Mental health problems in Austrian adolescents: a nationwide, two-stage epidemiological study applying DSM-5 criteria

Attitudes of the general population and mental health practitioners towards blended therapy in Austria

INTRODUCTION

Mental health problems are steadily increasing worldwide. In Austria, the overall supply of mental health services is low, especially in rural areas. Mobile technology and a blended care approach have the potential to overcome problems with service provision. The aim of this study was to map the attitudes of practitioners and people living in Austria towards blended therapy.

METHOD

Two individual online questionnaires (including the Unified Theory of Acceptance and Use of Technology, advantages and disadvantages, useful features) were distributed to practitioners and the general population in Austria.

RESULTS

The questionnaires were answered by 152 members of the general public and 129 practitioners. The general population and practitioners seem to be cautious, but slightly positive about blended therapy. Previous experience of practitioners with blended therapy was low. Practitioners are most worried about the therapeutic process and their work-life balance, while the general population is worried about being overwhelmed by the concept, mainly due to the time investment. Tracking, recording and reminding functions (e.g., for mood, homework) were seen as especially valuable features and accessibility was deemed the biggest advantage by both samples.

CONCLUSION

Practitioners' attitudes are important for implementation of blended therapy. More awareness might help against the cautiousness as well as implementing digital health applications in Austrian health policies.

Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity

Background: The present study aims to elucidate the association between adverse childhood experiences, parental bonding, fatherhood, and social anxiety symptoms among emerging adults within an Iranian context. Methods: This prospective cross-sectional study utilized self-reported assessments to evaluate fatherhood, parental bonding, anxious thoughts, and childhood trauma. The study was administered to 242 university students exhibiting social anxiety symptoms. Among the participants, 181 (74.8%) were boys and 61 (25.2%) were girls between the ages of 18 and 29. In terms of educational background, 64.9% of them held a bachelor's degree, and 35.1% held a master's degree. A majority of them (84.3%) were of middle-class socio-economic status, 6.6% were of low income, and 9.1% were of high income. Results: Analysis via multiple linear regression revealed that individuals with adverse childhood experiences exhibited heightened levels of social anxiety symptoms (R2 = 0.32) compared to their counterparts without such experiences. Furthermore, fatherhood (R2 = 0.28), paternal bonding (R2 = 0.26), and maternal bonding (R2 = 0.26) were all significantly and equally associated with variance in social anxiety symptoms. The findings underscored the substantial correlation between ACEs, fatherhood, and both maternal and paternal bonding with social anxiety symptoms in adulthood. Conclusions: Accordingly, the study emphasizes the importance of thoroughly assessing the multifaceted contributors to social anxiety. Such insights are pivotal for the design and implementation of community-based preventive interventions aimed at reducing the societal burden of social anxiety disorders.

Characteristics of mental health literacy measurement in youth: a scoping review of school-based surveys

Mental health literacy (MHL) was introduced 25 years ago as knowledge and beliefs about mental disorders which aid in their recognition, management, or prevention. This scoping review mapped the peer-reviewed literature to assess characteristics of secondary school-based surveys in school-attending youth and explore components of school-based programs for fostering MHL in this population. The search was performed following the method for scoping reviews by the Joanna Briggs Institute (JBI). Searches were conducted in four scientific databases with no time limit, although all sources had to be written in English. Primary studies (N = 44) provided insight into MHL surveys and programs for school-attending youth across 6 continents. Studies reported that most youth experience moderate or low MHL prior to program participation. School-based MHL programs are relatively unified in their definition and measures of MHL, using closed-ended scales, vignettes, or a combination of the two to measure youth MHL. However, before developing additional interventions, steps should be taken to address areas of weakness in current programming, such as the lack of a standardized tool for assessing MHL levels. Future research could assess the feasibility of developing and implementing a standard measurement protocol, with educator perspectives on integrating MHL efforts into the classroom. Identifying the base levels of MHL amongst school-attending youth promotes the development of targeted programs and reviewing the alignment with program components would allow researchers to build on what works, alter what does not, and come away with new ways to approach these complex challenges, ultimately advancing knowledge of MHL and improving levels of MHL.

A mixed-method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence

PROBLEM

The significance and complexities of a psychiatric diagnosis have been well-documented in existing literature. Despite the reliability and accuracy of such diagnoses, the impact and use of diagnostic labelling on young people remains unclear.

METHODS

A systematic review was conducted using six databases, identifying 13 studies that explored psychiatric diagnosis experiences in professionals, caregivers, and young people.

FINDINGS

This review focuses on three main themes related to psychiatric diagnosis in young people. The first theme is diagnostic subjectivity, which explores the accuracy, usefulness, potential harm and alternatives (e.g. psychological formulation) to psychiatric diagnosis in this population. The second theme is the utility of psychiatric diagnosis, which considers whether it helps young people access appropriate support and gain a better understanding of themselves and their presenting issues. The third theme is stigma, which examines the negative experiences and discrimination that young people may face due to their psychiatric diagnosis.

CONCLUSIONS

There is relatively limited literature which discusses the experience of psychiatric diagnosis in young people, caregivers and professionals. The available literature is difficult to compare due to discrepancies between methodologies and services, and there are several gaps i.e. a limited focus on the experience of young people themselves. Different views and experiences of psychiatric diagnosis among professionals, caregivers, and young people could impact young people's quality of life, access to healthcare, and identity development. The current literature needs to be more comprehensive to draw firm conclusions about young people's experiences with psychiatric diagnosis.

Mental health difficulties and related factors in Chinese children and adolescents during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health.

METHODS

This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire.

RESULTS

The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays ("≥2" h/d vs "< 1" h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays ("≥ 2" h/d vs "< 1" h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]).

CONCLUSION

The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact.

Prevalence and comorbidity of anxiety disorder in school-attending children and adolescents aged 6-16 years in China

BACKGROUND

The reported prevalence rate of anxiety disorder in the paediatric population varies widely between different counties. Currently, there is no national epidemiological survey of childhood anxiety disorder in China. This study aims to investigate the national prevalence of anxiety disorder, the distribution profiles of different subtypes and its comorbidity rates among school students.

METHODS

A nationwide epidemiological survey of mental disorders in school students aged 6-16 years was conducted. Participants were randomly recruited from five provinces in China. The Child Behavior Checklist was used to screen students at high risk for mental disorders. The final diagnosis was made based on the Diagnostic and Statistical Manual-IV. The point prevalence and comorbidity rate of anxiety disorder were calculated, and the difference between age, sex and socioeconomic status groups was also compared.

RESULTS

Generalised anxiety disorder (GAD) was the most common anxiety disorder in school-attending children and adolescents, with a prevalence rate of 1.3% (95% CI: 1.2 to 1.3). Separation anxiety and specific phobia were more common in children than in adolescents. Girls had a higher prevalence of panic disorder (0.3% vs 0.2%, χ2=14.6, p<0.001) and agoraphobia (0.9% vs 0.8%, χ2=4.3, p=0.03) than that of boys. We found no significant difference between developed and less developed areas. Girls were more likely to have panic disorder and GAD than boys, with ratios of 2.13:1 and 1.01:1, respectively. The co-occurrence of anxiety disorder and attention-deficit and disruptive behaviour disorder was very common, ranging from 40% to 85%.

CONCLUSIONS

Anxiety disorder was prevalent among school students in China, and comorbidity with attention-deficit and disruptive disorder was very common. The data imply that screening for anxiety disorder is needed in school settings. Policies should be adapted to provide psychological services to children and adolescents. A comprehensive assessment is recommended in clinical practice.

School students' burdens and resources after 2 years of COVID-19 in Austria: a qualitative study using content analysis

Introduction

The mental health of young people has been severely affected by the COVID-19 pandemic and the measures associated with it. Mental health symptoms increased across various domains during the pandemic and subjective wellbeing decreased.

Methods

This study examined the burdens and resources of Austrian school students (M = 16.63 years old) in the third year of the pandemic and compared them descriptively with the burdens and resources identified in a comparative study in 2021. A cross-sectional online survey with open-ended questions from April to May 2022 provided data that was analyzed using qualitative content analysis. A sub-sample of N = 214 was selected from the larger sample. This sub-sample is representative for the Austrian population aged 15-19 in terms of gender and migrant background.

Results

Analysis of the open-ended questions showed that concerns about the pandemic and the burdens of the measures were no longer on young people's minds at the time of the survey in 2022. On the other hand, stress at school was increasing and the opening of schools and the resumption of face-to-face teaching were challenging for respondents. While resuming social contacts and leisure activities was mentioned as a resource by many respondents, some also expressed a desire for more time off and a retreat into coping strategies such as sleeping more or avoiding problems.

Discussion

Our findings suggest that there is a need for low-threshold support from teachers and parents to help students catch up on missed lessons and to empathize with the mas they make the transition back to "old normal".

The Role of the Gut Microbiota in Anorexia Nervosa in Children and Adults-Systematic Review

Among the factors incriminated in the appearance of eating disorders, intestinal microbiota has recently been implicated. Now there is evidence that the composition of gut microbiota is different in anorexia nervosa. We gathered many surveys on the changes in the profile of gut microbiota in patients with anorexia nervosa. This review comprehensively examines the contemporary experimental evidence concerning the bidirectional communication between gut microbiota and the brain. Drawing from recent breakthroughs in this area of research, we propose that the gut microbiota significantly contributes to the intricate interplay between the body and the brain, thereby contributing to overall healthy homeostasis while concurrently impacting disease risk, including anxiety and mood disorders. Particular attention is devoted to elucidating the structure and functional relevance of the gut microbiota in the context of Anorexia Nervosa.

[Mental health of sexual and gender minority youth in Austria: scoping review and research agenda based on international evidence]

A robust body of international evidence documents that lesbian, gay, bisexual, transgender, and other youth with diverse sexual orientations and/or gender identities (i.e., sexual and gender minority youth) face unique mental health vulnerabilities but are also equipped with unique resources. However, it is unclear to what extent these findings are applicable to sexual and gender minority youth in Austria, because the sociolegal and developmental contexts differ across countries. According to PRISMA guidelines, we conducted a systematic scoping review (1) to identify published studies on the mental health of sexual and gender minority youth in Austria, and, based on this, (2) to derive research recommendations supplemented by international evidence. We searched five scientific databases (PsycInfo, PSYNDEX, PubMed, Scopus, Web of Science; March 2022) and additionally contacted researchers and community leaders to find pertinent studies. Only two published empirical studies on the mental health of sexual and gender minority youth in Austria could be located, reflecting the sparse state of research in Austria. Against this background, we outline a detailed research agenda following a socio-ecological approach. Including sexual orientation and non-binary gender identities in population-based studies to assess onset, prevalence, and trajectory of mental health burdens, as well as conducting targeted, resource-based, and developmentally sensitive research on all levels seem paramount to reduce health disparities and societal stigma and to support sexual and gender minority youth in their development.

The lived experience of Omani adolescents and young adults with mental illness: A qualitative study

There is currently limited knowledge about the firsthand experiences of adolescents and young adults with mental health problems and the meanings they ascribe to these experiences, particularly within Arab countries. This study, therefore, aimed to explore the lived experience of Omani adolescents and young adults with a mental health problem. A sample of 15 participants aged 13-22 diagnosed with a range of mental health problems took part in the study. A qualitative interview guide consisting of open-ended questions was used to allow participants to speak in-depth about their experiences. Using the thematic analysis approach to uncover patterns in the data, three major themes emerged: "living in darkness", "perilous journey" and "uncertain future". Results show that the progress of adolescents and young adults with mental health problems is characterized by several challenges; the most significant of which is having insufficient knowledge about their illness, leading to unnecessary delays in their treatment. These findings shed light on the breadth and depth of the experience of adolescents and young adults with mental health problems and lay the groundwork for further examinations. Implications lie in the development of approaches for preventing or mitigating difficulties faced by adolescents and young adults with mental health problems.

Treatment Rates for Mental Disorders Among Children and Adolescents: A Systematic Review and Meta-Analysis

Importance

Mental disorders among children and adolescents are global health concerns. Published studies have provided discordant results regarding treatment rates for mental disorders among youths.

Objective

To estimate combined treatment rates for several common psychiatric disorders among children and adolescents.

Data Sources

PubMed, Web of Science, PsycINFO, Scopus, and Embase were searched from database inception until September 23, 2022, and supplemented with hand-searching of reference lists.

Study Selection

Included studies were those that used validated methods to report treatment rates for any mental disorder, depressive disorders, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and behavior disorders among children and adolescents.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and scored quality. Studies with a Joanna Briggs Institute score of 5 or more were included in the meta-analysis. Treatment rates were pooled using random-effects models. Subgroup analyses were performed to investigate the association with treatment rates of factors, such as year of data collection, World Health Organization region, age, income level, timeframe of diagnosis, informant source, service type, sample origin, and internalizing or externalizing disorder.

Main Outcomes and Measures

Treatment rates for mental disorders among children and adolescents were the main outcomes, measured as percentage estimates.

Results

Forty studies were included in the analysis, comprising 310 584 children and adolescents, with boys accounting for 39% of participants (sex was not reported in 10 studies). The pooled treatment rate was 38% (95% CI, 30%-45%) for any mental disorder, 36% (95% CI, 29%-43%) for depressive disorders, 31% (95% CI, 21%-42%) for anxiety disorders, 58% (95% CI, 42%-73%) for ADHD, and 49% (95% CI, 35%-64%) for behavior disorders. Age, income level, and region were significantly associated with the combined treatment rates of mental disorders in children and adolescents. The treatment rate for depressive disorders was higher among adolescents than children (36% [95% CI, 25%-46%] vs 11% [95% CI, 0%-25%]), whereas the treatment rate for anxiety disorders was higher among children than adolescents (64% [95% CI, 52%-75%] vs 20% [95% CI, 9%-30%]). The treatment rate for any mental disorder in lower-middle income countries was 6% (95% CI, 2%-14%), in upper-middle income countries was 24% (95% CI, 2%-47%), and in high-income countries was 43% (95% CI, 35%-52%). For depressive disorders, treatment rates were higher in the Americas (40% [95% CI, 30%-51%]) than in Europe (28% [95% CI, 13%-43%]) and the Western Pacific region (6% [95% CI, 1%-16%]).

Conclusions and Relevance

This study suggests that, in general, the treatment rates for mental disorders among children and adolescents were low, especially for depression and anxiety. Targeted intervention policies and effective measures should be designed and implemented to improve treatment rates of psychiatric disorders among youths.

Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls

Social anxiety can have an adverse effect on social connections, educational achievement, and wellbeing. However, the extent to which students stigmatize their peers with social anxiety disorder (SAD) in female educational settings remains unknown. This study investigated the relationship between SAD, peer-liking and stigma in a cohort of early adolescent girls. The sample was 103 sixth and seventh graders attending three girls' schools in Australia. The students, aged between 10- and 13-years, were randomly allocated to either a control (n = 52) or experimental (n = 51) group. Participants completed an online survey while at school to examine their responses to one of two age-and-gender matched vignettes: a hypothetical peer with SAD (experimental condition), or without SAD (control condition). Contrary to expectations, group comparisons revealed that students with the SAD vignette liked their peer more than students with the non-SAD vignette. Also, students endorsed higher levels of pity, lower levels of fear, but similar levels of anger when considering their SAD (versus non-SAD) peer. In the SAD group, higher levels of pity were associated with greater peer-liking. The opposite pattern was evident in response to the non-SAD peer. Importantly, students discriminated less (preferred less social distance) in response to their peer with SAD. This points to the potential benefit of adolescent peer programs that aim to promote positive peer-relationships as a protective factor for students with SAD. Future research may examine gender and socio-economically diverse students to increase the confidence with which findings can be generalized to other educational settings.

[Transitional psychiatric needs and identity development of adolescents in Tyrol]

BACKGROUND

Due to the structural separation of child and adolescent psychiatric treatment and adult psychiatric treatment, a switch between these two systems upon the age of 18 is necessary. Considering the importance of an organized transition, patients from an age of 17 were asked about their transition needs and aspects of their identity development. Thus future improvements in the treatment structures in this sensitive phase should derive.

METHODS

With the help of the Transition Readiness and Appropriateness Measure (TRAM), the transition-specific needs of 17 to 24-year-old patients (N = 42) at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Hall in Tirol were surveyed. In addition, the connection between identity development and transition was examined using the Assessment of Identity Development in Adolescence (AIDA).

RESULTS

Almost 80% of the patients stated that they needed further care. 'Patient-related factors' and 'family support' were described as barriers to the willingness to transition. A significant connection was found between identity development and the willingness or need for transition (r = 0.431, p < 0.01), although this was more pronounced in relation to the need for transition (r = 0.821 p < 0.01). In addition, those affected stated that they were frequently and severely burdened by stress, 45% reported self-injurious behavior, 48% suicidal thoughts or behavior in the last six months. In terms of psychopathology, anxiety and depression were among the most common symptoms. In terms of functional impairment, the 'relationships' area was the most affected.

CONCLUSIONS

The study provides initial insights into the transition-specific characteristics and needs of patients in transition age. The integration of standardized measuring instruments in institutional care systems, which individually record the transition-related needs, the willingness and need of young people in transition age, can facilitate targeted and needs-based treatment or transition. Interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry as well as a continuous transfer of the therapeutic relationships in the transition process should also be guaranteed.

Metacognitive Transmission Between Parents and Children in the Context of Anxiety Disorders

One in ten children is affected by an anxiety disorder. Current state of research shows that transgenerational transmission as well as positive (POS) and negative (NEG) metacognitive beliefs are relevant in the context of anxiety disorders in youth. We investigated whether transgenerational transmission is also evident in conjunction with POS and NEG and cross-sectionally surveyed POS, NEG, anxiety symptoms and worry in 8-16-year-old children and adolescents with anxiety disorders (n = 71) and non-clinical controls (n = 40) and one of their parents. Our results revealed significant transgenerational correlations for NEG in both samples, and for POS in the non-clinical sample only. Mediation analysis showed that children's NEG did at least partly mediate the relationship between parents' NEG and children's anxiety and worry. Children's and parents' POS did not correlate in either sample with children's anxiety and worry. Further research on the transgenerational transmission of metacognition and longitudinal data is needed.

Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up

INTRODUCTION

The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT).

OBJECTIVE

The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years.

METHODS

Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported.

RESULTS

Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI.

CONCLUSIONS

The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.

Parents' views of psychological research with children: Barriers, benefits, personality, and psychopathology

Psychological studies with children have difficulty recruiting participants and samples are more often selective. Given parental consent for children's participation, this study examined parents' perceived barriers and benefits of participating in studies and associated parental personality and psychopathological characteristics. Since there are hardly any instruments available so far, the study also aimed to develop questionnaires for the systematic and standardized assessment of barriers and benefits. One hundred and nine parents with children < 18 years completed questionnaires on willingness to participate, perceived barriers (Parents' Barriers for Participating in Research Questionnaire, P-BARQ) and benefits (Parents' Benefits for Participating in Research Questionnaire, P-BERQ), personality traits, trait anxiety, and psychopathological characteristics. The P-BARQ and P-BERQ showed overall acceptable model fits (TLI/CFI = .90-.94; RMSEA = .08/.14) and internal consistencies (α = .68-.86). Parents' willingness to own participation in psychological studies and their support for children's participation correlated negatively with perceived barriers to participation (r ≥ ǀ-.32ǀ, p < .001). Parental personality traits (such as agreeableness/openness) showed positive associations with one's own participation (r ≥ .19, p < .005) and negative correlations with perceived barriers to participation (r ≥ ǀ-.24ǀ, p < .001), while parental psychopathological characteristics are more closely related to consent to children's participation (r = .24, p < .05). Parental trait anxiety showed both a positive correlation with perceived barriers (uncertainty) and benefits (diagnostics/help) (r ≥ .20, p < .05). For the willingness to participate in studies, barriers seem to play a more crucial role than the benefits of participation. If more information is given about psychological studies, uncertainties and prejudices can be reduced.

Socioeconomic and sex inequalities in parent-reported adolescent mental ill-health: time trends in four British birth cohorts

BACKGROUND

Studies using symptom-based screeners have suggested that mental ill-health has increased in adolescents in recent decades, however, few studies have tested the equivalence of their instruments, which is critical for inferring changes in prevalence. In addition, little research has explored whether socioeconomic position (SEP) and sex inequalities in adolescent mental health have changed over time.

METHODS

Using structural equation modelling, we explored SEP and sex differences in harmonised parent reports of emotional and behavioural problems, using data from four UK birth cohorts: the 1958 National Child Development Study (NCDS'58; n = 10,868), the 1970 British Cohort Study (BCS'70; n = 8,242), the 1991-92 Avon Longitudinal Study of Parents and Children (ALSPAC'91; n = 5,389), and the 2000-01 Millennium Cohort Study (MCS'01; n = 9,338).

RESULTS

Compared with the two earliest cohorts, members of MCS'01 had higher latent mean scores on emotional problems (both sexes), and lower scores on behavioural problems (females only). The associations between four indicators of SEP and emotional problems were strongest in MCS'01, with housing tenure having the strongest association. All four SEP indicators were associated with behavioural problems in each cohort, with housing tenure again more strongly associated with problems in the MCS'01. Mediation analyses suggested that the increase in emotional problems occurred despite broadly improving socioeconomic conditions.

CONCLUSIONS

Our findings suggest that parent reports of adolescent emotional problems, but not behavioural problems, have risen in recent generations and this trend is not solely due to reporting styles. A failure to address widening social inequalities may result in further increases in mental ill-health amongst disadvantaged young people.

Lifetime prevalence and treatment of mental disorders in Saudi youth and adolescents

Previous global and regional studies indicate that adolescents and young adults (i.e., youth) are affected by various mental disorders with lifelong consequences. However, there are no national estimates of mental disorders prevalent among Saudi youth. Using data from the Saudi National Mental Health Survey (SNMHS), we examined the lifetime prevalence, treatment, and socio-demographic correlates of mental disorders among Saudi youth (aged 15-30). A total of 4004 interviews were conducted using the adapted Composite International Diagnostic Interview (CIDI 3.0). Cross tabulations and logistic regression were used to generate estimates for the SNMHS youth sample (n = 1881). The prevalence of a mental disorder among Saudi youth was 40.10%, where anxiety disorders affected 26.84% of the sample, followed by disruptive behavior disorders (15.44%), mood disorders (9.67%), substance use disorders (4%) and eating disorders (7.06%). Sex, education, parental education, income, marital status, region, and family history of disorders were significant correlates of various classes of mental disorders. Only 14.47% of Saudi youth with any mental disorder received treatment for a lifetime disorder. Age, parental education, and family history of disorders emerged as significant correlates of mental health treatment. Lifetime mental disorders are highly prevalent among Saudi youth. There is an unmet need for culturally sensitive and age-appropriate treatment of lifetime mental disorders among youth in Saudi Arabia.

Recall bias of students' affective experiences in adolescence: The role of personality and internalizing behavior

INTRODUCTION

Adolescence is characterized by multiple biopsychosocial changes, associated with a high intraindividual variability of emotional experiences. Previous findings suggest that this intraindividual variability is reflected in a recall bias of adolescents' emotion reports. However, corresponding findings are scarce and inconclusive. Studies on predictors of recall bias in adulthood indicate that personality traits, especially neuroticism and extraversion, as well as specific internalizing disorders might affect recall bias of emotion reports.

METHODS

The sample consists of 118 Swiss adolescent students in grade 8 and 9 (M_age  = 15.15, SD_age  = 0.89). The students' momentary affective experience was recorded using smartphones over seven consecutive days in situ at 42 randomly generated occasions (six per day), with a total of 1059 protocols on current events. At the end of the experience-sampling phase, students filled out an online questionnaire, providing information about their personality and typical behavior as well as their retrospective affective experience. In addition, the students' behavior was evaluated by their teachers. We applied two-level structural equation modeling with latent difference variables.

RESULTS

Adolescents high in extraversion showed retrospective overestimation of positive affective experiences and underestimation of negative affective experiences. Adolescents with high neuroticism tended to overestimate negative affect retrospectively, showing no significant effects for positive affect. However, internalizing behavior did not predict a negative recall bias in adolescents' affective experience.

CONCLUSIONS

Retrospective self-reports about adolescents' affective experience are biased by relatively stable individual factors, whereas less stable individual factors did not seem to have any influence.

An Assessment of Austrian School Students' Mental Health and Their Wish for Support: A Mixed Methods Approach

The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students' mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) assessing wishes for support regarding mental well-being and mental health indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were "professional help" and "someone to talk to". The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people's mental health problems and that this need is even more urgent for students.

[Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. A survey of the demand situation]

An increasing need for child and adolescent psychiatric care is clearly observed in recent years. The present study deals with 20 child and youth care facilities taking care of 439 children and adolescents, in the industrial district, in Lower Austria. The aim of the study is to evaluate treatment needs of this special group of patients. The care facilities reported that 270 children and adolescents (62%) show psychiatric problems. Of these, 220 (50.1%) are diagnosed with one or more psychiatric diagnoses, and 200 children and adolescents are receiving child and adolescent psychiatric treatment. Eleven care facilities reported the necessity for treatment in 80-100% of their accommodated children and adolescents. This results in highly stressful working conditions for professional psychosocial helpers and high treatment needs within their fosterlings. It is evident that more intensive networking and cooperation between institutions and helpers involved is necessary. Further, the development of new, low-threshold child and adolescent psychiatric services would be desirable to adequately meet the increasing need for psychiatric treatment in children and adolescents.

Mental Health and Health-Related Quality of Life in Austrian Adolescents with Chronic Physical Health Conditions: Results from the MHAT Study

Chronic physical health conditions (CPHC) are on the rise in younger age groups and might have a negative impact on children and adolescents. In a representative sample of Austrian adolescents aged 10-18 years, internalizing, externalizing, and behavioral problems were assessed cross-sectionally using the Youth Self-Report and health-related quality of life (HrQoL) using the KIDSCREEN questionnaire. Sociodemographic variables, life events, and chronic illness specific parameters were considered as associated variables with mental health problems in individuals with CPHC. Of 3469 adolescents, 9.4% of girls and 7.1% of boys suffered from a chronic pediatric illness. Of these individuals, 31.7% and 11.9% had clinically relevant levels of internalizing and externalizing mental health problems, respectively, compared to 16.3% and 7.1% adolescents without a CPHC. Anxiety, depression, and social problems were twice as high in this population. Medication intake due to CPHC and any traumatic life-event were related to mental health problems. All HrQoL domains were deteriorated in adolescents with a double burden of mental and CPHC, whereas adolescents with a CPHC without mental health problems did not differ significantly from adolescents without a chronic illness. Targeted prevention programs for adolescents with a CPHC are urgently needed to prevent mental health problems in the long term.

Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences

BACKGROUND

Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs.

METHODS

N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses.

RESULTS

Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (β = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories.

CONCLUSION

While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

Moderated digital social therapy for young people with emerging mental health problems: A user-centered mixed-method design and usability study

Introduction

Over 25% of Dutch young people are psychologically unhealthy. Individual and societal consequences that follow from having mental health complaints at this age are substantial. Young people need care which is often unavailable. ENgage YOung people earlY (ENYOY) is a moderated digital social therapy-platform that aims to help youngsters with emerging mental health complaints. Comprehensive research is being conducted into the effects and to optimize and implement the ENYOY-platform throughout the Netherlands. The aim of this study is to explore the usability and user experience of the ENYOY-platform.

Methods

A user-centered mixed-method design was chosen. 26 young people aged 16-25 with emerging mental health complaints participated. Semi-structured interviews were conducted to explore usability, user-friendliness, impact, accessibility, inclusivity, and connection (Phase 1). Phase 2 assessed usability problems using the concurrent and retrospective Think Aloud-method. User experience and perceived helpfulness were assessed using a 10-point rating scale and semi-structured interviews (Phase 3). The Health Information Technology Usability Evaluation Scale (Health-ITUES; Phase 1) and System Usability Scale (SUS; Phase 2 and 3) were administered. Qualitative data was analyzed using thematic analysis. Task completion rate and time were tracked and usability problems were categorized using the Nielsen's rating scale (Phase 2).

Results

Adequate to high usability was found (Phase 1 Health-ITUES 4.0(0.34); Phase 2 SUS 69,5(13,70); Phase 3 SUS 71,6(5,63)). Findings from Phase 1 (N = 10) indicated that users viewed ENYOY as a user-friendly, safe, accessible, and inclusive initiative which helped them reduce their mental health complaints and improve quality of life. Phase 2 (N = 10) uncovered 18 usability problems of which 5 of major severity (e.g. troubles accessing the platform). Findings from Phase 3 (N = 6) suggested that users perceived the coaching calls the most helpful [9(0.71)] followed by the therapy content [6.25(1.41)]. Users liked the social networking aspect but rated it least helpful [6(2.1)] due to inactivity.

Conclusion

The ENYOY-platform has been found to have adequate to high usability and positive user experiences were reported. All findings will be transferred to the developmental team to improve the platform. Other evaluation methods and paring these with quantitative outcomes could provide additional insight in future research.

Lifetime prevalence and temporal trends of incidence of child's mental disorder diagnoses in Catalonia, Spain

INTRODUCTION

Most mental disorders have its onset during childhood, but less than one third of affected children seek professional help. The aim of this study is to (1) estimate the lifetime prevalence of mood, anxiety, conduct, and eating disorder diagnoses in 18-year-olds in 2017 and (2) the temporal trends of incidence diagnosis rates in 2009-2017 in children aged 2-18 in Catalonia, Spain.

MATERIAL AND METHODS

We used a registry-based cohort including all children aged 2-18 living in Catalonia in 2009-2017, from the Catalan Health Service. Cases were identified with ICD-9 codes. Lifetime prevalence was calculated for 2017, and annual incidence for 2009-2017. Temporal trends were analyzed with multivariate negative binomial regression models.

RESULTS

Lifetime prevalence of diagnoses was highest for conduct disorders (5.05%), followed by anxiety (4.37%), mood (3.07%), and eating disorders (2.11%). Median age of diagnosis was 16 years for mood, anxiety and eating disorders, and 15 years for conduct disorders. Comorbidity was present in 20.74% of those diagnosed with a mental disorder. Annual incidence rates for all disorders increased in 2011-2013/2014, and then stabilized. However, incidence rate of anxiety diagnoses in 13-18-year-old children doubled between 2016 and 2017.

CONCLUSIONS

Lifetime prevalence of diagnoses are lower than the expected rates of mental disorders based on interview/survey European studies. Further research is needed into the factors underlying (1) the underdiagnoses of mental disorders in children and (2) the increasing trend of anxiety disorder diagnoses in older children.

A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

[A three-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic]

BACKGROUND AND RESEARCH QUESTION

The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing a series of articles in a special issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape.

METHOD

First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other.

RESULTS AND CONCLUSIONS

On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, a significant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.

Worldwide prevalence of DSM-5 eating disorders among young people

PURPOSE OF REVIEW

Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22.

RECENT FINDINGS

In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men, bulimia nervosa by 0.8-2.6% of women and 0.1-0.2% of men, binge eating disorder by 0.6-6.1% of women and 0.3-0.7% of men, other specified feeding or eating disorders by 0.6-11.5% of women and 0.2-0.3% of men, and unspecified feeding or eating disorders 0.2-4.7% of women and 0-1.6% of men. Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalences. During the COVID-19 pandemic, the incidence of eating disorders has still increased.

SUMMARY

Eating disorders are a global health concern among young people. Improved detection, management, and prevention methods are urgently needed.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

Prevalence of social anxiety disorder and symptoms among Chinese children, adolescents and young adults: A systematic review and meta-analysis

The objective of the study is to provide a reliable estimate of the pooled prevalence of social anxiety disorder (SAD) and social anxiety symptoms (SAS) among children, adolescents, and young adults (CAYA) in China. Meta-analysis is used to provide pooled-prevalence rate of SAD and SAS. Literature searches were conducted in both English and Chinese databases from the database's inception to April 2019. Eleven studies were identified for SAD, and 17 were included for SAS. The results revealed a pooled prevalence of SAD of 2.1% (95% CI: 1.2-3.8%) with high between-studies heterogeneity (Q = 1,055.2, I 2 = 99.1%, p < 0.001). The pooled prevalence estimate of SAS was 23.5% (95% CI: 18.6-29.3%), also with significant heterogeneity (Q = 1,019.3, I 2 = 98.4%, p < 0.001). Different diagnostic tools or self-report scales reported significant different prevalence of SAD or SAS. Further analysis stratified by gender, age, sampling methods, economic status, and risk of bias were performed. Limitations include the high level of heterogeneity between studies, inadequate number of the studies, and significant differences in prevalence caused by measurements.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149591, identifier: PROSPERO CRD42020149591.

Mental health burden of high school students, and suggestions for psychosocial support, 1.5 years into the COVID-19 pandemic in Austria

The COVID-19 pandemic and containment efforts seem to be particularly challenging for adolescents. This study assessed mental health in high school students 1.5 years after the pandemic began in Austria. A cross-sectional survey was carried out from September to November 2021. Well-being (WHO-5), depressive symptoms, anxiety symptoms and sleep quality were assessed. A total of 1505 adolescents participated (78% girls). The cut-offs for clinically relevant symptoms were exceeded by 62% girls and 38.1% boys for depression (PHQ-9 score ≥ 11), 49% girls and 29% boys for anxiety (GAD-7 score ≥ 11) and 28% girls and 17% boys for insomnia (ISI score ≥ 15). The prevalence of suicidal ideation (item 9 of the PHQ-9) within the last 2 weeks was 47% in girls and 32% in boys. These data collected in autumn 2021 (the start of the second semester of reopened schools; t2) were compared to data collected in February 2021 (one semester after remote schooling; t1). A matched pairs analysis according to age, gender, region, school type and migration background resulted in a total sample size of N = 2514 adolescents. Results showed small deteriorations in mental health (i.e., well-being, depression, insomnia, suicidal ideation) in girls at t2 compared to t1, and an increase in suicidal thoughts in boys (all p-values < 0.05). Qualitative data show that young people have a need for more psychological support, both professional and informal, as well as increased mental health literacy. Results suggest that mental health burden in adolescents remains high 1.5 years into the pandemic and highlight the need to implement timely psychological support.

School Students’ Concerns and Support after One Year of COVID-19 in Austria: A Qualitative Study Using Content Analysis

Adolescents suffer severely from the psychological consequences of the COVID-19 pandemic. Using qualitative content analysis, this study examined open-ended responses to a survey on the mental health of school students in Austria in February 2021. A representative sample (n = 214) was drawn from a total survey sample of 3052 adolescents aged 14–20. The analysis revealed several areas of concern, including school-related concerns, concerns about restrictions, self-related concerns, and interpersonal problems. School-related concerns associated with distance learning were mentioned most frequently. Compared with research conducted at the beginning of the pandemic, it appeared that concerns about educational and professional futures increased. The analysis also indicated young people’s most important sources of support, such as social contacts, recreational activities, attitudes and abilities, distraction, and escape. Of concern is the proportion of young people citing maladaptive coping strategies and the reluctance to seek professional support. Ideas for practice-oriented measures were developed from the study results, such as embedding youth-led peer interventions in traditional mental health services.

Peer Facilitators as Core Co-developers of an Online Peer Encouragement Network (OPEN2chat) for Austrian Adolescents

Adolescence is a crucial developmental time, and it is essential to ensure stable mental health during the transition to adulthood. Peer-to-peer networks seem to be a promising tool to support adolescents during that time. While co-development often concentrates on the end-user, this paper focuses on the peer facilitators of an online peer encouragement network (OPEN2chat), where adolescents can chat with peer facilitators about their problems. We conducted 3 group discussions with 18 peer facilitators after a testing phase to improve the process of these interactions. Thematic analysis was used to analyse the data after transcription. The four main themes were the responsibility of the peer facilitators toward their peers, especially their role of giving advice; the interaction process itself; time management; and technology aspects of the application. Including these stakeholders in the development process empowered the young people, helped eliminate problems with the application, and made the researchers more sensitive toward potential issues and emotions that peer facilitators encounter that may have been missed without a co-development process. Eliminating these problems might also help establish a better environment and support system for the actual end-users.

Within-person Relations between Domains of Socio-emotional Development during Childhood and Adolescence

Adolescence is a critical period in the development of mental health with nearly 1 in 5 adolescents suffering from mental health problems and more than 40 percent of these experiencing at least one co-occurring mental health disorder. This study investigates whether there are differences in the relations between key dimensions of child and adolescent mental health in adolescence compared to childhood. Mental health and related socio-emotional traits were measured longitudinally at ages 4, 7, 8, 9, 11, 13, and 16 in the Avon Longitudinal Study of Parents and Children (N = 11279) using the Strengths and Difficulties Questionnaires. Graphical Vector Autoregression models were used to analyse the temporal within-person relations between conduct problems, emotional problems, hyperactivity/inattention, peer problems and prosociality across childhood (ages 4 to 9) and adolescence (11 to 16). Results suggest that adolescence is characterised by an increase in the number and strength of temporal relations between socio-emotional difficulties. In particular, in adolescence there were bidirectional connections between peer problems and emotional problems, between conduct problems and hyperactivity/inattention and between prosociality and conduct problems as well as hyperactivity/inattention. In childhood, conduct problems and prosociality were reciprocally related. Results also suggested peer problems as a potential mediating factor between conduct and emotional problems in childhood. Overall, this study suggests that different domains of socio-emotional development influence each other over development. Adolescence is characterised by an increase in temporal connections, which may be one factor underlying the increased vulnerability to the onset of mental health problems during that period.

Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach

Introduction

To optimize treatment, it is of utmost importance to take into account the myriad of biological, social, and psychological changes that young people go through during adolescence which make them more vulnerable for developing mental health problems. Biocueing, a non-invasive method to transform physiological parameters into an observable signal, could strengthen stress- and emotion regulation by cueing physiologically unusual values in daily life. The aim of this study is to investigate the usability, feasibility, and exploratory effect of biocueing in addition to ENgage YOung people earlY (ENYOY), a moderated digital social therapy-platform, in young people with emerging mental health complaints.

Methods

A user-centered mixed-method design was used. A focus group was conducted to optimize the ENYOY-platform and biocueing intervention. Biocueing was operationalized by a smartwatch and the Sense-IT app. A within-subjects design was used; 10 days for all participants 'biofeedback off' (control), followed by 10 days 'biofeedback on' (experimental). Emotional awareness and perceived stress were measured using ecological momentary assessment. Eight individuals participated. User-friendliness, usability, and acceptance were assessed using a qualitative design.

Results

Findings from the focus group resulted in several adaptations of the biocueing intervention to the ENYOY-platform and vice versa. The average measurement compliance rate was 78.8%. Level-one findings showed different individual effects on perceived stress and emotional awareness. Level-two analyses showed no overall effects on perceived stress (B = -0.020, p = 0.562) and overall positive effects on emotional awareness (B = 0.030, p = 0.048) with small effect sizes (Improvement Rate Difference = 0.05-0.35). The intervention was found to be acceptable and showed moderate usability. Participants indicated they experienced improvements in reflection on feelings and changes in behavior, such as pausing and evaluating the situation.

Conclusion

These preliminary results show that biocueing could be a promising addition to digital treatment platforms and help young people become more emotionally aware. Improvements should be made regarding the usability and acceptability of the smartwatch, as well as more extensive integration of the biocueing intervention with a digital treatment platform. It would be relevant to gain a better understanding of which individuals would benefit most from an additional biocueing intervention.

Prevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China

Mental health issues are becoming increasingly prevalent amongst university students. However, research on the psychological profile of the general university population is relatively limited. Thus, this study analyses the current state of university students' psychological conditions; the demographic differences in depression, anxiety, and stress and the influencing factors. The objectives are to provide additional appropriate guidance in mental health for university students with different demographic characteristics. A cross-sectional study of 6,032 university students nationwide was conducted from October 2020 to January 2021. A randomized whole-group sampling method was used to select the study participants, and the 21-item Depression, Anxiety, and Stress Scale (DASS) was used. P < 0.05 in the final model were considered statistically significant. The number of university students with no complain of depression, anxiety, or stress was 3,751 (62.2%). The odds of developing complain of depression were higher amongst anxious respondents (AOR = 23.417, 95% CI: 19.706, 27.826) and senior year (AOR = 2.210, 95% CI: 1.657, 2.947) than their counterparts. Students with "myopia" were 1.263 times more likely to be anxious (AOR = 1.263, 95% CI: 1.042-1.530). In terms of "impaired" or not, impaired is defined as any injury, such as sprain, strain, and fracture, "impaired" university students were 1.321 times more likely to be anxious (AOR = 1.321, 95% CI: 1.064-1.641). Furthermore, history of impairment and myopia increased the odds of stress by 1.305 (AOR = 1.305, 95% CI: 1.022-1.667) and 1.305 (AOR = 1.305, 95% CI: 1.012-1.683), respectively. Myopia, physical-activity-related injury (PARI) and irrational eating habits are risk factors for complain of anxiety and stress. Males, upper grades, low parental education, and irrational eating habits are risk factors for complain of depression. Low physical activity levels are also an influential factor for complain of depression. DASS consists of interchangeable risk factors and multiple complains of DASS may coexist.

Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective

BACKGROUND

In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance.

METHODS

We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria.

RESULTS

We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework.

CONCLUSIONS

Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.

Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy?

Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.

The black hole of the transition process: dropout of care before transition age in adolescents

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

Outcomes and Mechanisms of Change of the Strengthening Families Program in a Clinical Sample of Children and Their Families in Austria

Family context and parenting behavior have the greatest influence on children's mental health and well-being, and interventions that take the whole family system into account are promising. This study aims to evaluate the outcomes, i.e., family strength, parenting behavior, and child behavior, of the Strengthening Families Program (SFP), developed by Kumpfer which was implemented in an outpatient clinic of a community-based non-governmental organization in Austria between 2012 and 2018. Furthermore, the program's mechanism of change as formulated by the program authors (i.e., to what extent parenting behavior mediates the relationship between family strength and child behavior) was tested in this clinical sample. Instruments measuring family strength, parenting behavior, and child behavior were administered before, immediately after, and 6 months after participation in the SFP. To test the mechanisms of change, a half-longitudinal model was applied with two measurement points (before and after). A total of 62 families (50 boys, 24 girls, and 69 parents) participated in the culturally adapted SFP. Regarding the outcomes of the program, all variables yielded significant improvement in all variables. With respect to the mechanism of change, no significant association between the variables could be found. Implications for the implementation of the SFP in a clinical population and how further adaptation of the program could enhance the adherence of this target group are discussed.

The Associations Between the Anorexic Readiness Syndrome, Familism, and Body Image Among Physically Active Girls

Introduction: Anorexic Readiness Syndrome (ARS) is a construct of prophylactic importance, useful in the selection of people showing a tendency to use restrictive diets and increased concentration on the body. The aim of the research was to verify the significance of the type of physical activity, body perception and familism for the development of ARS. Material and Method: The research was carried out in the first half of 2021on a sample of 163 girls. It consisted of: (1) physically inactive girls (n = 48), (2) physically active girls in disciplines other than aesthetic (n = 69), (3) girls engaged in aesthetic physical activity (n = 46). The study used: Anorexic Readiness Syndrome Questionnaire (ARS-12), Familism Scale (FS) and Body Image Avoidance Questionnaire (BIAQ). Results: The highest average ARS score was recorded in the group of girls engaged in aesthetic activity. A significant difference in the severity of ARS occurs between people who do not engage in activity and those who practice aesthetic activity. The severity of ARS rises as the difference between real and ideal body weight increases. People active in aesthetic disciplines who obtained a high score on the Respect scale (FS subscale) have a lower ARS score than those physically active in other disciplines who obtained low scores on the Respect scale. The higher the score on the Material success and achievement scale (FS), the greater the ARS intensity in all subgroups. What is much more important in shaping ARS is the perception of your body. The focus on eating and body weight and Clothing and appearance (BIAQ subscales) are relevant to the ARS and moderate the relationship between Material success (FS subscale) and anorexic readiness. Conclusions: People engaging in aesthetic physical activity are more likely to suffer from ARS. The family can certainly prevent a child from developing anorexic readiness by shaping a sense of community and family identity, a clear division of roles, limiting the importance of materialism and competition in raising children. The prevention of ARS and eating disorders should also focus on strengthening the realistic assessment of body parameters and their acceptance, as well as promoting strategies for healthy weight control.

Mental health over nine months during the SARS-CoV2 pandemic: Representative cross-sectional survey in twelve waves between April and December 2020 in Austria

BACKGROUND

There is accumulating evidence about detrimental impacts of the pandemic on population mental health, but knowledge on risk of groups specifically affected by the pandemic and variations across time is still limited.

METHODS

We surveyed approximately n=1,000 Austrian residents in 12 waves between April and December 2020 (n=12,029). Outcomes were suicidal ideation (Beck Suicidal Ideation Scale), depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Depression Scale), and domestic violence. We also assessed the perceived burden from the pandemic. Demographic and Covid-19 specific occupational and morbidity-related variables were used to explain outcomes in multivariable regression analyses, controlling for well-established risk factors of mental ill-health, and variations over time were analyzed.

RESULTS

Young age, working in healthcare or from home, and own Covid-19 illness were consistent risk factors controlling for a wide range of known mental health risk factors. Time patterns in the perceived burden from Covid-19-related measures were consistent with the time sequence of restrictions and relaxations of governmental measures. Depressive and anxiety symptoms were relatively stable over time, with some increase of depression during the second phase of lockdowns. Domestic violence increased immediately after both hard lockdowns. Suicidal ideation decreased slightly over time, with a low during the second hard lockdown. Mental health indicators for women and young people showed some deterioration over time, whereas those reporting own Covid-19 illness improved.

LIMITATIONS

Data from before the pandemic were not available.

CONCLUSIONS

Among mental health outcomes, increases in domestic violence and, to some smaller extent, depressive symptoms, appeared most closely related to the timing of hard lockdowns. Healthcare staff, individuals working from home, those with Covid-19, as well as young people and women are non-traditional risk groups who warrant heightened attention in prevention during and in the aftermath of the pandemic.

Brain Stimulation for Emotion Regulation in Adolescents With Psychiatric Disorders: Study Protocol for a Clinical-Transdiagnostical, Randomized, Triple-Blinded and Sham-Controlled Neurotherapeutic Trial

BACKGROUND

Anxiety, conduct and depressive disorders represent three highly prevalent psychiatric conditions in adolescents. A shared underpinning of these disorders is a shortcoming in emotion regulation, connected to the functioning of the ventromedial prefrontal cortex. Thus, an intervention able to target the suggested neural correlate seems to be highly desirable, aiming to hinder a maladaptive development of emotion regulation abilities and chronification of associated psychiatric disorders. As transcranial direct current stimulation (tDCS) was repeatedly demonstrated as a safe and non-invasive method to modulate specific brain activity, research is in demand to evaluate neurotherapeutic applications in adolescents with psychiatric disorders.

METHOD

This transdiagnostic, randomized, triple-blind and sham-controlled clinical neurostimulation trial primary aims to investigate if emotion regulation abilities are increased after tDCS in adolescents with psychiatric disorders. Secondly, disorder-specific changes in the anxiety, depression or conduct disorder will be investigated, as well as changes in quality of life, and cognitive and emotional functioning after tDCS intervention. We will include 108 adolescents with psychiatric disorders, displaying a substantial deficit in emotion regulation. Of these, one third each has to be primarily diagnosed with a depressive, anxiety or conduct disorder, respectively. Participants will be randomized to the experimental group (n = 54) receiving real anodal tDCS, or to the control group (n = 54) receiving sham tDCS. Brain stimulation will be applied for 20 min on five consecutive days twice targeting the ventromedial prefrontal cortex (vmPFC). Changes in emotion regulation, together with changes in disorder-specific clinical symptoms will be recorded by multi-informant psychological ratings. To inspect changes in behavior and gaze, computerized tasks and an eye tracker system will be used. Changes in brain responses to emotional and cognitive stimuli will be examined with three functional magnetic resonance imaging (fMRI) paradigms. In addition, a resting state MRI will be acquired to investigate possible changes in brain connectivity.

DISCUSSION

By investigating "emotion regulation" as transdiagnostic treatment target, this project is oriented toward the Research Domain Criteria framework with a dimensional view on mental illness. The study aims at investigating the potential of tDCS as non-invasive intervention for depressive, anxiety and conduct disorders in adolescents and broadening the scientific foundation for its clinical application.

CLINICAL TRIAL REGISTRATION

The study is ongoing and has been registered in the German Registry of Clinical Trials (DRKS-ID: DRKS00025601X) on the 28.06.2021.

[Current situation of child and adolescent psychiatric care in Austria in the outpatient setting]

The status of care in child and adoelscent psychiatry in Austria is still incomplete but increasing since the foundation of this medical specialty. Corona pandemia increases the pressure on the caring structures.In this paper the current state of publically paid outpatient care is reviewed and summarized. Differences between current state and the desired/planned state of care will document existing deficits and needed developments.The 9 federal states of Austria have made variable progress in developing the general child psychiatric care. We conclude with recommendations for further implementations.