Optimal approaches for preventing depressive symptoms in children and adolescents based on the psychosocial interventions: A Bayesian Network Meta-Analysis

Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis

BACKGROUND

Myopia is a pervasive global public health concern, particularly among the younger population. However, the escalating prevalence of myopia remains uncertain. Hence, our research aims to ascertain the global and regional prevalence of myopia, along with its occurrence within specific demographic groups.

METHODS

An exhaustive literature search was performed on several databases covering the period from their inception to 27 June 2023. The global prevalence of myopia was determined by employing pooled estimates with a 95% CI, and further analysis was conducted to assess variations in prevalence estimates across different subgroups. Additionally, a time series model was utilised to forecast and fit accurately the future prevalence of myopia for the next three decades.

RESULTS

This study encompasses a comprehensive analysis of 276 studies, involving a total of 5 410 945 participants from 50 countries across all six continents. The findings revealed a gradual increase in pooled prevalence of myopia, ranging from 24.32% (95% CI 15.23% to 33.40%) to 35.81% (95% CI 31.70% to 39.91%), observed from 1990 to 2023, and projections indicate that this prevalence is expected to reach 36.59% in 2040 and 39.80% in 2050. Notably, individuals residing in East Asia (35.22%) or in urban areas (28.55%), female gender (33.57%), adolescents (47.00%), and high school students (45.71%) exhibit a higher proportion of myopia prevalence.

CONCLUSION

The global prevalence of childhood myopia is substantial, affecting approximately one-third of children and adolescents, with notable variations in prevalence across different demographic groups. It is anticipated that the global incidence of myopia will exceed 740 million cases by 2050.

An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents

Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.

Sleep duration is associated with depressive symptoms in Chinese adolescents

BACKGROUND

Depressive symptoms have become one of the most common mental health problems in adolescents. Identifying potential factors associated with adolescent depressive symptoms could be practical and essential for early intervention programs. The association between sleep duration and depressive symptoms in adolescents is inconsistent and needs further exploration.

METHODS

A total of 7330 participants aged 10-19 years were included in this study. Sleep duration was categorized into <7 h, 7-8 h, 8-9 h, and ≥ 9 h per day. The Chinese version of the Center for Epidemiology Scale for Depression was used to assess depressive symptoms. Binary logistic regression analysis was performed to evaluate the association between sleep duration and the risk of depressive symptoms. Restrictive cubic spline analyses were conducted to evaluate the dose-response relationship between sleep duration and depressive symptoms.

RESULTS

Thirty-four percent of the participants suffered from depressive symptoms. The prevalence of depressive symptoms in adolescents with sleep durations of <7 h, 7-8 h, 8-9 h, and ≥9 h per day was 52.66 %, 37.80 %, 27.55 %, and 20.49 %, respectively. After adjusting for potential covariates, long sleep duration was significantly associated with a decreased risk of depressive symptoms in adolescents. A nonlinear relationship between sleep duration and depressive symptoms was identified.

CONCLUSIONS

Long sleep duration is independently associated with a decreased risk of depressive symptoms in Chinese adolescents.

The effectiveness of Interpersonal Psychotherapy-Adolescent Skills Training for adolescents with depression: a systematic review and meta-analysis

Background

Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is a standardized depression prevention program for adolescents conducted in campus settings. The purpose of this review is to examine the randomized controlled trials of IPT-AST for the prevention of adolescent depression in the past 20 years.

Methods

A systematic search of relevant electronic databases (PubMed, WOS, Embase, PsycINFO, the Cochrane Library, CNKI and WANFANG DATA) and study reference lists was conducted. Any study investigating the effectiveness of IPT-AST in 12- to 20-year-olds with depressive symptoms was eligible. Synthesis was via narrative summary and meta-analysis.

Results

A total of 6 studies met the inclusion criteria. Meta-analysis results showed a remarkable improvement in patients' depressive symptoms after IPT-AST intervention (WMD = -5.05, 95% CI = -8.11 to -1.98, p < 0.05, I2 = 77%). Six month follow-up data showed that the intervention outcomes of IPT-AST remained significant (WMD = -3.09, 95% CI: -5.23 to -0.94, p < 0.05, I2 = 57%).

Conclusion

This meta-analysis showed that IPT-AST was effective in adolescents with depressive symptoms at post-prevention and at 6-month follow-up. However, these conclusions are cautious, as they are based on a small number of studies and the presence of author duplication. Future studies should use multi-center, large-sample randomized controlled trials to evaluate the efficacy of IPT-AST for preventing depression in adolescents.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023393047.

Associations between Adverse Childhood Experiences and Pandemic-Related Stress and the Impact on Adolescent Mental Health during the COVID-19 Pandemic

Vulnerabilities of adolescents during times of crisis have been previously identified, but little research has investigated the compounding effects of lifetime adversities and pandemic-related stress on adolescent mental health. This study uses adolescent self-report data to model relationships between stress exposures and indicators of poor mental health from the longitudinal COVID Experiences (CovEx) Surveys. These surveys were administered online in English to U.S. adolescents ages 13-19 using the NORC AmeriSpeak® panel, a probability-based panel designed to be representative of the U.S. household population. Two waves of data were collected (Wave 1: October-November 2020, n = 727; Wave 2: March-May 2021, n = 569). Measures included demographics, adverse childhood experiences (ACEs, 8 items), pandemic-related stress (Pandemic-Related Stress Index [PRSI], 7 items), and depression symptoms (Patient Health Questionnaire for Adolescents [PHQ-A], 9 items). Path analyses were conducted to examine pathways between Wave 1 ACEs, Wave 1 PRSI, and Wave 2 PHQ with covariates of sex and race/ethnicity. Females had higher ACEs, PRSI, and PHQ scores than males. The PRSI score at Wave 1 was positively associated with the PHQ at Wave 2 (b = 0.29, SE = 0.14, p < 0.001). ACEs at Wave 1 were positively associated with PRSI at Wave 1 (b = 0.31, SE = 0.03, p < 0.001) and with PHQ at Wave 2 (b = 0.32, SE = 0.12, p < 0.001). The direct effect of ACEs on PHQ (b = 0.23, SE = 0.12, p < 0.001) remained significant even after accounting for the indirect effect of pandemic-related stress (b = 0.09, SE = 0.05, p < 0.001). Pandemic-related stress had a direct, adverse impact on adolescent depressive symptoms and demonstrates a compounding effect of childhood adversity and pandemic-related stress on depression. Findings can aid the design of interventions that promote mental health and support adolescent coping and recovery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00502-0.

Testing Bidirectional, Longitudinal Associations Between Disturbed Sleep and Depressive Symptoms in Children and Adolescents Using Cross-Lagged Models

IMPORTANCE

Understanding the longitudinal, bidirectional associations between disturbed sleep and depression in childhood and adolescence is crucial for the development of prevention and intervention programs.

OBJECTIVE

To test for bidirectional associations and cascade processes between disturbed sleep and depressive symptoms covering both childhood and adolescence and to test for the moderating processes of sex and pubertal status in adolescence.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study using the Québec Longitudinal Study of Child Development (QLSCD; 1997-ongoing). QLSCD's objective is to identify early childhood factors associated with long-term psychosocial and academic adjustment. Data were collected across 8 waves between ages 5 years (2003) and 17 years (2015). Associations were tested through cross-lagged models in childhood (5, 7, and 8 years), and in adolescence (10, 12, 13, 15, and 17 years). Data were analyzed from February to October 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes were disturbed sleep and depressive symptoms. Disturbed sleep was parent-reported and included sleep duration, time awake in bed, daytime sleepiness, sleep talking, sleepwalking, night terrors, and nightmares. Depressive symptoms were parent-reported in childhood (Child Behavior Checklist and Revised Ontario Child Health Study Scales), and self-reported in adolescence (Mental Health and Social Inadaptation Assessment for Adolescents).

RESULTS

Data on 1689 children (852 female [50.4%]) and 1113 adolescents (595 female [53.5%]) were included in the analyses. In childhood, significant bidirectional associations between depressive symptoms and disturbed sleep at all time points were found, indicating cascade processes (range β = 0.07; 95% CI, 0.02-012 to β = 0.15; 95% CI, 0.10-0.19). In adolescence, significant bidirectional associations from depressive symptoms to disturbed sleep (β = 0.09; 95% CI, 0.04-0.14) and vice versa (β = 0.10; 95% CI, 0.04-0.16) between 10 and 12 years were found. Between 12 and 13 years, depressive symptoms were modestly associated with disturbed sleep (β = 0.05; 95% CI, 0.001-0.10) but the reverse association was not significant. Cross-lagged estimates were nonsignificant after 13 years. The associations did not vary as a function of either sex or puberty-by-sex.

CONCLUSIONS AND RELEVANCE

These findings suggest that disturbed sleep is associated with the consolidation of depressive symptoms starting in childhood, which, in turn, is associated with ongoing sleep problems. It is possible that timely and appropriate interventions for incipient disturbed sleep and depression prevent spiraling effects on both domains.

From Personal Observations to Recommendation of Tailored Interventions based on Causal Reasoning: a case study of Falls Prevention in Elderly Patients

OBJECTIVE

While the challenge of estimating the efficacy of therapies using observational data has received a lot of attention, little work has been done on estimating the treatment effect from interventions. In this paper, we tackle this problem by proposing an early guidance system based on a causal Bayesian network (CBN) for recommending personalized interventions. We are interested in the elderly fall prevention context. The objective is to develop a practical tool to help doctors estimate the effects of each intervention (or compound interventions) on a given patient and then choose the one that best fits each patient's health situation to reduce the risk of falling.

METHODS

On a real-world elderly information base, we undertake an empirical investigation for the proposed approach, which is based on a 44-node CBN. Then, we describe what is possible to achieve using state-of-the-art machine learning methods, namely Support Virtual Machine (SVM), Decision Tree (DT), and Bayesian Network (BN), and how well these methods can be used in recommending personalized interventions compared to the proposed approach.

RESULTS

1174 elderly patients from Lille University Hospital, between January 2005 and December 2018 are included. The results reveal that none of the classifiers is significantly superior to the others, even if BN delivers somewhat better results (41.6%) and DT most often slightly lower performance (31.2%). Results also show that none of these three classifiers performs comparable to the proposed system (89.7%). The interventions recommended by the system are in agreement with the expert's judgment to a satisfactory level. The reaction of the physicians to the proposed system in its first trial version was very favorable.

CONCLUSION

The study showed the efficacy and utility of the causality-based strategy in recommending tailored interventions to prevent elderly falls compared to automated learning methods that had failed to infer a solid interventional paradigm for precision medicine.

Updates in treatment of depression in children and adolescents

PURPOSE OF REVIEW

To examine recent evidence that informs the treatment of depression in children and adolescents.

RECENT FINDINGS

There are no new leads in the prevention and early intervention of depression in children and adolescents. For acute treatment of major depressive disorder, talking therapies are moving increasingly to internet-based platforms. Family therapy may have a slight edge over individual psychotherapy in the short-term. Patients with severe depression with endogenous features have a more robust response to pharmacotherapy than do patients with mild-to-moderate depression. Findings in relation to reward sensitivity and changes in brain-derived neurotrophic factor levels contradict research conducted in adults, suggesting developmental differences in the mechanisms underlying depression. Ketamine infusion could have a role for adolescents with treatment refractory depression. There was no new evidence concerning relapse prevention.

SUMMARY

Most new findings have been concerned with moderators and mediators of treatment.

Depression and Suicide-Risk Screening Results in Pediatric Primary Care

BACKGROUND AND OBJECTIVES

Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches.

METHODS

From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10).

RESULTS

Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription.

CONCLUSIONS

Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.