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

A Systematic Scoping Review of the Resilience Intervention Literature for Indigenous Adolescents in CANZUS Nations

Background: The concept of resilience offers a strengths-based framework for interventions to enhance Indigenous adolescent social and emotional well-being. Resilience interventions in or with schools encompass individual, social, and environmental factors that encourage health-promoting behaviors and assist adolescents in navigating toward resources that can sustain their health and well-being in times of adversity. This scoping review examined the literature on resilience-enhancing interventions for Indigenous adolescent students in Canada, Australia, New Zealand, and the United States (CANZUS nations). Intervention strategies, adherence to theoretical constructs, and outcomes were analyzed. Methods: A systematic search was conducted of intervention studies aimed at improving Indigenous adolescent resilience and published in CANZUS nations between January 1990 and May 2016. Eleven peer-reviewed databases and 11 websites and clearing houses were searched for relevant studies. Following double-blinded screening, a total of 16 intervention papers were included for analysis. Study characteristics were identified and study quality was assessed using appropriate assessment tools. Results: Twelve interventions (75%) were delivered in school settings and four (25%) were community-based, conducted in partnership with schools. Seven publications (44%) reported interventions focused exclusively on fostering individual resilience. Another seven (44%) included components that aimed to build staff, school, and/or community capacity to support adolescent resilience, and two (12.5%) had community/school capacity-building as the primary focus. Culturally based approaches to enhancing resilience were evident in most studies (81%). The publications documented the use of a range of program models, processes, and activities aligned with resilience theory. Positive outcomes were reported for improved individual assets (e.g., strengthened self-esteem and Indigenous identity), environmental resources (e.g., increased peer support and social/community connection), and increased community capacity (e.g., increased youth training and leadership opportunities). On average, study quality was assessed as moderate to high. The strongest evidence of intervention effectiveness was for improvements in mental health symptoms and outcomes. Conclusion: Interventions indicated strong alignment with ecological and culturally based resilience theories and models. While the results of the studies indicate some positive impacts on the resilience of Indigenous adolescents, future evaluations should aim to ensure high study quality and focus on measuring strengths-based resilience outcomes.

The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents

Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (β = - 1.70, 95% CI [- 2.72, - 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care.

Bounce Forward: A School-Based Prevention Programme for Building Resilience in a Socioeconomically Disadvantaged Context

Socioeconomic status is a strong predictor of normative development and well-being in young people. It is well-known that growing up in a socioeconomically disadvantaged context may lead to negative outcomes, both in childhood and in adulthood. Early intervention and prevention programmes are crucial for building resilience and improving health, well-being and equity. Bounce Forward is a school-based prevention programme implemented in Blackpool, a town in the United Kingdom facing multiple challenges. It was part of a whole town resilience approach and nascent global social movement known as the "Resilience Revolution." Between 2017 and 2019, the programme was delivered in all Year 5 classes at every primary school in Blackpool (n _school = 36), reaching out to 3,134 students (ages 9-10; 50.4% male). The programme aimed to increase resilience in young people by building knowledge and skills about mental health and resilience through 10 sessions. In the current study, we longitudinally examined a range of protective factors, which are relevant to young people's resilience, as well as their mental health outcomes at three time points: before they participated in Bounce Forward, at the end of the programme, and 3-5 months later, when they started Year 6. The current sample included 441 Year 5 students (54.2% male) from 11 primary schools in Blackpool. Nineteen teaching staff also participated in the study and provided qualitative data regarding the impact of the programme on their students. Results showed improvement in some areas of young people's resilience after taking part in Bounce Forward. We also identified gender differences in several protective factors, indicating that boys may need further support. Teaching staff highlighted improvements in various areas; and also observed that their students have been using the strategies that they learnt from the programme. Altogether, findings suggested that young people benefitted from Bounce Forward. The programme is sustainable, offering a free to download teacher resource pack that allows schools to self-deliver it.

Implementation science in global health settings: Collaborating with governmental & community partners in Uganda

Approximately 450 million people, many of whom live in poverty and are from low and middle-income countries (LMICs), experience serious mental health challenges. Children in sub-Saharan Africa comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs and evidence-based practices (EBPs) are scarce. In Uganda, one in five children present mental health challenges, including disruptive behavior disorders. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners to invest in a collaborative, longitudinal study in Uganda aimed at improving youth behavioral health outcomes by testing a collaboratively adapted EBP. We emphasize that implementation scientists should be prepared and willing to invest time and effort engaging key stakeholders and sustain relationships through a full range of collaborative activities; ensure that their science meets a felt need among the stakeholders; and translate their research findings rapidly into accessible and actionable policy recommendations. Finally, we highlight that collaboration with global communities and governments plays a critical role in the adaptation, uptake, scalability, and sustainability of EBPs, and that the process of engagement and collaboration can be guided by conceptual frameworks.

Association between family dinner frequency and mental health in children and adolescents; the CASPIAN-V study

This cross-sectional study was conducted among 14,400 Iranian students, aged 7-18 years to determine the association between the frequency of family dinner and mental health. Family dinner frequency, family relationship, life satisfaction (LS), self-perceived health and anxiety were assessed by validated questionnaires. Of 14,274 participants, 50.6% were boys and 71.4% were urban residents, with a mean (SD) age of 12.28 (3.16) years. Family dinner frequency was significantly correlated with LS (boys: β = 0.27, p < .001; girls: β = 0.26, p < .001) and socio-economic status (boys: β = 0.05, p < .001; girls: β = 0.02, p < .001). A significant inverse association was observed between family dinner frequency and family relationship with anxiety, which was more evident in boys than in girls (p < .05). This study underscores the important role of family dinner frequency with lower anxiety in children as well as a better family relationship with better LS.

Multi-informant universal screening: Evaluation of rater, item, and construct variance using a trifactor model

Universal screening is a proactive method for identifying student risk, yet remains under-utilized in school systems. Instead, many schools rely on teacher reports and referrals without accounting for different informant perspectives. In the current study, multi-informant universal screening in evaluated using a trifactor model. The study utilized the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), specifically the teacher (SAEBRS-TRS) and student (mySAEBRS) self-report forms, with items indicating risk for social, academic, and emotional behavior. Data from a national sample of over 24,000 K-12 teacher-student dyads were used to examine the extent and variance of discrepant reports between students and teachers of common, perspective, and item factors. Results demonstrated that informant perspective factors were a strong predictor for student and teacher emotional behavior item ratings. Whereas age had a positive effect on younger student reports of risk on the behavior items compared to older student reports, teachers showed the opposite effect. The teacherperspective of social and emotional behaviors of students was predicted by gender. Implications and directions for future research are further discussed.

Effectiveness of a school-based mental health education program in an impoverished urban area of Peru

This study aimed to evaluate the effectiveness of a school-based mental health education program in preventing adolescent suicide attempts in an impoverished urban area in Peru, as part of an Official Development Assistance project by the Korea International Cooperation Agency. The PRECEDE-PROCEED model informed the effectiveness study. In this intervention, the participants were first to fifth grade students in public secondary schools. The pre-post intervention survey was conducted with a stratified random sampling method. A sample of 768 and 738 students in experimental and control groups was analyzed comparatively, using chi-squared tests and logistic regression. This study found that the program had a positive effect on adolescent mental health-related risk behaviors and suicide attempts in the experimental group compared to the control group. Thus, the intervention may have helped prevent the increase in mental health-related risk behaviors and suicide attempts. Further, parental affection, when included in the intervention, had a significant effect on suicide attempts. As such, the involvement of parental affection in the intervention might be effective in preventing suicide attempts. To enhance the effectiveness of interventions aiming to prevent adolescent suicide, the participation and attention of parents, as well as adolescents, must be encouraged. Further, to maintain the effectiveness of the intervention and expand coverage to other schools in the neighborhood, a strategy for project sustainability is needed, particularly with regards to capacity-building in schools and communities.

Emotional and behavioral problems, social competence and risk factors in 6-16-year-old students in Beijing, China

Introduction

Child emotional or behavioral problems and insufficient social development has been a heavy burden on family and society. However, currently large-scale studies on emotional and behavioral problems as well as social competence among school children in China are still lacking. This cross-sectional study analyzed the current status and risk factors of behavioral problems and social competences in Beijing students.

Method

A total of 9,295 students, with ages ranging from 6 to 16 years old, were enrolled in the study. The Child Behavior Checklist (CBCL) was used to screen emotional and behavioral problems, social competences of students. We then assessed significant predictors factors associated with children behavioral problems and social competences.

Results

The total detection rate of behavioral problems of this cohort was 16.7%. All kinds of social competence scores of boys were lower than girls (P <0.05). The scores of social and learning ability in children with behavioral problems were significantly lower than those without behavior problems (P <0.05). Gender, developmental delay, recent life events, negative relationships and negative child-rearing styles were the shared influencing factors for behavioral problems and social competence. In addition, age, macrosomia, threatened abortion, hospitalization for physical illness, physical illness, poor sleep were independent risk factors for children's emotional and behavioral problems, and non-breastfeeding was an independent risk factor for abnormal social competence.

Conclusion

The social competence, emotional and behavioral problems are serious among students in Beijing. More attention should be paid to mental health and effective intervention measures should be provided.

The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial

BACKGROUND

Conduct, anxiety, and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial.

METHODS/DESIGN

We will conduct a two-arm, individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated distress/impairment. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention) or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported distress/impairment, perceived stress, mental wellbeing, and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added effect of a classroom-based sensitization intervention over and above school-level sensitization activities on the primary outcome of referral rate into the host trial. Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding.

DISCUSSION

Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems.

TRIAL REGISTRATION

Both trials are registered prospectively with the National Institute of Health registry ( www.clinicaltrials.gov ), registration numbers NCT03633916 and NCT03630471 , registered on 16th August, 2018 and 14th August, 2018 respectively).

[Intensive psychiatric care of children and adolescents in their natural environment : Alternatives to inpatient treatment]

Mental health disorders are one of the main diseases in children and adolescents, the persistence rate into adulthood being around 50%. Early intervention is therefore essential. However, present treatment options reach only 50% of children and adolescents with mental health problems.The objective of this article is to depict why legal deficits complicated the establishment of outreach treatment in the past and to illustrate recent legal changes that now allow innovative outreach treatment programs that meet the need of children and adolescents with mental health issues.This review is based on pertinent publications that were retrieved by a selective literature search in PubMed and Cochrane Library concerning types of home treatment in child and adolescent psychiatry, with due reference to the authors' own experience with intensive home treatment.The literature shows that outreach work has been effective in many other countries. In Germany however, clear separation in finances between outpatient and inpatient treatment did not allow the establishment of outreach teams in the past. On 01.01.2017 a new law, the PsychVVG, entered into force, and now provides a sound legal basis for outreach work. Home treatment in the form of, for example, intensive outreach work that equals the intensity and frequency of inpatient treatment (StäB) or continuum of care school (CCSchool), a project that joins school-based diagnostic elements with school-based treatment, can now be installed and evaluated.Intensive outreach work, especially in child and adolescent psychiatry, will now be a good alternative to inpatient treatment that integrates parents into the treatment approach.

Testing the Reliability and Construct Validity of a Chinese Translation of BASC-3-SRP for 12- to 18-Year-Old Youth

We tested the reliability and construct validity of a Chinese translation of one of the forms of the Behavior Assessment System for Children (3rd Edition)–Self-Report of Personality for adolescent 11- to 21-year olds (BASC-3-SRP-A). The BASC-3-SRP-A yields 16 subscales that form four composite scales. Data were obtained from 444 12- to 14-year olds (Group 1; girls: 59.0%) and 759 15- to 18-year olds (Group 2; girls: 69.2%). For both groups, Cronbach’s alphas for most of the 16 subscales were higher than .70 and were higher than .83 for the four composite scales. Confirmatory factor analysis (CFA) using Mplus 8 on the combined sample yielded support for the construct validity of the Chinese translation of the BASC-3-SRP-A. Findings support the use of BASC-3-SRP-A among Chinese youth.

Physical activity and sport participation among adolescents: associations with mental health in different age groups. Results from the Young-HUNT study: a cross-sectional survey

OBJECTIVES

Knowledge of how physical activity (PA) and sport participation are related to mental health throughout adolescence is scarce. Our objective was to describe PA levels and sport participation in a population-based sample of adolescents, and to explore how they relate to mental health in different age groups.

DESIGN

A population-based cross-sectional study.

SETTING AND PARTICIPANTS

The adolescent part of the Nord-Trøndelag Health Study, a Norwegian population-based health survey, conducted from 2006 to 2008. Of 10 464 invited participants (age 13-19 years), 7619 (73%) participated, of whom 3785 (50%) were boys.

OUTCOME MEASURES

Mental health outcomes included psychological distress assessed using a short version of the Hopkins Symptom Check List Five items, self-esteem assessed using a short version of the Rosenberg Self-Esteem Scale and life satisfaction assessed with a single-item satisfaction with life measure.

METHOD

Logistic regression models were used to estimate the likelihood of psychological distress, low self-esteem and low life satisfaction, according to self-reported PA level and type of sport participation, stratified by gender and school level (junior vs senior high school).

RESULTS

Fewer senior high school students participated in team sports compared with junior high school students (p<0.001). Physically active adolescents and participants in team sports had higher self-esteem and life satisfaction. A high PA level, compared with a low PA level, was associated with reduced odds of psychological distress among senior high school students (OR 0.63, 95% CI 0.46 to 0.86 for girls and OR 0.46, 95% CI 0.27 to 0.79 for boys). Team sport participation was associated with reduced odds of psychological distress in senior high school girls.

CONCLUSION

A high PA level was favourably associated with various dimensions of mental health, especially for adolescents in senior high school. Team sport participation may have a positive impact on mental health and should, therefore, be encouraged.

Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.

Come together: case specific cross-institutional cooperation of youth welfare services and child and adolescent psychiatry

BACKGROUND

Due to the increasing rate of children and families who require support from both youth welfare services and from mental health services, a solid cross-institutional cooperation is needed to provide coordinated and integrated help. Studies involving not only qualitative, but also quantitative information from both services regarding not only general, but also case specific views on cross-institutional cooperation and psychosocial needs are lacking.

METHODS

Hence, we collected data from n = 96 children and families who received support from youth welfare office (YWO) and child and adolescents psychiatry (CAP) simultaneously. In a longitudinal survey, we assessed the evaluation of case specific cross-institutional cooperation and psychosocial needs by employees of YWO and CAP as well as descriptive data (including psychopathology of children) over a 6-month period. Repeated-measures ANOVAs were conducted to assess the effects of time and institution (YWO/CAP) on employees' evaluation of case specific cross-institutional cooperation and psychosocial needs as well as children's psychopathology.

RESULTS

The data showed that generally YWO employees rated the case specific communication better than CAP employees. Furthermore, CAP employees estimated psychosocial needs higher than YWO employees did. The employees' evaluation of total case specific cross-institutional cooperation did not differ between the employees of both institutions; it further did not change over time. The case specific evaluations did not correlate between the case responsible employees of YWO and CAP.

CONCLUSION

The data showed satisfaction with the case specific cross-institutional cooperation in general, but meaningful differences in case specific ratings between both institutions indicate the possibility and need for improvement in daily work and cooperation as well as in regulations and contractual agreements. The implementation of more exchange of higher quality and transparency will ensure smoother cross-institutional cooperation. Future research should pursue this topic to convey the need for further improvement in cross-institutional cooperation into decision-making processes and to evaluate the success of innovative projects in this field.

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania

Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

Mental health of transitional aged youth in Nicaragua: Perceptions and experiences of educators

Mental illnesses contribute to a large proportion of the disease burden in children and adolescents in low and middle-income countries (LMICs). There is limited research completed in LMICs about paediatric mental health, particularly related to youth. School is a place where many adolescents first seek mental health support. This study examined how educators in Nicaragua view youth mental health and how mental health can be supported in LMIC schools. Focus groups were completed with teachers serving youth from a variety of socioeconomic settings within León, Nicaragua. The study was completed from an Interpretivist theoretical paradigm and coding of qualitative data was completed consistent with Constructivist Grounded Theory. Educators described their roles in as detecting mental health problems and liasing with other supports; they noted barriers as cross-sector integration and social challenges. Educators felt that youth would be better served by improving integration of care, addressing structural factors, and providing more teacher supports. A model for addressing youth mental health in LMICs could include a stepped-care approach with schools providing preventative programming as well as developing within school referral strategies for youth with higher needs. There may be a role for the use of community health promoters.

Protocol for a systematic review of the development of depression among adolescents and young adults: psychological, biological, and contextual perspectives around the world

BACKGROUND

Depression is a leading contributor to disability-adjusted life-years because of early onset and chronicity throughout the lifecycle. It is crucial to identify early predictors of depression among adolescents and young people to effectively target prevention. A gap in the literature is a comprehensive systematic review of predictors of depression among adolescents around the globe, especially in low- and middle-income countries LMICs. This review aims to identify evidence for biological, psychological, and contextual risk factors for the development of depression among adolescents and young adults (10-24 years of age) in high-income countries (HICs) and LMICs, ultimately contributing to (a) identification of potential mechanisms underlying depression development, (b) selection of common risk and protective factors as targets for detection, and (c) refinement of risk models that can be evaluated through existing cohorts in HICs and LMICs.

METHODS

This review will follow the Population, Exposure, Comparison, Outcome (PI(E)CO) model and adheres to the PRISMA-P guidelines. A search strategy was developed by a multidisciplinary research consortium. Seven databases (MEDLINE via Ovid, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, Global Health) will be searched to identify articles. Independent raters will screen and retrieve articles for inclusion, conduct quality ratings, and extract data. The Systematic Assessment of Quality in Observational Research adapted for Cultural Psychiatry Epidemiology (SAQOR-CPE) will be used to assess quality of observational studies. We will assess for publication bias using funnel plots and statistical methods. We will use narrative synthesis to present results, addressing the study's objectives following the Cochrane Handbook guidelines. Meta-analyses will be used to report summary statistics for association of risk factors with development of depression.

DISCUSSION

This systematic review will summarize evidence-based research that examines the psychological, biological, and contextual factors contributing to the onset of depression in adolescents across the globe. Results will support the development of a model that can be evaluated in existing cohorts around the world.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration CRD42018103973 .

The Role of Emotional Intelligence in the Maintenance of Depression Symptoms and Loneliness Among Children

Identifying factors that predict the maintenance of depression and loneliness in children is important for intervention design. Whilst emotional intelligence (EI) has been identified as a predictor of mental health, research examining how both trait and ability EI contribute to long-term patterns of symptomatology in children is markedly absent. We examined the impact of both TEI and AEI on the maintenance of loneliness and depressive symptoms over 1 year in children aged 9-11 years. Two hundred and thirteen children (54% male) completed the TEIQue-CF and the MSCEIT-YV at the first time point of the study, and the Child Depression Inventory and the Loneliness and Aloneness Scale for Children and Adolescents at Time 1 and, again, 1 year later. Findings indicate that emotional skills (AEI) are important for predicting the maintenance of depressive symptoms and loneliness in children over 1 year; emotional self-competency (TEI) is less influential, only contributing to long-term loneliness in girls. Moreover, whilst deficiencies in the ability to perceive and understand emotions were predictive of prolonged symptomatology, so, too, were proficiencies in using emotion to facilitate thinking and emotion management. Those findings carry important implications for EI theory and future research. They also indicate that EI interventions tailored to groups of "at risk" school children may be useful for reducing specific profiles of internalizing symptoms. Programs targeting AEI skills may be universally helpful for reducing the likelihood that depressive symptoms and loneliness will be maintained over time in middle childhood; girls at risk for prolonged loneliness would additionally benefit from opportunities to bolster TEI.

Effect of Physical Activity on Self-Concept: Theoretical Model on the Mediation of Body Image and Physical Self-Concept in Adolescents

Objective: The aim of this research was to study the mediation of body dissatisfaction, physical self-concept, and body mass index (BMI) on the relationship between physical activity and self-concept in adolescents.

Materials and Methods: A sample of 652 Spanish students between 12 and 17 years participated in a cross-sectional study. Physical self-concept and general self-concept were assessed with the Physical Self-Concept Questionnaire (CAF), body dissatisfaction with the Body Shape Questionnaire (BSQ), and physical activity was estimated with the International Physical Activity Questionnaire (IPAQ-SF). BMI was utilized as a measurement of body composition. Structural equation modeling was used to assess the results.

Results: The resulting models showed good fit indexes. Final model for all participants explained the 17% of the variance of body dissatisfaction, 57% of physical self-concept, and 60% of general self-concept. Physical activity had a positive and indirect effect on self-concept (β = 0.29, p < 0.01) and direct effects on body dissatisfaction (β = −0.26, p < 0.01) and physical self-concept (β = 0.20, p < 0.01). BMI had a direct effect on body dissatisfaction (β = 0.31, p < 0.01) and on physical self-concept (β = −0.10, p < 0.01) and an indirect effect on general self-concept (β = −0.24, p < 0.01). However, it was only associated with physical activity in males, playing a mediating role between physical activity and body dissatisfaction.

Conclusion: Physical activity can help individuals to achieve a positive self-concept and promote psychological well-being in adolescents through the improvement of physical perceptions and body satisfaction. The importance of BMI, body dissatisfaction, and physical self-concept on the configuration of the self-concept is also emphasized. Educational policymakers and Physical Education teachers should implement strategies to promote physical activity in the schools and provide a Quality Physical Education programs to increase physical activity during adolescence.

A systematic review exploring how young people use online forums for support around mental health issues

Background: Young people increasingly look towards the Internet for support. Online forums have been developed to provide mental health support, but they have received little attention in the research to date. Aims: To summarise the existing literature examining how individuals use online forums to obtain support for mental health difficulties. Methods: A systematic review of electronic databases was conducted to identify empirical literature in this area. The papers that met the inclusion criteria and satisfied quality assessment review were analysed for key themes. Results: Twenty-one papers were found. Three common themes in the papers were associated with opportunities of the technology: (1) Providing stand alone or complementary informal support, (2) Providing informational, emotional and infomotional support, and (3) Making use of the specific practical opportunities afforded by forum technology. A further three themes were associated with challenges: (1) Managing the expectations of forum users, (2) Ensuring service user safety, and (3) Navigating the technical challenges associated with forums. Conclusions: The paper highlights the potential for individuals to access dynamic and responsive support within online forums. Additionally, it reflects upon the major areas that mental health professionals need to be aware of when entering into this arena.

The Relationship Between Parenting Styles Practiced By Grandparents And Children's Emotional And Behavioral Problems

OBJECTIVES

To examine the relationship between grandparenting styles and grandchildren's emotions and behaviors, while controlling for parenting styles, and to compare the effects of grandparenting styles and parenting styles on children's behavioral problems in China.

METHODS

A sample of 765 children, with a mean age of 12.02 years (SD = 0.38), participated in this cross-sectional study in Jintan city, Jiangsu province, China. All participants completed the self-report measures of emotions and behaviors, grandparenting styles, and sociodemographic variables.

RESULTS

Results showed that the well-recognized parenting styles (Care, Indifference, Overprotection, and Autonomy), when implemented by grandparents (grandparenting styles) and parents (parenting styles), had different patterns of effects on children's emotional and behavioral problems. Grandparenting styles, especially grandparental Care and Overprotection, were positively related to emotional and behavioral problems, while parental Care was negatively related to children's externalizing behaviors.

CONCLUSIONS

These results highlight the importance of grandparenting styles in grandchildren's development. Practitioners working with grandparents and grandchildren need to recognize the complexity of grandparent-grandchild relationships and implement suitable interventions to meet the family needs.

Overall Care-Seeking Pattern and Gender Disparity at a Specialized Mental Hospital in Bangladesh

Introduction:

The National Institute of Mental Health (NIMH) is the only national level mental health institution in Bangladesh, with both academic and clinical functions, thus playing a crucial role in delivering specialized mental health care for the entire population.

Aim:

This study examined the overall pattern of mental health care seeking, age and sex distribution of patients and mental health problems diagnosed in the facility.

Methods:

Using a facility-based cross-sectional study design, secondary data was collected from various hospital records and reports from April 2001 to June 2016, and quantitatively analyzed.

Results:

There has been a steady increase in the number of patients at NIMH over the years. Typically, female patients were about half in number compared to male patients and fewer in each age group and all disease categories except inpatients with neurotic, stress-related and somatoform disorders. The highest number of inpatients and outpatients were 15-30 years old and those with schizophrenia, schizotypal and delusional disorders.

Conclusion:

Minors and females seeking care at NIMH were underrepresented, thus highlighting the need for interventions to improve access for these patients.

Nash-wo-Numa (childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan

INTRODUCTION

Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world's largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study's primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition.

METHODS

This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales.

ETHICS AND DISSEMINATION

The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03647553; Pre-results.

Perceived social status and mental health among young adolescents: Evidence from census data to cellphones

Adolescents in the United States live amid high levels of concentrated poverty and increasing income inequality. Poverty is robustly linked to adolescents' mental health problems; however, less is known about how perceptions of their social status and exposure to local area income inequality relate to mental health. Participants consisted of a population-representative sample of over 2,100 adolescents (ages 10-16), 395 of whom completed a 14-day ecological momentary assessment (EMA) study. Participants' subjective social status (SSS) was assessed at the start of the EMA, and mental health symptoms were measured both at baseline for the entire sample and daily in the EMA sample. Adolescents' SSS tracked family, school, and neighborhood economic indicators (|r| ranging from .12 to .30), and associations did not differ by age, race, or gender. SSS was independently associated with mental health, with stronger associations among older (ages 14-16) versus younger (ages 10-13) adolescents. Adolescents with lower SSS reported higher psychological distress and inattention problems, as well as more conduct problems, in daily life. Those living in areas with higher income inequality reported significantly lower subjective social status, but this association was explained by family and neighborhood income. Findings illustrate that adolescents' SSS is correlated with both internalizing and externalizing mental health problems, and that by age 14 it becomes a unique predictor of mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Innovation and Integrity: Desiderata and Future Directions for Prevention and Intervention Science

This article summarizes essential implications of the papers within this special issue and discusses directions for future prevention and intervention research on conceptual issues, methodological and transfer-related challenges and opportunities. We identify a need to move from programs to principles in intervention research and encourage the implementation of research on potential mechanisms underlying intervention effectiveness. In addition, current methodological issues in intervention research are highlighted, including advancements in methodology and statistical procedures, extended outcome assessments, replication studies, and a thorough examination of potential biases. We further discuss transfer-related issues, for example the need for more research on the flexibility and adaptability of programs and intervention approaches as well as more general problems in knowledge translation reasoning the need for enhanced communication between practitioners, policy makers, and researchers. Finally, we briefly touch on the need to discuss the relation between single intervention programs, the mental health system, and changes of contextual conditions at the macro level.

International and Spanish Findings in Scientific Literature about Minors' Mental Health: Predictive Factors Using the Strengths and Difficulties Questionnaire

Minors' mental health is a subject of high global concern. Understanding the factors that influence their mental health is essential to improving the health of future generations. In this study, an analysis of the Strengths and Difficulties Questionnaire's usefulness is carried out, as a validated tool, recognized in Spain and internationally, for the measurement of minors' mental health. In turn, the influence of the variables of gender, age, and physical health, along with the occupational social class of parents on Spanish minors' mental health, has been analyzed. Spanish minors with good physical health and of parents with middle and higher education, as well as in an occupational social class, are less likely to suffer mental health problems. On the other hand, it seems that internalizing symptoms are more likely in girls, and externalizing symptoms are more likely in boys. However, when a global measure of mental health is made without specific subscales, the effects of gender and age diverge greatly, according to the studies. Although there are examples of current research using the same measurement tool, there is still a need for many more international studies that are coordinated using the same methodology. This study identifies the factors which the international and Spanish scientific literature has revealed as being determinants in minors' mental health. Finally, it is essential that the influence of these factors be assessed in the areas of primary care and mental health to facilitate better detection, intervention, or prevention of mental health problems in today's children, as well as the children of future generations.

Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data

The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d's ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.

Emotional and behavioral problems and associated factors among children and adolescents on highly active anti-retroviral therapy in public hospitals of West Gojjam zone, Amhara regional state of Ethiopia, 2018: a cross-sectional study

Background

Children and adolescents with HIV/AIDS are more likely to have emotional and behavioral problems than the general population. This can result in a continuing negative influence on the quality of life, school performance, immunity and co-morbidity of children and adolescents with HIV/AIDS.

Objective

To assess the prevalence and associated factors of Emotional and Behavioral Problems among children and adolescents on Highly Active Anti-Retroviral Therapy in the public hospitals of West Gojjam Zone, Amhara regional state of Ethiopia.

Methods

An institutional based cross sectional study was conducted by screening 411 children and adolescents for emotional and behavioral problems using Pediatric Symptomatology Check List (PSCL). Systematic random sampling technique was used to select the study participants. Data analysis was done using SPSS version 23. Bivariable and multivariable logistic regression analysis were fitted to identify factors associated with Emotional and Behavioral Problems. Odds ratio (OR) with 95% confidence interval (CI) was computed to determine the level of significance.

Result

Out of the total 411 participants, 43.6% were screened positive for Emotional and Behavioral Problems. Lower age (AOR = 5.33, 95%CI: 2.56–11.04), having non-kin care giver (AOR = 4.64, 95%CI: 1.20–17.90), parental loss (AOR = 2.15, 95%CI: 1.03–4.49), non self -disclosure of HIV sero status (AOR = 1.99, 95% CI: 1.16–3.41) and having distressed care giver (AOR = 1.64, 95%CI: 1.04–2.57) had statistically significant association with EBPs.

Conclusion

The prevalence of Emotional and Behavioral Problems is high among children and adolescents on HAART. Lower age, care giver’s mental distress, non-self disclosure status, having non-kin care giver and parental loss were variables significantly associated with EBPs. This demonstrates a need for the integration of Mental Health and Psycho Social Support (MHPSS) service with HIV/AIDS care.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1453-3) contains supplementary material, which is available to authorized users.

A screening tool for psychological difficulties in children aged 6 to 36 months: cross-cultural validation in Kenya, Cambodia and Uganda

BACKGROUND

In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6-36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months.

METHODS

A primary validation of the PSYCa 6-36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6-36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6-36 and external validity was assessed by comparing the results of the PSYCa 6-36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant.

RESULTS

The PSYCa 6-36 showed satisfactory psychometric properties (Cronbach's alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia.

CONCLUSIONS

The PSYCa 6-36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children's psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6-36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties.

Prevalence of behavioral disorders and attention deficit/hyperactive disorder among school going children in Southwestern Uganda

BACKGROUND

Disruptive Behavioral Disorders (DBDs) and Attention Deficit/Hyperactivity Disorder (ADHD) are chronic, impairing, and costly child and adolescent mental health challenges which, when untreated, can result in disruptions in school performance, friendships and family relations. Yet, there is dearth of prevalence data on child and adolescent behavioral challenges within sub-Saharan Africa, including Uganda. This study aims to estimate the prevalence rate of behavioral challenges and ADHD among young school going children and early adolescents (ages 8-13 at study enrollment), utilizing a school-based sample in southwest Uganda.

METHODS

We present screening results from a 5-year scale-up study titled SMART Africa-Uganda (2016-2021), set across 30 public primary schools located in the greater Masaka region in Uganda, a region heavily impacted by poverty and HIV/AIDS. Specifically, we draw on screening data from caregivers of 2434 children that used well-established standardized measures that had been pre-tested in the region. These were: 1) oppositional defiant disorder (ODD) and conduct disorder (CD) subscales of the Disruptive Behavior Disorders (DBD) scale; and 2) the Iowa Connors and Impairment scales. Slightly over half of the children in the sample were female (52%), with a mean age of 10.27 years.

RESULTS

Of the 2434 participants screened for disruptive behaviors: 1) 6% (n = 136) scored positive on ODD and 2% (n = 42) scored positive on CD subscales of the DBD scale; 2) 9.61% (n = 234), and 2.67% (n = 65) were reported to have elevated symptoms of ODD and ADHD on the Iowa Connors caregiver report scale respectively. Twenty-five percent (n = 586) of children were described by their caregivers as having experienced some form of impairment in at least four domains of the Impairment scale.

CONCLUSION

The results indicate the presence of behavioral challenges and ADHD among school going children, aged 8-13 years, in Uganda. Given the negative outcomes associated with behavioral challenges as children transition to adolescence and adulthood, detecting these emerging behavioral challenges early is critical in developing appropriate interventions. School settings could be considered as one of the contextually-relevant, culturally-appropriate, and non-stigmatizing venues to implement screening procedures and to detect emerging behavioral challenges and to make necessary referrals.

[The prevention of externalizing disturbances]

The prevention of externalizing disturbances Abstract. Objectives: Externalizing disturbances (attention deficit-hyperactivity disorders, oppositional defiant disorders, conduct disorders) in children and adolescents have a high prevalence, are stable over time, and precipitate a high individual and economic burden. Method: This review article presents the state of research based on selected current meta-analyzes and systematic reviews. Additionally, evidenced-based German-language prevention programs are discussed. Results: As in treatment, a multimodal approach to prevention is recommended which aims at reducing externalizing symptoms in specific settings. Interventions that focus on the specific environment in the family and the (pre-)school are preferable. Child-focused interventions are especially important in the context of peer-related problematic behavior because parent-based or teacher-based interventions may be less able to affect peer interactions. Conclusions: Comprehensive parent-based and (pre-)school-based preventive interventions of externalizing disturbances should be implemented. These should also include child-based approaches and additional parent-based group interventions. The effects of these interventions should be tested in large-scale studies.

Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study

Aim

Children and adolescents with low socioeconomic status (SES) suffer from mental health problems more often than their peers with high SES. The aim of the current study was to investigate the direct and interactive association between commonly used indicators of SES and the exposure to stressful life situations in relation to children’s mental health problems.

Methods

The prospective BELLA cohort study is the mental health module of the representative, population-based German National Health Interview and Examination Survey for children and adolescents (KiGGS). Sample data include 2,111 participants (aged 7–17 years at baseline) from the first three measurement points (2003–2006, 2004–2007 and 2005–2008). Hierarchical multiple linear regression models were conducted to analyze associations among the SES indicators household income, parental education and parental unemployment (assessed at baseline), number of stressful life situations (e.g., parental accident, mental illness or severe financial crises; 1- and 2-year follow-ups) and parent-reported mental health problems (Strength and Difficulties Questionnaire; 2-year follow-up).

Results

All indicators of SES separately predicted mental health problems in children and adolescents at the 2-year follow-up. Stressful life situations (between baseline and 2-year follow-up) and the interaction of parental education and the number of stressful life situations remained significant in predicting children’s mental health problems after adjustment for control variables. Thereby, children with higher educated parents showed fewer mental health problems in a stressful life situation. No moderating effect was found for household income and parental employment. Overall, the detected effect sizes were small. Mental health problems at baseline were the best predictor for mental health problems two years later.

Conclusions

Children and adolescents with a low SES suffer from multiple stressful life situations and are exposed to a higher risk of developing mental health problems. The findings suggest that the reduction of socioeconomic inequalities and interventions for families with low parental education might help to reduce children’s mental health problems.

Screening for depressive and anxiety disorders among adolescents in Indonesia: Formal validation of the centre for epidemiologic studies depression scale - revised and the Kessler psychological distress scale

BACKGROUND

This study aimed to culturally verify and examine the empirical psychometric properties of the Indonesian versions of the Centre for Epidemiologic Studies Depression Scale - Revised (CESD-R), the Kessler Psychological Distress Scale - 10 items (K10) and a subset of 6 items of the K10, the K6 to detect depressive and anxiety disorders among older adolescents in Indonesia.

METHODS

The empirical psychometric properties were examined formally among students aged 16-18 years attending high schools in Jakarta. The scales were validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid) modules for major depressive episode, dysthymia, panic disorder, separation anxiety disorder, and generalized anxiety disorder.

RESULTS

In total, 196 students contributed complete data. All of the scales had Cronbach's alpha >0.8. The areas under the ROC Curve of CESD-R against MINI depressive disorders and K10/K6 against MINI depressive and anxiety disorders were at moderate to high accuracy levels (0.78 to 0.86). The optimal cut-off value of CESD-R (scores ranging: 0-60) to screen for any depressive disorder is ≥20 (sensitivity 75.0%; specificity 79.9%). The optimal cut-off value of K10 to detect any depressive/anxiety disorders is ≥18 (sensitivity 85.7%; specificity 74.7%); and K6 is ≥12 (sensitivity 81.0%; specificity 76.6%); LIMITATIONS: The school-based sample limits the generalisability of the findings to this group.

CONCLUSIONS

This study suggests that the CESD-R I is a useful tool for screening for depressive disorders and both the K10 I and K6 I are useful for screening for any depressive or anxiety disorders among Indonesian adolescents.

Changes in irrational beliefs are responsible for the efficacy of the REThink therapeutic game in preventing emotional disorders in children and adolescents: mechanisms of change analysis of a randomized clinical trial

The mechanisms of change are rarely investigated in the field of gamified interventions for preventing emotional disorders in children and adolescents despite the wide recognition for the advantages they offer as prevention tool. Therefore, the aim of the present study was to investigate the mechanisms of change of a therapeutic game (REThink), specifically mediators and moderators of its efficacy. We conducted a randomized controlled trial, involving 165 children (age range 10-16 years), who were randomly distributed across three groups: the REThink group (N = 54), the Rational Emotive Behavior Education group (N = 55) and the Waitlist condition (N = 56). Results indicated that changes in irrational beliefs were significant mediators for the REThink intervention on depressive mood and overall negative emotions. Age did not moderate the effect of REThink, which indicates that the program was equally effective for children and adolescents.Trial Registration ClinicalTrials.gov NCT03308981.

Relation Between Attention-Deficit Hyperactivity Disorder and IgE-Dependent Allergy in Pediatric Patients

Food allergy is a common condition in children and adolescent, remitting with time. Few clinical studies have emphasized the link between food allergies and psychosocial conditions, suggesting a profound impact of atopic diseases on the development of attention-deficit hyperactivity disorder (ADHD) in children. The objective of this study was to compile and assess available studies on the comorbidity or causality between ADHD and atopic food allergy in children. We discuss epidemiology, interrelated mechanisms, and potential dietary interventions in the management of children with ADHD.

Parental Psychological Control and Emotional and Behavioral Disorders among Spanish Adolescents

There is no denying the fundamental role played by parents in the psychosocial development of their children—either as a liability or as protection against mental health disorders. This study seeks to ascertain, by means of odds ratio statistics (OR), the correlation between parental psychological control and emotional and behavioral disorders. A total of 762 students took part in this study, with an average age of 12.23 years—53.8% of whom were girls and 46.2% were boys. Children and adolescents reported their parental psychological control and their emotional and behavioral disorders (i.e., emotional and behavioral problems, internalizing and externalizing problems). Minors who perceive their psychological control as high are 6 times more likely to suffer from internalizing disorders and 4.8 times more likely to develop externalizing disorders. Furthermore, the probability of suffering externalizing disorders is higher among males who perceive a high degree of psychological control. This study breaks new ground on the importance of perceived psychological control—considered as a negative form of control by parents—in the emotional and behavioral disorders among children and adolescents.

School-based assessment of mental health risk in children: the preliminary development of the Child RADAR

BACKGROUND

Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems.

METHOD

Three hundred and thirty-nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well-being.

RESULTS

Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test-retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression.

CONCLUSIONS

The Child RADAR shows preliminary promise as a school-based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations.

Adherence to a healthy dietary pattern is associated with less severe depressive symptoms among adolescent girls

There is growing interest on the impact of diet on depressive disorders. However, there are limited data on the association between dietary patterns and depression symptoms among Iranian adolescents. The aim of this study was to evaluate the association between dietary patterns and depression score among Iranian adolescent girls. Data were obtained from 750 adolescent girls, who were recruited from several schools using a random cluster sampling. Dietary data were collected using a valid and reliable food frequency questionnaire (FFQ). Beck's depression inventory (BDI-II) was used to assess depression severity score. The prevalence of girls diagnosed with depression was 29.1%. Three major dietary patterns were identified in the study based on factor analysis: "Healthy", "Traditional" and "Western". The multivariate-adjusted odds ratio of having depressive symptoms was 0.55 (95% confidence intervals, 0.34-0.89) for the highest versus lowest quartile of the healthy dietary pattern score. However, there were no significant associations between the Traditional and Western dietary patterns and depression symptoms. Our results indicate that adherence to a Healthy dietary pattern characterized by high intakes of fruits, vegetables, fish and dairy products is associated with a lower probability of having depressive symptoms among Iranian adolescent girls.

Child mental illness and the help-seeking process: a qualitative study among parents in a Ugandan community

BACKGROUND

Child mental illness contributes significantly to the burden of disease worldwide, and many are left untreated due to factors on both the provider and user side. Recognising this, the Ugandan Ministry of Health recently released the Child and Adolescent Mental Health (CAMH) Policy Guidelines. However, for implementation to be successful the suggested policy changes must resonate with the service users. To better understand the sociocultural factors influencing parental mental help-seeking, we sought insights from parents in the Mbale district of eastern Uganda.

METHOD

In this qualitative study, eight focus group discussions were conducted with mothers and fathers in urban and rural communities. Parents of children younger than 10 years were purposively selected to discuss a vignette story about a child with symptoms of depression or ADHD as well as general themes relating to child mental illness. The data were analysed using qualitative content analysis.

RESULTS

Descriptions of severe symptoms and epileptic seizures were emphasised when recognising problem behaviour as mental illness, as opposed to mere 'stubbornness' or challenging behaviour. A mixture of supernatural, biomedical, and environmental understandings as underlying causes was reflected in the help-seeking process, and different treatment providers and relevant institutions, such as schools, were contacted simultaneously. A notion of weakened community social support structures hampered access to care.

CONCLUSION

Awareness of symptoms closer to normal behaviour must be increased in order to improve the recognition of common mental illnesses in children. Stakeholders should capitalise on the common recognition of the importance of the school when planning the upscaling of and improved access to services. Multifactorial beliefs within the spiritual and biomedical realms about the causes of mental illness lead to multisectoral help-seeking, albeit without collaboration between the various disciplines. The CAMH Policy Guidelines do not address traditional service providers or provide a strategy for better integration of services, which might mean continued fragmentation and ineffective service provision of child mental health care.

Inanspruchnahme von Hilfe und Versorgung bei psychischen Auffälligkeiten im Kindergartenalter

Zusammenfassung. Trotz Gefahr der Chronifizierung ist die Inanspruchnahme professioneller Unterstützung beim Vorliegen von psychischen Auffälligkeiten im Kindergartenalter gering. In der vorliegenden Übersichtsarbeit wird die Studienlage zu subjektiven Barrieren aus Elternperspektive sowie zu Prädiktoren der Inanspruchnahme von Unterstützungsmaßnahmen zusammengefasst. Neben äußeren Hindernissen benennen Eltern mangelnde Kenntnisse über das Hilfesystem sowie negative Überzeugungen gegenüber Inanspruchnahme als Barrieren. Als elternbezogene Prädiktoren der Inanspruchnahme zeigen sich v. a. positive Einstellungen bzw. Vorbehalte gegenüber Inanspruchnahme sowie eigenes elterliches Inanspruchnahmeverhalten bei psychischen Schwierigkeiten. Ein höheres Alter der Kinder, die Schwere der Psychopathologie sowie Entwicklungsverzögerungen sind kindbezogene Prädiktoren. Als Hauptprädiktor stellt sich die elterliche Problemerkennung und Sorge heraus. Die Rolle der Fachkräfte in der Kindertagesbetreuung sollte in zukünftigen Studien systematischer berücksichtigt werden.

India's response to adolescent mental health: a policy review and stakeholder analysis

PURPOSE

Mental health problems and suicide are the leading cause of mortality in young people globally. India is home to the largest number of adolescents in the world. This study was undertaken to assess the policy environment for addressing adolescent mental health in India.

METHODS

We conducted a review of 6 policies and programs and 11 in-depth interviews with key stakeholders. The findings were analyzed using the policy triangle analysis framework (i.e., context, content, actors and process).

RESULTS

There is no conformity of the age ranges addressed by these documents nor are vulnerable groups explicitly recognized. Stress, anxiety and depression were commonly identified as mental health concerns and diverse platforms such as community, family, school, digital and health facility were recommended to deliver preventive and treatment interventions. Some interventions specifically targeted some social determinants (like safe and supportive schools) but many others (like social norms) were not addressed. Preventive interventions were recommended for delivery through peers and other non-specialist providers while treatment interventions were recommended for delivery in healthcare facilities by specialist health professionals. There was very little engagement of young people in the development of these policies or in their implementation, except for peer educators mentioned in one policy. Stakeholders identified several major challenges in implementing these policies, notably the lack of inter-sectoral coordination and fragmentation of governance; budgetary constraints; and scanty human resources.

CONCLUSIONS

Although there are now several policy instruments testifying to a comprehensive approach on adolescent mental health, there are gaps in the extent of engagement of young people and how these will be operationalized that may limit their impact on addressing the burden of mental health problems in young people in India.

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches.

Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012

OBJECTIVE

To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012.

METHODS

A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12.

RESULTS

A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%).

CONCLUSIONS

Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.