30.7%). Patients with suicide risk scored scientifically higher on sleep variables, depressive and anxiety symptoms than those without the risk. Further logistic regression analysis indicated that female gender, junior grade, recurrent depressive episode, severe nightmare distress and severe depressive symptoms were independently and significantly associated with suicide risk.

CONCLUSION

Our study provided evidence that adolescents with MDD experienced a higher prevalence of frequent nightmares and suffered more nightmare distress. Nightmare distress is an independent risk factor for suicide risk.

Child and Adolescent Mental Health Training Programs for Non-specialist Mental Health Professionals in Low and Middle Income Countries: A Scoping Review of Literature

Large treatment deficits in child and adolescent mental health (CAMH) care exist in low and middle income countries (LMICs). This study reviewed CAMH training programs for non-specialist health professionals (NSHPs) in LMICs. Multiple databases were searched for peer-reviewed articles describing programs from 2005 to 2018. Educational source materials, trainee evaluation methods, and perspectives on teaching methods, course content and scheduling were studied. Six programs were identified. NSHPs were most appreciative of training which included case-based discussions, role plays and clinical demonstrations that were relevant to local contexts. A need for less intense and more flexible timetables to enable reflection was identified. WHO's mental health gap action program intervention guide (mhGAP-IG) and international association of child and adolescent psychiatrists and allied professionals resources should be used; they are free, easily accessible, and developed with extensive international contributions. Additionally, mhGAP-IG assessment tool encourages mutual learning, thereby iteratively enhancing training programs.

Changes in major psychiatric disorders in children and adolescents from 2001 to 2020: A retrospective single-center study

OBJECTIVE

This study aimed to determine the hospitalization rates, length of stay, age at the time of admission, and sex distribution for major psychiatric disorders in children and adolescents and provide a reference for early intervention for these diseases and distribution of medical resources in hospitals.

METHODS

We screened 4,423 patients in the child and adolescent wards of the Anhui Provincial Mental Health Center from 2001 to 2020, and examined the top four (81.1%) mental health disorders that accounted for the overall proportion of patients admitted, namely schizophrenia (SCZ) (45.7%), depressive disorder (DD) (14.5%), bipolar disorder (BD) (9.3%), and childhood emotional disorder (CED) (11.6%), and for each disorder, the percentage of hospitalization, length of stay, age at admission, and sex distribution were analyzed.

RESULTS

From 2001 to 2020, there was a significantly decreasing trend in the proportion of hospitalizations for SCZ (p < 0.001) and an increasing trend for depression and CED (p < 0.001). In terms of length of stay, SCZ was significantly longer than the other three disorders (p < 0.001), whereas there was no significant difference between DD, BD, and CED, and there was no significant trend in length of stay for any of the four disorders. The age at admission for CED was significantly lower than that for the other three disorders (p < 0.001). There was a decreasing trend in the age at admission for DD (p = 0.011) and an increasing trend for BD (p = 0.001). A significant increase in the number of female patients admitted for SCZ, DD, and CED was observed, while there was no significant change in the sex ratio for BD.

CONCLUSION

Although there is a significant downward trend in the percentage of hospitalizations for SCZ, it is still the most common psychiatric disorder in children and adolescents. We observed a significant increase in the percentage of hospitalizations for DD and CED. In addition, the proportion of female patients being hospitalized is on the rise, and this aspect requires continuous attention.

Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals

BACKGROUND

To date, no national-scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up-to-date systematic nationwide psychiatric epidemiological survey.

METHODS

We conducted a two-stage large-scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini-International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio-demographic factors. Prevalence in socio-demographic factor subgroups and overall were estimated. Rao-Scott adjusted chi-square tests were utilized to determine if between-group differences were present. Factor interactions were checked by logistic regression analyses.

RESULTS

A total of 73,992 participants aged 6-16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2-18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ² (1, N = 71,929) = 223.0, p < .001], age groups [χ² (1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ² (1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ² (1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity.

CONCLUSIONS

The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long-term negative impact of these conditions on families and the society as a whole.

Youth in a pandemic: a longitudinal examination of youth mental health and substance use concerns during COVID-19

OBJECTIVE

This study analyses longitudinal data to understand how youth mental health and substance use are evolving over the course of the COVID-19 pandemic, which is critical to adjusting mental health response strategies.

SETTING

Participants were recruited from among existing participants in studies conducted in an urban academic hospital in Ontario, Canada.

PARTICIPANTS

A total of 619 youth aged 14-28 years participated in the study (62.7% girls/young women; 61.4% Caucasian).

MEASURES

Data on mood, substance use and COVID-19-related worries were collected over four time points, that is, every 2 months beginning in the early stages of the pandemic in April 2020. Latent class analyses were conducted on the longitudinal data to identify distinct groups of youth who have different trajectory profiles of pandemic impact on their mood, substance use and COVID-19-related worries.

RESULTS

For the majority of participants, mood concerns increased early in the pandemic, declined over Canada's summer months and subsequently increased in autumn. Among the youth with the highest level of mood symptoms at the beginning of the pandemic, increases in mental health concerns were sustained. Substance use remained relatively stable over the course of the pandemic. COVID-19-related worries, however, followed a trajectory similar to that of mood symptoms. Girls/young women, youth living in urban or suburban areas, in larger households, and with poorer baseline mental and physical health are the most vulnerable to mental health concerns and worries during the pandemic.

CONCLUSIONS

Youth mental health symptom levels and concerns are evolving over the course of the COVID-19 pandemic, in line with the evolution of the pandemic itself, and longitudinal monitoring is therefore required. It is also essential that we engage directly with youth to cocreate pandemic response strategies and mental health service adaptations to best meet the needs of young people.

Mental health and well-being from childhood to adulthood: design, methods and results of the 11-year follow-up of the BELLA study

Mental health and well-being are of great interest in health policy and research. Longitudinal surveys are needed to provide solid population-based data. We describe the design and methods of an 11-year follow-up of the German BELLA study in children, adolescents and young adults, and we report on age- and gender-specific courses of general health and well-being, long-term health-related outcomes of mental health problems, and mental health care use. The BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Standardised measures were used at each of the five measurement points of the BELLA study. In the 11-year follow-up, young people aged 7-31 years participated (n = 3492). Individual growth modelling, linear regression and descriptive analyses were conducted. Self-reported general health and well-being were both better in younger (vs. older) and in male (vs. female) participants according to the data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) predicted impaired health outcomes at 6-year and 11-year follow-ups. Approximately one out of four children with a diagnosed mental disorder was not undergoing mental health treatment. With its 11-year follow-up, the prospective longitudinal BELLA study provides new and solid data on mental health and well-being from childhood to adulthood in Germany, and these data are important for health promotion and prevention practices. These results are consistent with previous findings. Promising future analyses are planned.

Common mental health problems among adolescents in sub-Saharan Africa: A systematic review and meta-analysis

Background and aim: This review examined the prevalence of mental health problems among adolescents in sub-Saharan Africa.Methods: The review included studies indexed in the MEDLINE, EMBASE, and PsycINFO databases, supplemented by a search on Google Scholar and tracking of references from articles identified. A total of 725 articles were found, of which 28 met the inclusion criteria. Finally, 22 eligible studies were reviewed.Findings: The pooled current prevalence of mental health problems was 23% (95% CI: 18; 28, I2 = 99.41%). Any depression, 19% (95% CI: 9; 30, I2 = 99.64%), and anxiety, 20% (95% CI: 01; 31, I2 = 99.64%), were the most common mental health problems reported. Attention deficit hyperactivity disorder, 5% (95% CI: 3; 7, I2 = 97.60%), and conduct disorders, 15% (95% CI: 8; 22, I2 = 99.58%), were also significant mental health problems among adolescents in the region.Conclusion: About one in five adolescents in sub-Saharan Africa suffer from one or more mental health problems. The findings have important implications for policy and practice as they indicate that mental health problems are a major public health issue among adolescents in sub-Saharan Africa and that there is a need for effective and context-specific interventions that address mental health.

Diagnostic efficiency and validity of the DSM-oriented Child Behavior Checklist and Youth Self-Report scales in a clinical sample of Swedish youth

The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) are widely used measures of psychiatric symptoms and lately also adapted to the DSM. The incremental validity of adding the scales to each other has not been studied. We validated the DSM subscales for affective, anxiety, attention deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct problems (CD), and obsessive-compulsive disorder (OCD) in consecutively referred child and adolescent psychiatric outpatients (n = 267) against LEAD DSM-IV diagnoses based on the K-SADS-PL and subsequent clinical work-up. Receiver operating characteristic analyses showed that the diagnostic efficiency for most scales were moderate with an area under the curve (AUC) between 0.70 and 0.90 except for CBCL CD, which had high accuracy (AUC>0.90) in line with previous studies showing the acceptable utility of the CBCL DSM scales and the YSR affective, anxiety, and CD scales, while YSR ODD and OCD had low accuracy (AUC<0.70). The findings mostly reveal incremental validity (using logistic regression analyses) for adding the adolescent to the parent version (or vice versa). Youth and parent ratings contributed equally to predict depression and anxiety disorders, while parent ratings were a stronger predictor for ADHD. However, the youth ADHD rating also contributed. Adding young people as informants for ODD and OCD or adding the parent for CD did not improve accuracy. The findings for depression, anxiety disorders, and ADHD support using more than one informant when conducting screening in a clinical context.

Effectiveness of the Elos 2.0 prevention programme for the reduction of problem behaviours and promotion of social skills in schoolchildren: study protocol for a cluster-randomized controlled trial

BACKGROUND

Early interventions benefit the mental health, academic performance and productivity of children and adolescents throughout their life. The present study protocol will evaluate the effectiveness of the Elos 2.0 Programme, which is a version adapted for Brazil by the Ministry of Health, in reducing problem behaviours (e.g., disruptiveness, aggressivity and shyness) and promoting social skills in the school context in children 6 to 10 years of age. The Elos Programme is based on the Good Behaviour Game, which is widely used and prevents and/or reduces students' disruptive behaviours by establishing cooperation contingencies.

METHOD

A cluster-randomized controlled trial will be performed in 30 schools in three cities (15 controls and 15 in the experimental group), with a total of 3800 children participating in the test (1900 in the control group and 1900 in the intervention group). Data will be collected by having teachers in the control and experimental classes complete the Teacher Observation of Classroom Adaptation (TOCA) questionnaire, which is an instrument used to observe children's behaviour in the classroom. We will collect data before and after the intervention period in the same year. Due to the hierarchical structure of the data, multilevel analysis will be performed to detect simultaneous differences in prevalence over time and across groups to control for sociodemographic variables.

DISCUSSION

The current study will examine the effectiveness of the Elos 2.0 Programme in reducing problem behaviours (e.g., disruptiveness, aggressivity and shyness) and promoting social skills in the school context. The findings of this school-based prevention programme for children will influence the development and implementation of similar programmes for schools and educational policymakers by identifying mechanisms that are central to achieving positive outcomes for participants.

TRIAL REGISTRATION

Registry of Clinical Trials of the Ministry of Health RBR-86c6jp . Registered February 2, 2019.

Feasibility of School-Based Identification of Children and Adolescents Experiencing, or At-risk of Developing, Mental Health Difficulties: a Systematic Review

Under-identification of mental health difficulties (MHD) in children and young people contributes to the significant unmet need for mental health care. School-based programmes have the potential to improve identification rates. This systematic review aimed to determine the feasibility of various models of school-based identification of MHD. We conducted systematic searches in Medline, Embase, PsycINFO, ERIC, British Education Index, and ASSIA using terms for mental health combined with terms for school-based identification. We included studies that assessed feasibility of school-based identification of students in formal education aged 3-18 with MHD, symptomatology of MHD, or exposed to risks for MHD. Feasibility was defined in terms of (1) intervention fit, (2) cost and resource implications, (3) intervention complexity, flexibility, manualisation, and time concerns, and (4) adverse events. Thirty-three studies met inclusion criteria. The majority focused on behavioural and socioemotional problems or suicide risk, examined universal screening models, and used cross-sectional designs. In general, school-based programmes for identifying MHD aligned with schools' priorities, but their appropriateness for students varied by condition. Time, resource, and cost concerns were the most common barriers to feasibility across models and conditions. The evidence base regarding feasibility is limited, and study heterogeneity prohibits definitive conclusions about the feasibility of different identification models. Education, health, and government agencies must determine how to allocate available resources to make the widespread adoption of school-based identification programmes more feasible. Furthermore, the definition and measurement of feasibility must be standardised to promote any future comparison between models and conditions.

Coping Strategies by University Students in Response to COVID-19: Differences between Community and Clinical Groups

Last year, the COVID-19 pandemic had severe consequences on the health and well-being of millions of people. Different studies try to identify the main effects that the crisis and several lockdowns have had on the citizens’ mental health. This research analyses the coping strategies generated by students from a community group and a clinical group in response to this crisis, using the Coping Responses Inventory—Adult Form (CRI-A) by Moos with a sample of 1074 students of Universidad de Extremadura. Multivariate analysis and receiver operating characteristic curve analysis have been carried out, revealing, amongst other things, a greater predisposition of the clinical sample towards factors such as seeking guidance and support, cognitive avoidance or emotional discharge. Results show that students with prior mental health problems perform an unhealthy coping response based on avoidance strategies. This group of students suffers a double source of distress and anxiety, one derived from their prior psychopathologic problems and the stress of the lockdown and another one originating from an inefficient coping response, which makes coping strategies raise levels of distress and anxiety.

Dietary fibre intake and its associations with depressive symptoms in a prospective adolescent cohort

Depression is a major cause of disability in adolescents. Higher dietary fibre intake has been associated with lower depressive symptoms in adults, but there is a lack of research in adolescents. We examined the association between dietary fibre intake (Commonwealth Scientific and Industrial Research Organisation (CSIRO) FFQ) and depressive symptoms (Beck Depression Inventory for Youth) in adolescents with prospective data from the Raine Study Gen2 14- and 17-year follow-ups (n 1260 and 653). Odds of moderate/extreme (clinically relevant) depressive symptoms by quartile of fibre intake were calculated using mixed-effects logistic regression for all participants, in a paired sample without moderate/extreme depressive symptoms at 14 years and in a sub-sample of participants with available inflammatory data at the ages of 14 and 17 years (n 718 and 547). Odds of moderate/extreme depressive symptoms were lower in the fourth (highest) quartile of overall fibre intake (OR 0·273, 95 % CI 0·09, 0·81) compared with the first (lowest) quartile, adjusting for sex, age, energy intake, adiposity, and family and lifestyle factors. However, further adjustment for dietary patterns attenuated the results. Associations of depressive symptoms with cereal or fruit and vegetable fibre intake were not significant in the final model. Adjustment for inflammation had no effect on OR. The association between a higher dietary fibre intake and lower odds of clinically relevant depressive symptoms may be more reflective of a high-fibre diet with all its accompanying nutrients than of an independent effect of fibre.

Adaptation and Implementation of the Multiple-Family Group Intervention in Ghana

BACKGROUND

The health system in Ghana is severely underequipped to meet the needs of children with behavioral health problems. A substantial treatment gap exists among individuals with behavioral challenges, necessitating the implementation of an evidence-based intervention to address child behavioral challenges in Ghana. This article presents learning opportunities from the adaptation and initiation process of an evidence-based approach, the multiple-family group (MFG) intervention, aimed at addressing child behavioral challenges in northern Ghana.

METHODS

The MFG intervention will be tested and implemented in three schools selected through a clustered randomization process, with 60 child-caregiver dyads per school. Each school will be assigned to MFG delivery by parent peers, MFG delivery by School Health Education Program (SHEP) coordinators, or an intervention where students are supplied only with mental health wellness materials and educational supports. The providers will be assessed on a fidelity measure.

RESULTS

The approach of engaging stakeholders in Ghana is anticipated to prove challenging because multiple partners are involved in MFG implementation. Participants are expected to actively participate, however, given some changes to the protocol to adapt it to the Ghanaian context, including the types of MFG facilitators and sample size. Other anticipated challenges include obtaining permission from key partners such as the education authorities, timing of the study within the academic calendar in Ghana, and meeting the high expectations of school authorities for the study.

NEXT STEPS

The MFG intervention will be delivered by parent peers and SHEP coordinators at the selected schools.

Understanding Youth's Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

Living with anxiety can be a complex, biopsychosocial experience that is unique to each person and embedded in their contexts and lived worlds. Scales and questionnaires are necessary to quantify anxiety, yet these approaches are not always able to reflect the lived experience of psychological distress experienced by youth. Guided by hermeneutic phenomenology, our research aimed to amplify the voices of youth living with anxiety. Fifty-eight youth living with anxiety took part in in-depth, open-ended interviews and participatory arts-based methods (photovoice and ecomaps). Analysis was informed by van Manen's method of data analysis with attention to lived space, lived body, lived time, and lived relationships, as well as the meanings of living with anxiety. Youth relied on the following metaphors to describe their experiences: A shrinking world; The heavy, heavy backpack; Play, pause, rewind, forward; and A fine balance. Overall, youth described their anxiety as a monster, contributing to feelings of fear, loss, and pain, but also hope. The findings from this study can contribute to the reduction of barriers in knowledge translation by encouraging the use of narrative and visual metaphors as a communicative tool to convey youth's lived experience of anxiety to researchers, clinicians, and the public.

The Behavior and Postnatal Development in Infant and Juvenile Rats After Ultrasound-Induced Chronic Prenatal Stress

Fetal development is susceptible to environmental factors. One such factor is exposure to stress during pregnancy. The present study aimed to investigate the effects of chronic prenatal stress (PS) on the development and behavior of rat offspring during infancy and juvenile ages. Existing approaches to modeling prenatal stress on animals do not correlate with the main type of stress in pregnant women, namely psychological stress. We used a new stress paradigm in the experiment, namely, stress induced by exposure to variable frequency ultrasound (US), which acted on pregnant Wistar rats on gestational days 1–21. This type of stress in rodents can be comparable to psychological stress in humans. We assessed physical development, reflex maturation, motor ability development, anxious behavior, response to social novelty, and social play behavior in male and female offspring. Additionally, we investigated maternal behavior and the effect of neonatal handling (NH) on behavior. Prenatal stress did not affect postnatal developmental characteristics in rat pups, but prenatally stressed rats had higher body weight in early and adult age than controls. Prenatal exposure to a stressor increased anxiety in the open-field test (OF), changed social preferences in the social novelty test (SN), and impaired social play behavior in males. Neonatal handling reduced anxiety and restored social behavior, but evoked hyperactive behavior in rat pups. Maternal behavior did not change. Our study demonstrated for the first time that exposure to variable frequency ultrasound during pregnancy influences offspring development and impairs behavior, correlating with the effects of other types of stress during pregnancy in rodents. This supports the idea of using this exposure to model prenatal stress.

The Recognition of Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and Conduct Disorder in Adolescents and Adults—Assessing Differences in Mental Health Literacy

This was a Mental Health Literacy (MHL) study looking at three disorders, part of a systematic research programme on MHL using vignette methodology to examine lay people’s knowledge and recognition. The study compared the recognition of the disorders in children and adults. In all 485 participants, aged 18–69 years, read three vignettes describing a person with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Conduct Disorder (CD). Vignette characters were described as either a child (aged 8yrs) or adult (aged 28 yrs). Participants attempted to label the disorder and then rated perceived seriousness and likelihood of disorder. Results from a 2 (sex) × 3 (disorder) way analysis of variance showed that CD was significantly perceived as the most serious disorder. ADHD was significantly considered more likely to be a disorder in adults yet recognised more in children. Younger participants correctly recognised ADHD, yet gave lower seriousness ratings. ASD was considered more serious in children. Women and highly educated individuals perceived ASD more seriously and recognised it more. Parents incorrectly identified CD but considered all disorders more seriously than non-parents. Clinical behaviours are more likely to be perceived as a disorder if they occur in adults, rather than children.

A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration

BACKGROUND

Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging.

OBJECTIVE

This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP.

METHODS

A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers).

RESULTS

A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations).

CONCLUSIONS

Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers.

Association of home cooking with caregiver-child interaction and child mental health: results from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study

OBJECTIVE

To examine the associations of home cooking with caregiver-child interaction and child mental health in Japan.

DESIGN

Cross-sectional data collected in 2018. Frequency of home cooking was assessed by a questionnaire among 4126 caregivers and classified as high (almost every day), medium (4-5 d/week) or low (≤3 d/week). Caregiver-child interaction was evaluated by assessing frequency of talking and playing together (per week). Behaviour problems and prosocial behaviour were assessed by the Strengths and Difficulties Questionnaire, and resilience was assessed using the Children's Resilient Coping Scale.

SETTING

Japan.

PARTICIPANTS

Children aged 9-10 years and their caregivers in Adachi, Tokyo, Japan.

RESULTS

Low and middle frequency of home cooking were associated with lower frequencies of talking about school life, talking about news with the child, talking about television shows with the child and helping with the child's homework. Children with low and/or middle frequency of home cooking had more behaviour problems (low frequency: β = 3·95, 95 % CI 1·30, 6·59 and medium frequency: β = 3·38, 95 % CI 2·07, 4·70), lower prosocial behaviour (low frequency: β = -5·85, 95 % CI -10·04, -1·66) and lower resilience (low frequency: β = -6·56, 95 % CI -9·77, -3·35 and medium frequency: β = -4·11, 95 % CI -5·71, -2·51), compared with children with high frequency of home cooking after adjusting covariates including socio-economic status. These associations were mediated by child's eating behaviours and/or caregiver-child interaction.

CONCLUSIONS

Creating an environment that encourages caregivers to cook at home may be important for children's mental health.

Inequalities in the Universal Right to Health

Child health inequalities violate children's rights to optimal wellbeing. Different issues worldwide affect children's physical and mental health as well as their development, influencing their future as adults. Inequities are avoidable inequalities. Despite improvements in the past two decades, the ambitious goals of global agendas have, for the most part, remained as expectations with regard to childhood rights, social justice, and health equity in practice. The concept of social determinants of health has become part of the common language in certain settings, but this is still too little to improve health in practice on a global scale, particularly for underprivileged subgroups of the community, as children and adolescents often are. Pediatric health professionals and their organizations are also responsible for guaranteeing children's and adolescents' right to health and better wellbeing, helping to reduce health inequalities.

Teacher Nominations of Preschool Children at Risk for Mental Health Problems: how False Is a False Positive Nomination and What Make Teachers Concerned?

Identification attempts in populations with a low prevalence of problems usually result in a considerable number of false positives. Thus, the aim of the current study was to investigate the false positive rate following nomination of developmental concerns by preschool teachers and the reasons for which teachers raise developmental concerns about children who display non-clinical levels of mental health problems.A total of 1430 children aged 1 to 6 years in Norwegian childcare centers were classified as true positive, false positive, true negative, or false negative by comparing preschool teachers’ nomination with their ratings on the Caregiver-Teacher Report Form, resulting in 127 (9%) false positives and 1142 (80%) true negatives.Compared to the true negative group, the false positive group received significantly higher scores on internalizing problems, externalizing problems than true negatives, conflict and significantly lower scores on closeness. Children’s internalizing and externalizing problems and age were the main factors that increased the likelihood of teachers raising concerns, while increased closeness in the teacher-child relationship reduced the likelihood of being nominated. Children’s gender and conflict level were not significant when adjusting for other factors.These findings suggest that preschool teachers’ concerns about children’s development should not be discarded as the false positive group did show elevated levels of problem behavior and poorer teacher-child relationship compared to the true negative group. Scrutinizing concerns in collaboration with parents and other mental health professionals may be beneficial to ensure healthy development for children with elevated problem levels.

Relationship between dietary diversity score and general health in female students

BACKGROUND

Adolescence is a critical period with respect to mental and psychological issues. The role of nutrients is well known in health condition in adolescents, but little emphasis is placed on total diet quality. Dietary diversity score (DDS) is often used to assess diet quality. The objective of this study was to investigate the relationship between DDS and general health in girl students.

METHODS

The present research is a cross-sectional study which used descriptive-analytical approach. A total of 384 high-school female students selected using proportional stratified sampling. Physical activity level, diet and general health information collected using International Physical Activity Questionnaire (IPAQ), Dietary Diversity Questionnaire (FAO-2013) and 28-item self-reported general health questionnaire (GHQ-28), respectively. In addition, weight, height and waist circumference (WC) measured. Data analyzed using Chi-Square test, one-way ANOVA and Multinomial Logistic Regression.

RESULTS

Mean DDS was 4.43±1.09. After adjustment for confounders of age, body mass index, physical activity, socioeconomic status and nutritional supplement intake, students with higher DDS were less prone to general health disorders (P≤0.05).

CONCLUSIONS

These finding implicate higher DDS in adolescents may associate with better general health.