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Zhong X, Wang C, Xu M, Yuan X, Jiang C. Physical training improves inhibitory control in children aged 7-12 years: An fNIRS study. Behav Brain Res 2024; 463:114902. [PMID: 38341102 DOI: 10.1016/j.bbr.2024.114902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Physical exercise plays a crucial role in the development of cognition and brain functions in children. Inhibitory control is an advanced cognition that affects children's life and learning. In the current study, the relationship between physical training and inhibitory control was explored. In total, 80 children were randomly but equally assigned to the experimental and control groups. The experimental group underwent physical training (volleyball) for 60 min, thrice a week for 12 weeks. In contrast, the control group did not undergo any training and continued with their daily routines. The flanker task and functional near-infrared spectroscopy (fNIRS) were employed to investigate the effects of 12-week physical training on inhibitory control and changes in the oxy-Hb concentration in the prefrontal cortex (PFC) during the task. The behavioral results revealed that the experimental group performed better on the flanker task (e.g., shorter response time [F(1,74) = 18.420, p < 0.001, ηp2 = 0.199] and higher accuracy [F(1,74) = 15.00, p < 0.001, ηp2 = 0.169] than the control group. The oxy-Hb concentration in the right dorsolateral PFC (R-DLPFC) was higher and the activation level of this region was higher during the flanker task [F(1,74) = 6.216, p < 0.05, ηp2 = 0.077]. Moreover, the McNemar test revealed improved cognitive performance in response time or accuracy and R-DLPFC activation induced by physical exercise coincided significantly (χ2 = 5.49, p < 0.05; χ2 = 6.081, p < 0.05). These findings suggest that the R-DLPFC is likely the neural substrate for improved cognitive performance elicited by 12-week physical training.
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Affiliation(s)
- Xiaoke Zhong
- Graduate Department, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Chen Wang
- Graduate Department, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Mingchao Xu
- Graduate Department, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Xiaoxia Yuan
- Graduate Department, Capital University of Physical Education and Sports, Beijing 100191, China
| | - Changhao Jiang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100089, China.
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Mürner-Lavanchy I, Koenig J, Reichl C, Josi J, Cavelti M, Kaess M. The quest for a biological phenotype of adolescent non-suicidal self-injury: a machine-learning approach. Transl Psychiatry 2024; 14:56. [PMID: 38267430 PMCID: PMC10810046 DOI: 10.1038/s41398-024-02776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
Non-suicidal self-injury (NSSI) is a transdiagnostic psychiatric symptom with high prevalence and relevance in child and adolescent psychiatry. Therefore, it is of great interest to identify a biological phenotype associated with NSSI. The aim of the present study was to cross-sectionally investigate patterns of biological markers underlying NSSI and associated psychopathology in a sample of female patients and healthy controls. Comprehensive clinical data, saliva and blood samples, heart rate variability and pain sensitivity, were collected in n = 149 patients with NSSI and n = 40 healthy participants. Using machine-based learning, we tested the extent to which oxytocin, dehydroepiandrosterone (DHEA), beta-endorphin, free triiodothyronine (fT3), leukocytes, heart rate variability and pain sensitivity were able to classify participants regarding their clinical outcomes in NSSI, depression and borderline personality disorder symptomatology. We evaluated the predictive performance of several models (linear and logistic regression, elastic net regression, random forests, gradient boosted trees) using repeated cross-validation. With NSSI as an outcome variable, both logistic regression and machine learning models showed moderate predictive performance (Area under the Receiver Operating Characteristic Curve between 0.67 and 0.69). Predictors with the highest predictive power were low oxytocin (OR = 0.55; p = 0.002), low pain sensitivity (OR = 1.15; p = 0.021), and high leukocytes (OR = 1.67; p = 0.015). For the psychopathological outcome variables, i.e., depression and borderline personality disorder symptomatology, models including the biological variables performed not better than the null model. A combination of hormonal and inflammatory markers, as well as pain sensitivity, were able to discriminate between participants with and without NSSI disorder. Based on this dataset, however, complex machine learning models were not able to detect non-linear patterns of associations between the biological markers. These findings need replication and future research will reveal the extent to which the respective biomarkers are useful for longitudinal prediction of clinical outcomes or treatment response.
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Affiliation(s)
- Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Johannes Josi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Kim S, Yoon H, Shin J, Yang CM. Classification of fNIRS signals from adolescents with MDD in suicide high- and low-risk groups using machine learning. J Affect Disord 2023; 340:379-386. [PMID: 37536425 DOI: 10.1016/j.jad.2023.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
Prefrontal cortex activation is attenuated during cognitive tasks in patients with suicidal ideation or major depressive disorder (MDD). However, the apparent relationship between patients with MDD, especially suicide high-risk (SHR) adolescents, and the characteristics of their hemodynamic responses has not yet been elucidated. To investigate this relationship, we recruited 30 patients with MDD aged 13-19. Functional near-infrared spectroscopy (fNIRS) data were collected for all patients during a Stroop test. Through a ten-time iterative leave-one-out cross-validation via 1000 iterative random search-based feature selections, we achieved a generalized classification accuracy of 70.3±5.0 % (from min. 63.3 % to max. 76.7 %). From the results of random search-based feature selection, Ch08oxy and Ch09deoxy were identified as the two most relevant fNIRS channels. This finding implies that these fNIRS channels can be used as neurological biomarkers to distinguish SHR adolescents with MDD from suicide low-risk (SLR) adolescents. In addition, we determined the oxy-Hb channels of the SHR group, except for Ch01oxy, Ch02oxy, Ch11oxy, and Ch14oxy, were hyperactivated compared to the SLR group.
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Affiliation(s)
- Seonghyeon Kim
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Haram Yoon
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Jaeyoung Shin
- Department of Electronic Engineering, Wonkwang University, Iksan 54538, Republic of Korea.
| | - Chan-Mo Yang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea.
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Kriegmair V, Sigrist C, Vöckel J, Kaess M, Koenig J. Red cell distribution width and depressive symptoms: A failed replication in female adolescents. World J Biol Psychiatry 2023; 24:754-759. [PMID: 37070471 DOI: 10.1080/15622975.2023.2203222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Despite the increasingly high prevalence and serious consequences of depression in adolescents, there is a lack of economical and reliable biomarkers to aid the diagnostic process. Recent findings suggest that red blood cell distribution width (RDW) is an easily obtainable biomarker of depression in adults. Here, we aimed to replicate the finding of increased RDW in clinically depressed adolescents. METHODS Data from depressed adolescent female patients (n = 93) and healthy controls (HC) (n = 43) aged 12-17 years from the AtR!Sk-bio cohort study were retrospectively analysed. We compared RDW between groups and tested whether there was an association between RDW and depression severity and global (psychiatric) symptom severity. We also examined the influence of age on RDW. RESULTS There was no significant difference between depressed patients and healthy controls and no association between RDW and depression severity. However, higher RDW values were associated with greater global symptom severity. Regardless of group, there was a positive association between RDW and age. CONCLUSIONS RDW appears to be unfit as an aid for clinical diagnosis of depression in adolescents, but may be useful in assessing global psychiatric symptom burden.
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Affiliation(s)
- Valentin Kriegmair
- Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christine Sigrist
- Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasper Vöckel
- Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Li L, Yang H. Heterogeneity in Adolescents' Non-Suicidal Self-Injury Behaviour Trajectories Based on the Group-Based Trajectory Model and a Decision Tree Analysis of Family-Related Determinants. Psychol Res Behav Manag 2023; 16:3359-3371. [PMID: 37654969 PMCID: PMC10465360 DOI: 10.2147/prbm.s427090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a global public health problem. While some studies have noted the importance of behavioural development patterns in NSSI, most NSSI research is based on cross-sectional survey data. Few studies explore the time-series heterogeneity of trajectories of NSSI symptoms and family-related influencing factors of NSSI. Aim The purpose of the study was to identify the heterogeneity in trajectories of adolescents' NSSI behaviour and their family-related influencing factors. Methods The group-based trajectory model (GBTM) was used to identify the heterogeneity in the NSSI behaviour trajectories of 208 adolescents in China. Next, the decision tree model (DTM) was used to analyse which family related factors influence the trajectory type. Results The GBTM revealed two heterogeneous trajectories of NSSI behaviour: the high-risk and low-risk NSSI behaviour groups. Next, DTM's average accuracy was 83.2%. A total of seven independent variables were used for the DTM: gender, number of NSSIs in the past month, and family economic, family structure, family conflict, parental psychological control, parental behavior control and family intimacy risks. Family conflict risk was located at the root node and was the most important factor. Conclusion Heterogeneity within the population should be considered in the management of adolescents' NSSI behaviours. Further, from the perspective of family system theory and cumulative risk, focusing on the adverse effect of multiple risk factors on adolescents' NSSI addiction is more meaningful rather than the impact of single risk factors. Studies that use time series data should focus on the trend of dynamic changes in NSSI addiction characteristics over time.
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Affiliation(s)
- Linbo Li
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Hui Yang
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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Lee SM, Cha J, Hong M. Increased Right Dorsolateral Prefrontal Cortex Connectivity During Emotion Recognition Task in Adolescents With Self-Injurious Behavior: A Functional Near-Infrared Spectroscopy Study. Psychiatry Investig 2023; 20:137-143. [PMID: 36891598 PMCID: PMC9996148 DOI: 10.30773/pi.2022.0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Research on neural correlates in the prefrontal cortex (PFC) associated with self-injurious behavior has mainly been performed in adults. However, studies on adolescents are scarce. We aimed to investigate the activation and connectivity of the PFC between adolescents with self-injurious behavior (ASI) and psychiatric controls (PC) using functional near-infrared spectroscopy (fNIRS). METHODS We used an emotion recognition task during fNIRS to assess 37 adolescents (23 with self-injurious behavior and 14 PC) between June 2020 and October 2021 and compared connectivity and activation between the two groups. We also measured adverse childhood events (ACE, Adverse Childhood Experiences) and performed a correlation analysis of channel activation according to ACE total scores. RESULTS The difference in activation between the groups was not statistically significant. The connectivity of channel 6 was statistically significant. The interaction between channel 6 and the ACE total score showed statistical significance between the two groups(t[33] -2.61; p=0.014). The ASI group showed a negative correlation with the total ACE score. CONCLUSION This is the first study to investigate PFC connectivity using fNIRS in ASI. It has the implication of a novel attempt with a practically useful tool to uncover neurobiological differences among Korean adolescents.
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Affiliation(s)
- Sang Min Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | | | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.,UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
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Han K, Ji L, Chen C, Hou B, Ren D, Yuan F, Liu L, Bi Y, Guo Z, Wu N, Feng M, Su K, Wang C, Yang F, Wu X, Li X, Liu C, Zuo Z, Zhang R, Yi Z, Xu Y, He L, Shi Y, Yu T, He G. College students’ screening early warning factors in identification of suicide risk. Front Genet 2022; 13:977007. [DOI: 10.3389/fgene.2022.977007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
This study aimed to explore the main influencing factors of suicide risk among Chinese students and establish an early warning model to provide interventions for high-risk students. We conducted surveys of students in their first and third years from a cohort study at Jining Medical College. Logistic regression models were used to screen the early warning factors, and four machine learning models were used to establish early warning models. There were 8 factors related to suicide risk that were eventually obtained through screening, including age, having a rough father, and CES-D, OHQ, ASLEC-4, BFI-Neuroticism, BFI-Openness, and MMC-AF-C scores. A random forest model with SMOTE was adopted, and it verified that these 8 early warning signs, for suicide risk can effectively predict suicide risk within 2 years with an AUC score of 0.947. Among the factors, we constructed a model that indicated that different personality traits affected suicide risk by different paths. Moreover, the factors obtained by screening can be used to identify college students in the same year with a high risk of suicide, with an AUC score that reached 0.953. Based on this study, we suggested some interventions to prevent students going high suicide risk.
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Sui Y, Kan C, Zhu S, Zhang T, Wang J, Xu S, Zhuang R, Shen Y, Wang T, Guo C. Resting-state functional connectivity for determining outcomes in upper extremity function after stroke: A functional near-infrared spectroscopy study. Front Neurol 2022; 13:965856. [PMID: 36438935 PMCID: PMC9682186 DOI: 10.3389/fneur.2022.965856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/10/2022] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Functional near-infrared spectroscopy (fNIRS) is a non-invasive and promising tool to map the brain functional networks in stroke recovery. Our study mainly aimed to use fNIRS to detect the different patterns of resting-state functional connectivity (RSFC) in subacute stroke patients with different degrees of upper extremity motor impairment defined by Fugl-Meyer motor assessment of upper extremity (FMA-UE). The second aim was to investigate the association between FMA-UE scores and fNIRS-RSFC among different regions of interest (ROIs) in stroke patients. METHODS Forty-nine subacute (2 weeks-6 months) stroke patients with subcortical lesions were enrolled and were classified into three groups based on FMA-UE scores: mild impairment (n = 17), moderate impairment (n = 13), and severe impairment (n = 19). All patients received FMA-UE assessment and 10-min resting-state fNIRS monitoring. The fNIRS signals were recorded over seven ROIs: bilateral dorsolateral prefrontal cortex (DLPFC), middle prefrontal cortex (MPFC), bilateral primary motor cortex (M1), and bilateral primary somatosensory cortex (S1). Functional connectivity (FC) was calculated by correlation coefficients between each channel and each ROI pair. To reveal the comprehensive differences in FC among three groups, we compared FC on the group level and ROI level. In addition, to determine the associations between FMA-UE scores and RSFC among different ROIs, Spearman's correlation analyses were performed with a significance threshold of p < 0.05. For easy comparison, we defined the left hemisphere as the ipsilesional hemisphere and flipped the lesional right hemisphere in MATLAB R2013b. RESULTS For the group-level comparison, the one-way ANOVA and post-hoc t-tests (mild vs. moderate; mild vs. severe; moderate vs. severe) showed that there was a significant difference among three groups (F = 3.42, p = 0.04) and the group-averaged FC in the mild group (0.64 ± 0.14) was significantly higher than that in the severe group (0.53 ± 0.14, p = 0.013). However, there were no significant differences between the mild and moderate group (MD ± SE = 0.05 ± 0.05, p = 0.35) and between the moderate and severe group (MD ± SE = 0.07 ± 0.05, p = 0.16). For the ROI-level comparison, the severe group had significantly lower FC of ipsilesional DLPFC-ipsilesional M1 [p = 0.015, false discovery rate (FDR)-corrected] and ipsilesional DLPFC-contralesional M1 (p = 0.035, FDR-corrected) than those in the mild group. Moreover, the result of Spearman's correlation analyses showed that there were significant correlations between FMA-UE scores and FC of the ipsilesional DLPFC-ipsilesional M1 (r = 0.430, p = 0.002), ipsilesional DLPFC-contralesional M1 (r = 0.388, p = 0.006), ipsilesional DLPFC-MPFC (r = 0.365, p = 0.01), and ipsilesional DLPFC-contralesional DLPFC (r = 0.330, p = 0.021). CONCLUSION Our findings indicate that different degrees of post-stroke upper extremity impairment reflect different RSFC patterns, mainly in the connection between DLPFC and bilateral M1. The association between FMA-UE scores and the FC of ipsilesional DLPFC-associated ROIs suggests that the ipsilesional DLPFC may play an important role in motor-related plasticity. These findings can help us better understand the neurophysiological mechanisms of upper extremity motor impairment and recovery in subacute stroke patients from different perspectives. Furthermore, it sheds light on the ipsilesional DLPFC-bilateral M1 as a possible neuromodulation target.
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Affiliation(s)
- Youxin Sui
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Chaojie Kan
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
- Department of Rehabilitation Medicine, Changzhou Dean Hospital, Changzhou, China
| | - Shizhe Zhu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Tianjiao Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Jin Wang
- Department of Rehabilitation Medicine, Changzhou Dean Hospital, Changzhou, China
| | - Sheng Xu
- Department of Rehabilitation Medicine, Changzhou Dean Hospital, Changzhou, China
| | - Ren Zhuang
- Department of Rehabilitation Medicine, Changzhou Dean Hospital, Changzhou, China
| | - Ying Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Tong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Chuan Guo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
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Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
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Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
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