Towards a youth mental health paradigm: a perspective and roadmap

The relationship between stress and clinical high-risk symptoms of psychosis in daily life: impact of contemporaneous paths on cross-lagged effects

BACKGROUND

This study aimed to deepen the understanding of the psychological mechanisms underlying the formation and maintenance of clinical high-risk symptoms for psychosis (CHR-P) in real-life contexts. Specifically, it examined whether (i) momentary feelings of stress increase the frequency of CHR-P symptoms, or conversely, (ii) CHR-P symptoms increase the intensity of stress. Additionally, potential moderators of the relationship between stress and CHR-P symptoms were explored.

METHODS

Using Ecological Momentary Assessment, 79 patients (age: 11-36; 50.6% female) recruited from an early detection center for psychosis, reported their momentary stress levels and the frequency of CHR-P symptoms eight times a day for seven days. Time series data were analyzed using residual dynamic structural equation modeling in a random intercept cross-lagged panel design, comparing differently modeled contemporaneous effects.

RESULTS

There was no evidence of a contemporaneous or temporal link between stress on CHR-P symptoms. However, a contemporaneous effect of CHR-P symptoms on stress was found, while the corresponding temporal effect was not significant. The severity of interview-assessed CHR-P symptoms, age, and type of CHR-P symptoms (i.e., basic symptoms vs. [attenuated] positive symptoms) did not affect the contemporaneous effect of CHR-P symptoms on stress. However, nonperceptive symptoms had a greater contemporaneous effect on stress than perceptive symptoms.

CONCLUSIONS

The findings suggest a greater contemporaneous impact of CHR-P symptoms on stress than vice versa. The experience of nonperceptive symptoms, in particular, may alter the appraisal of stress in daily life and represent a target for early interventions in real-time daily life (i.e., ecological momentary interventions).

Irritability and stress: Prospective, bidirectional relationships in adolescence

BACKGROUND

Irritability is a transdiagnostic risk factor for psychopathology and interpersonal problems in youth. However, there is little research on the role of life stress in irritability. The association between stress and irritability may be bidirectional, with irritability leading to stress exposure and stress aggravating irritability. Moreover, it is conceivable that there are sex differences in these relationships. Therefore, we examined the prospective, bidirectional relationships between irritability and stressful life events in a sample of adolescents while considering the role of biological sex.

METHODS

We tested multi-group path models investigating bidirectional associations of irritability with dependent and independent episodic stressors in a community sample of 520 adolescents (52.1 % male) across ages 12, 15, and 18.

RESULTS

All models had acceptable fit. For males, dependent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18. For females, irritability at age 12 predicted dependent stress at age 15, which in turn predicted more irritability at age 18. For independent events in males, irritability at age 15 predicted stress at age 18. For females, independent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18.

CONCLUSION

There are significant bidirectional relationships between irritability and episodic stressors, although the relationships varied depending on youth's age, sex, and role in contributing to stressor occurrence.

Serum proteomic correlates of mental health symptoms in a representative UK population sample

Poor mental health constitutes a public health crisis due to its high prevalence, unmet need and its mechanistic heterogeneity. A comprehensive understanding of the biological correlates of poor mental health in the population could enhance epidemiological research and eventually help guide treatment strategies. The human bloodstream contains many proteins, several of which have been linked to diagnosed mental health conditions but not to population mental health symptoms, however recent technological advances have made this possible. Here we perform exploratory factor analyses of 184 proteins from two panels (cardiometabolic and neurology-related) measured using proximity extension assays from Understanding Society (the UK Household Longitudinal Study; UKHLS). Data reduction results in 28 factors that explain 55-59% of the variance per panel. We perform multiple linear regressions in up to 5304 participants using two mental health symptom-based outcomes: psychological distress assessed with the general health questionnaire (GHQ-12) and mental health functioning assessed with the 12-Item Short Form Survey, Mental Component Summary (SF12-MCS) using the proteomic factors as explanatory variables and adjusting for demographic covariates. We use backward selection to discard non-significant proteomic factors from the models. Ten factors are independently associated with population mental health symptoms, three of which are immune-related (immunometabolism, immune cell-mediated processes, acute phase processes), three brain-related (neurodevelopment, synaptic processes, neuroprotective processes), two proteolysis-related (proteolysis & the kynurenine pathway, haemostasis & proteolysis), growth factors & muscle, and oxidative stress & the cytoskeleton. Associations partially overlap across the two outcomes, and a sensitivity analysis excluding people taking antidepressants or other central nervous system medications suggestively implicates some of the factors in treatment-resistant poor mental health. Our findings replicate those of case-control studies and expand these to underlie mental health symptomatology in the adult population. More work is needed to understand the direction of causality in these associations.

Developmental trajectories of gyrification and sulcal morphometrics in children and adolescents at high familial risk for bipolar disorder or schizophrenia

Offspring of parents with severe mental illness are at increased risk of developing psychopathology. Identifying endophenotypic markers in high-familial-risk individuals can aid in early detection and inform development of prevention strategies. Using generalized additive mixed models, we compared age trajectories of gyrification index (GI) and sulcal morphometric measures (i.e., sulcal depth, length and width) between individuals at familial risk for bipolar disorder or schizophrenia and controls. 300 T1-weighted MRI scans were obtained of 187 individuals (53 % female, age range: 8-23 years) at familial risk for bipolar disorder (n = 80, n families=55) or schizophrenia (n = 53, n families=36) and controls (n = 54, n families=33). 113 individuals underwent two scans. Globally, GI, sulcal depth and sulcal length decreased significantly with age, and sulcal width increased significantly with age in a (near-)linear manner. There were no differences between groups in age trajectories or mean values of gyrification or any of the sulcal measures. These findings suggest that, on average, young individuals at familial risk for bipolar disorder or schizophrenia have preserved developmental patterns of gyrification and sulcal morphometrics during childhood and adolescence.

Cannabis and mental health in adolescents: changes in associations over 15 years

PURPOSE

Recent changes in the cannabis market, including decreased adolescence usage, increased Δ9-tetrahydrocannabinol levels and rising mental disorders over the last decade raises questions about the changing profile of cannabis consumers.

METHODS

This study explores the trends of associations between regular cannabis use and mental health in five waves of a national representative survey of 17-year-old French adolescents, including more than 150,000 participants. Multivariable models, adjusted for gender and socioeconomic variables, were used.

RESULTS

Cannabis use and mental health indicators showed some variations over time, with increasing divergence between 2017 and 2022. Regular use of cannabis decreased from 7.4% in 2008 to 3.8% in 2022 (p < 0.001). In contrast, suicidal ideation in the past year increased from 16% in 2008 to 18% in 2022 (p = 0.009), although it followed a U-shaped trend. The association between regular cannabis use and suicidal ideation in the past year increased from 1.44 (CI: 1.29-1.61) in 2008 to 2.52 (CI: 2.05-3.10) in 2022. Similarly, the association between cannabis use and antidepressant use in the past year increased from 2.57 (CI: 2.18-3.03) in 2008 to 4.47 (CI: 3.35-5.97) in 2022.

CONCLUSION

These results suggest that cannabis users are now more prone to mental health disorders compared to 15 years ago. Several mechanisms might explain these findings, including the self-selection of a population with both vulnerabilities, changes in the effects of cannabis, or the use of cannabis as a self-medication strategy.

The quest for systematization in educational psychology practice-the case of SDQ

Introduction

The field of Educational Psychology (EP) practice is currently shaped by debates on the balance between systematized and situated approaches. This study explores these debates through the lens of the Strengths and Difficulties Questionnaire (SDQ).

Methods

Utilizing data from a current research project, the application of the SDQ in EP practice was analyzed. The study involved analyses of SDQ responses and psychoeducational reports and interviews with educational psychologists who used the SDQ in their assessments.

Results

The findings indicate that the participating educational psychologists were generally satisfied with the use of the SDQ. Additionally, a significant portion of the SDQ responses suggested that many of the examined children exhibited symptoms warranting further investigation for ADHD.

Discussion

The article concludes with a discussion on the dual perspectives regarding the systematic use of the SDQ. On one hand, there are arguments for its systematic application On the other hand, while a standardized use of the SDQ ensures systematic information, the questionnaire also contributes to a specific framing of the issue. It is crucial to recognize that the SDQ, originally developed by a child psychiatrist and not specifically designed for EP practice, frames the understanding of issues in a predominantly psychiatric manner. This can lead to a narrow focus on diagnosing and treating perceived deficiencies, potentially overlooking the broader educational and contextual factors that influence student wellbeing.

Promoting Resilience in Youth through Mindfulness mEditation (PRYME): Study protocol for a randomized controlled trial investigating the effects of mindfulness training as add-on to care-as-usual on internalizing problems, mental illness development, and associated brain and cognitive processes in help-seeking youth

BACKGROUND

Internalizing problems, such as worrying, anxiety and low mood, are increasingly common in youth and may constitute an early stage of mental illness development. There is thus an urgent need for effective measures to address mental health complaints as they develop and to prevent progression into more serious mental illness. Enhanced understanding of early-stage mental illness development, associated cognitive and brain processes, and their amenability to early intervention is crucial to this effort. Mindfulness-based interventions offer an accessible intervention option with demonstrated positive effects on internalizing disorders such as depression. Furthermore, mindfulness-based interventions may modulate cognitive processes and brain activity patterns associated with internalizing disorders. This study aims to determine how early-stage mindfulness-based intervention impacts internalizing symptom development, associated cognitive and brain processes, and mental illness progression in help-seeking youth.

METHODS

This longitudinal two-arm randomized controlled trial will be conducted in 155 help-seeking youth between 16 and 25 years of age. The investigational treatment, the Learning to Offset Stress program, is an adaptation of existing mindfulness-based programs. Developed for youth with internalizing problems, the training combines mindfulness exercises with mindful physical activity and yoga in 8 weekly 2-hour sessions. Participants are randomized to either Learning to Offset Stress program as an add on to care-as-usual, or care-as-usual-only. Assessments take place at baseline, end of treatment, and 2 months and 6 months after completion of treatment. The primary outcome is the level of internalizing problems measured with the internalizing subscale of the Adult Self Report questionnaire at end of treatment. Secondary outcomes include measures of self-compassion, rumination, experiential avoidance, and well-being. In addition, (functional) magnetic resonance imaging and computerized cognitive tasks are conducted at baseline and at end of treatment.

DISCUSSION

The current randomized controlled trial aims to enhance our understanding of the trajectory of emerging mental illness, associated cognitive and brain processes, and their modulation by early-stage mindfulness-based intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05916651. Registered on 23 June 2023.

Advances in Neuroimaging and Deep Learning for Emotion Detection: A Systematic Review of Cognitive Neuroscience and Algorithmic Innovations

Background/Objectives: The following systematic review integrates neuroimaging techniques with deep learning approaches concerning emotion detection. It, therefore, aims to merge cognitive neuroscience insights with advanced algorithmic methods in pursuit of an enhanced understanding and applications of emotion recognition. Methods: The study was conducted following PRISMA guidelines, involving a rigorous selection process that resulted in the inclusion of 64 empirical studies that explore neuroimaging modalities such as fMRI, EEG, and MEG, discussing their capabilities and limitations in emotion recognition. It further evaluates deep learning architectures, including neural networks, CNNs, and GANs, in terms of their roles in classifying emotions from various domains: human-computer interaction, mental health, marketing, and more. Ethical and practical challenges in implementing these systems are also analyzed. Results: The review identifies fMRI as a powerful but resource-intensive modality, while EEG and MEG are more accessible with high temporal resolution but limited by spatial accuracy. Deep learning models, especially CNNs and GANs, have performed well in classifying emotions, though they do not always require large and diverse datasets. Combining neuroimaging data with behavioral and cognitive features improves classification performance. However, ethical challenges, such as data privacy and bias, remain significant concerns. Conclusions: The study has emphasized the efficiencies of neuroimaging and deep learning in emotion detection, while various ethical and technical challenges were also highlighted. Future research should integrate behavioral and cognitive neuroscience advances, establish ethical guidelines, and explore innovative methods to enhance system reliability and applicability.

The correlation between resilience and mental health of adolescents and young adults: a systematic review and meta-analysis

Background

Adolescents and young adults (AYAs) aged 10-25 exhibit an increased prevalence of mental health disorders. Resilience has been well established as a positive factor in promoting and protecting mental health. This systematic review and meta-analysis aimed to quantify the correlation between resilience and mental health in AYAs by including relevant observational studies. Additionally, it explored potential moderators such as percentage of female participants, sample regions, and resilience measurements.

Methods

A comprehensive search of the PubMed, Embase, Cochrane Library, Web of Science and Scopus databases was conducted until September 2024. CMA 3.0 software was used to perform meta-analysis, publication bias and sensitivity analysis of the included studies, and the moderating effect was verified by meta-analysis of variance (ANOVA).

Result

Nineteen studies involving a total of 17,746 participants were included, and the summary effect sizes from the random effect model showed that resilience among AYAs had a correlation coefficient of -0.391 with negative indicators of mental health (95% CI: - 0.469, - 0.308, p < 0.001), and a correlation coefficient of 0.499 with positive indicators of mental health (95% CI: 0.400, 0.586, p < 0.001). Additionally, sample regions and resilience measurements significantly moderated the correlation between resilience and positive indicators of mental health.

Conclusion

Resilience in AYAs showed a moderately negative correlation with negative indicators of mental health and a moderately strong positive correlation with positive indicators of mental health. The findings strengthened the basis for future resilience research in AYAs aged 10-25, highlighting the potential of resilience to help mitigate the increasing mental health challenges faced by this population.

Editorial Perspective: A systems approach to addressing young people's mental health

This editorial explores how adopting a social determinants and systemic perspective can enhance preventative measures to boost the mental health of young people. It argues that to effectively elevate the mental health of young people, it is essential to tackle both the overarching influences and their specific local impacts. We maintain that a strategy combining systems thinking with evidence tailored to the local environment and participatory design is essential.

Concurrent and prospective associations of social media usage with binge eating symptoms in early adolescence

OBJECTIVE

This study investigated longitudinal relationships between social media usage and binge eating (BE) in early adolescence and explored potential moderating effects of sex and BMI.

METHODS

Data from the Adolescent Brain Cognitive Development (ABCD) Study, including 1940 participants aged 11 to 12 years at Wave 1, were analyzed over three annual waves. Social media addiction (SMA) scores and time spent on social media were calculated from self-report questionnaires. BE symptoms were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) through self-reports and parent reports. Modified Poisson regression was used to estimate associations, adjusting for demographic and behavioral covariates.

RESULTS

SMA symptoms, but not time on social media, were cross-sectionally and prospectively associated with BE. Prospective associations were stronger in male adolescents and differed by baseline body weight. The consistently high SMA group showed the strongest association with follow-up BE compared with the consistently low SMA group, whereas decreased and increased SMA groups showed similarly positive associations.

CONCLUSIONS

SMA scores predict BE in early adolescence, with differentiation in the relationship by sex and weight status. Further observational and interventional research could illuminate underlying mechanisms and test the value of targeting social media-addictive behaviors to mitigate the risk of disordered eating.

Novel youth mental health services in Australia: What differences are being reported about the clinical needs of those who attend and the outcomes achieved?

Globally, youth mental health services are evolving, with Australia's headspace services presented as a leading exemplar. headspace services were designed as enhanced primary care-based entities and were expected to collaborate with local acute, and specialist clinical and psychosocial services. The lack of large-scale health services trials necessitates understanding their impact through systematic monitoring and evaluation. This paper compares data from differing sources that describe the demographic and clinical features, and functional outcomes, of young people presenting to various headspace services. headspace National reports that care is provided largely to youth with transient distress, minimal clinical disorders, suicidality or comorbidities and limited functional impairment. Almost 50% of clients are reported to have no significant psychological symptoms or risk factors, and less than 30% to have a clinical disorder. Consequently, 36% receive only a single session of care and the median number of clinical sessions provided is three. By contrast, empirically derived estimates, utilising data from an academic centre and its affiliated centres, other independent agencies and more refined analyses of headspace national data variously portray 50-60% of youth as presenting with at least moderate clinical complexity (including at least 20% with high complexity), and with another 27% requiring active clinical intervention. Together, these data suggest approximately 75% of attendees require substantive clinical care. Clinical outcomes data from all sources indicate limited impacts on functional outcomes, with less than a third achieving significant improvement. These data support the original intent of headspace services to focus on equitable access to multidimensional and clinical assessment, evidence-based early interventions for early stages of major anxiety, mood or psychotic disorders. As demand for youth services continues to rise, there is an urgent need to reconfigure our national youth service networks to address the unmet clinical and psychosocial needs of youth presenting in the early stages of major mental disorders.

Longitudinal evolution of the transdiagnostic prodrome to severe mental disorders: a dynamic temporal network analysis informed by natural language processing and electronic health records

Modelling the prodrome to severe mental disorders (SMD), including unipolar mood disorders (UMD), bipolar mood disorders (BMD) and psychotic disorders (PSY), should consider both the evolution and interactions of symptoms and substance use (prodromal features) over time. Temporal network analysis can detect causal dependence between and within prodromal features by representing prodromal features as nodes, with their connections (edges) indicating the likelihood of one feature preceding the other. In SMD, node centrality could reveal insights into important prodromal features and potential intervention targets. Community analysis can identify commonly occurring feature groups to define SMD at-risk states. This retrospective (2-year) cohort study aimed to develop a global transdiagnostic SMD network of the temporal relationships between prodromal features and to examine within-group differences with sub-networks specific to UMD, BMD and PSY. Electronic health records (EHRs) from South London and Maudsley (SLaM) NHS Foundation Trust were included from 6462 individuals with SMD diagnoses (UMD:2066; BMD:740; PSY:3656). Validated natural language processing algorithms extracted the occurrence of 61 prodromal features every three months from two years to six months before SMD onset. Temporal networks of prodromal features were constructed using generalised vector autoregression panel analysis, adjusting for covariates. Edge weights (partial directed correlation coefficients, z) were reported in autocorrelative, unidirectional and bidirectional relationships. Centrality was calculated as the sum of (non-autoregressive) connections leaving (out-centrality, cout) or entering (in-centrality, cin) a node. The three sub-networks (UMD, BMD, PSY) were compared using permutation analysis, and community analysis was performed using Spinglass. The SMD network revealed strong autocorrelations (0.04 ≤ z ≤ 0.10), predominantly positive connections, and identified aggression (cout = 0.103) and tearfulness (cin = 0.134) as the most central features. Sub-networks for UMD, BMD, and PSY showed minimal differences, with 3.5% of edges differing between UMD and PSY, 0.8% between UMD and BMD, and 0.4% between BMD and PSY. Community analysis identified one positive psychotic community (delusional thinking-hallucinations-paranoia) and two behavioural communities (aggression-cannabis use-cocaine use-hostility, aggression-agitation-hostility) as the most common. This study represents the most extensive temporal network analysis conducted on the longitudinal interplay of SMD prodromal features. The findings provide further evidence to support transdiagnostic early detection services across SMD, refine assessments to detect individuals at risk and identify central features as potential intervention targets.

Modelling the impact of environmental and social determinants on mental health using generative agents

Mental health is shaped by socio-environmental determinants, yet traditional research approaches struggle to capture their complex interactions. This review explores the potential of generative agents, powered by large language models, to simulate human-like behaviour in virtual environments for mental health research. We outline potential applications including the modelling of adverse life events, urbanicity, climate change, discuss potential challenges and describe how generative agents could transform mental health research.

Eating Problems Among Adolescent Boys and Girls Before and During the Covid-19 Pandemic

OBJECTIVE

Studies suggest that adolescents reported more eating problems during the pandemic. Using a population-based sample, we compared eating problems-and how they associate with a range of personal characteristics and genetic factors-among adolescents before (June 2017-April 2020) versus during (April 2020-December 2022) the pandemic.

METHOD

Based on a preregistered analysis plan, we used cross-sectional data collected from 22,706 14-16-year-olds over 6 years (55% during the pandemic) in the Norwegian Mother, Father, and Child Cohort. We used measurement invariance analyses to compare the level of eating restraint and body concern before and during the pandemic, and multi-group structural equation models to estimate pre-pandemic and pandemic patterns of associations.

RESULTS

Pandemic responders generally reported more eating problems than pre-pandemic responders, specifically on dieting and body dissatisfaction. However, after adjusting for a general linear increase in eating problems across all 6 years of data collection, the pandemic itself seems to be associated with more eating problems only among girls, reporting more eating restraints (meanΔ = 0.14 [CI: 0.07, 0.20]) and body concern (meanΔ = 0.17 [CI: 0.11, 0.23]). Associations between eating problems and a range of other characteristics did not differ across the pandemic and pre-pandemic groups.

CONCLUSIONS

There was a general increase in eating problems among 14-16-year-olds over time. Adjusting for this trend, the pandemic seems to exacerbate problems among girls. Although the mechanisms are unclear, our results point to factors susceptible to change that could have been intensified during the pandemic (e.g., screen time, mental distress). Our results highlight the importance of recognizing sex-specific differences in eating problems.

Emotion regulation: From neural circuits to a transdiagnostic perspective

Emotion regulation is a critical factor implicated in diverse psychopathologies. However, evidence for the transdiagnostic feature of emotion regulation remains inconclusive. This study explored whether emotion regulation warrants designation as a transdiagnostic construct by examining its distinct neural basis compared to constructs within the existing Research Domain Criteria (RDoC) framework and searching for convergent regional brain activity during emotion regulation across psychiatric disorders. Thus, a two-step analysis approach was implemented. First, using coordinate-based meta-analyses, we reanalysed data from ten prior meta-analyses covering current RDoC domains, assessing unique and overlapping brain regions associated with emotion regulation. This analysis included 3.463 experimental contrasts from 78.338 healthy adults. Results indicated that emotion regulation overlapped with each RDoC domain, especially for those related to cognitive and social processes, yet maintained distinct neural patterns, particularly involving the inferior frontal and medial frontal gyrus. Second, in a separate and the most comprehensive meta-analysis to date, we analysed the neural patterns of emotion regulation in clinical populations. This analysis included 3.576 experimental contrasts from 342 participants, contrasting brain activation patterns during emotion regulation in patients suffering from psychiatric disorders with healthy controls. The findings highlighted the dorsomedial prefrontal cortex's role in emotion regulation across psychiatric disorders. Taken together, these findings support the transdiagnostic nature of emotion regulation by demonstrating its unique neural underpinnings within the RDoC framework and across psychiatric disorders. Recognising the critical importance of emotion regulation in both health and disease may help refine diagnostic criteria and develop treatment strategies, improving mental health outcomes through tailored therapeutic approaches.

Integrating youth mental health practice nurses into general practice: effects on outpatient mental health care utilization among children and adolescents

Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0-17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN.

Anxiety symptoms are differentially associated with facial expression processing in boys and girls

Facial expressions convey important social information and can initiate behavioral change through the processing and understanding of emotions. However, while this ability is known to evolve throughout development, it remains unclear whether this ability differs between girls and boys or how other variables such as level of anxiety can modulate it. Furthermore, understanding the underlying neural mechanisms of facial expression processing and how they are linked by sex and anxiety during development is essential, as alterations in this processing have been associated with psychiatric disorders. Herein, 191 typically developing youth (6- to 15-years old) completed an implicit face processing task involving three facial expressions (angry, happy, and neutral) during functional magnetic resonance imaging. We conducted linear models on the fMRI data to investigate the impact sex and anxiety on brain responses to emotional faces, accounting for age. Our findings indicated a significant anxiety-by-sex interaction in a posterior network covering bilateral visual and medial temporal cortices during the happy > neutral contrast. Specifically, girls with higher anxiety showed weaker activation while boys showed the opposite pattern. These findings suggest that the inter-subject variability reported in typically developing individuals in response to facial emotions may be related to many factors, including sex and anxiety level.

Adolescents' experiences of a whole-school preventive intervention addressing mental health and nonsuicidal self-injury: a qualitative study

BACKGROUND

Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents' experiences of such interventions.

METHODS

A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13-15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

RESULTS

The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents' conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents' experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

CONCLUSIONS

Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents' need for autonomy when planning mental health prevention and intervention.

The double disadvantage faced by adolescents from low socioeconomic backgrounds with mental health problems affects earnings up to mid-life

Early childhood socioeconomic disadvantage and mental health problems are both important determinants of adult social and economic experiences, but little is known about how they interact in this respect. We aimed to assess whether poor mental health in adolescence exacerbates labour market inequalities originating from low socioeconomic status (SES) in childhood. We use a birth cohort of individuals born in 1958 in England and follow their employment experiences and cumulative earnings up to age 55. We proxy low SES in childhood with father's occupational class at the time the respondent was aged 11, and use caregiver (usually, parent) ratings of the Rutter inventory at age 16 to identify mental health problems in adolescence. We fit ordinary least squares (OLS) models to estimate the effect of growing up in a low-SES family and experiencing mental health problems (conduct or emotional problems) in adolescence on cumulative earnings (log-transformed). We use an interaction term to test whether the association between mental health problems (conduct and emotional separately) and earnings differed by socioeconomic group. Individuals who experienced conduct problems in adolescence had lower cumulative earnings and employment levels up to age of 55. Moreover, the association between mental health problems and cumulative earnings was higher among individuals who also experienced low SES in childhood. Families from a higher socioeconomic group may have more effective means to counteract the adverse impacts of adolescent mental health problems, likely due to broader access to resources, support systems and opportunities. This underscores the role of structural supports in addressing socioeconomic inequalities in mental health outcomes and their long-terms implications.

What's next for the field of multigenerational mental health? The need for deep behavioral phenotyping via a prenatal mental health registry

From its inception, development and psychopathology theorists have sought to uncover the earliest forms of risk for mental health challenges in children, to prevent the development of more severe, intractable manifestations of psychopathology. Large familial risk registries have advanced our understanding of early, potentially modifiable factors that could prevent or mitigate the expression of challenging symptoms of neurodevelopmental conditions, and similar registries have been proposed to advance understanding of ADHD and related phenotypes. Data from single-site studies, largely focused on perinatal exposure to maternal mood disorders, reveal that a robust predictor of child psychopathology is parental psychopathology. However, early developmental trajectories of psychopathology risk may be better captured using transdiagnostic approaches in pregnancy, capturing the full range of mental health symptoms. We describe here the need for a parental mental health registry that begins prenatally that includes deep behavioral phenotyping across a range of transdiagnostic indicators of mental health risk to prevent psychopathology in children. This registry has the potential to uncover pathways to psychopathology risk in childhood and support the discovery of novel mechanisms to be targeted for prevention and intervention.

Next generation brain health: transforming global research and public health to promote prevention of dementia and reduce its risk in young adult populations

Efforts to prevent dementia can benefit from precision interventions delivered to the right population at the right time; that is, when the potential to reduce risk is the highest. Young adults (aged 18-39 years) are a neglected population in dementia research and policy making despite being highly exposed to several known modifiable risk factors. The risk and protective factors that have the biggest effect on dementia outcomes in young adulthood, and how these associations differ across regions and groups, still remain unclear. To address these uncertainties, the Next Generation Brain Health team convened a multidisciplinary expert group representing 15 nations across six continents. We identified several high-priority modifiable factors in young adulthood and devised five key recommendations for promoting brain health, ranging from individual to policy levels. Increasing research and policy focus on brain health across the life course, inclusive of younger populations, is the next crucial step in the efforts to prevent dementia at the global level.

The effects of adverse life events on brain development in the ABCD study®: a propensity-weighted analysis

Longitudinal studies of the effects of adversity on human brain development are complicated by the association of stressful events with confounding variables. To counter this bias, we apply a propensity-weighted analysis of the first two years of The Adolescent Brain Cognitive DevelopmentSM (ABCD) Study® data, employing a machine learning analysis weighted by individuals' propensity to experience adversity. Data included 338 resting-state functional connections from 7190 youth (46% female), divided into a training group (80%) and an independent testing group (20%). Propensity scores were computed using 390 variables to balance across two-year adverse life event exposures. Using elastic net regularization with and without inverse propensity weighting, we developed linear models in which changes in functional connectivity of brain connections during the two-year period served as predictors of the number of adverse events experienced during that same period. Haufe's method was applied to forward-transform the backward prediction models. We also tested whether brain changes associated with adverse events correlated with concomitant changes in internalizing or externalizing behaviors or to academic achievement. In the propensity-weighted analysis, brain development significantly predicted the number of adverse events experienced during that period in both the training group (ρ = 0.14, p < 0.001) and the independent testing group (ρ = 0.10, p < 0.001). The predictor indicated a general pattern of decreased functional connectivity between large-scale networks and subcortical brain regions, particularly for cingulo-opercular and sensorimotor networks. These network-to-subcortical functional connectivity decreases inversely associated with the development of internalizing symptoms, suggesting adverse events promoted adaptive brain changes that may buffer against stress-related psychopathology. However, these same functional connections were also associated with poorer grades at the two-year follow-up. Although cortical-subcortical brain developmental responses to adversity potentially shield against stress-induced mood and anxiety disorders, they may be detrimental to other domains such as academic success.

Revisiting Resting-State Functional Connectivity of the Amygdala and Subgenual Anterior Cingulate Cortex in Adolescents and Adults With Depression

BACKGROUND

Adolescent depression is a growing public health concern, and neuroimaging offers a promising approach to its pathology. We focused on the functional connectivity of the amygdala and subgenual anterior cingulate cortex (sgACC), which is theoretically important in major depressive disorder (MDD), but empirical evidence has remained inconsistent. This discrepancy is likely due to the limited statistical power of small sample sizes.

METHODS

We rigorously examined sgACC-amygdala connectivity in adolescents and adults with depression using data from the Healthy Brain Network (n = 321; 170 female), the ABCD (Adolescent Brain Cognitive Development) Study (n = 141; 56 female), the Boston Adolescent Neuroimaging of Depression and Anxiety study (n = 108; 75 female), and the REST-meta-MDD project (n = 1436; 880 female). Linear mixed models, Bayesian factor analyses, and meta-analysis were used to assess connectivity.

RESULTS

Our analyses revealed that sgACC-amygdala connectivity in adolescents with MDD was comparable to that in healthy control individuals, whereas adults with recurrent MDD exhibited reduced connectivity. Resampling analysis demonstrated that small sample sizes (i.e., n < 30 MDD cases) tend to inflate effects, potentially leading to misinterpretations.

CONCLUSIONS

These findings clarify the state of sgACC-amygdala connectivity in MDD and underscore the importance of refining neurocognitive models separately for adolescents and adults. The study also highlights the necessity for large-scale replication studies to ensure robust and reliable findings.

Symptom Shifting From Nonsuicidal Self-Injury to Substance Use and Borderline Personality Pathology

Importance

A decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered.

Objective

To examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology.

Design, Setting, and Participants

This cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024.

Main Outcomes and Measures

The frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria.

Results

Overall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P < .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54]).

Conclusions and Relevance

In this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.

Functional imaging derived ADHD biotypes based on deep clustering: a study on personalized medication therapy guidance

Background

Attention deficit hyperactivity disorder (ADHD) is one prevalent neurodevelopmental disorder with childhood onset, however, there is no clear correspondence established between clinical ADHD subtypes and primary medications. Identifying objective and reliable neuroimaging markers for categorizing ADHD biotypes may lead to more individualized, biotype-guided treatment.

Methods

Here we proposed a graph convolution network for biological subtype detection (GCN-BSD) using both functional network connectivity (FNC) and non-imaging phenotypic data for ADHD biotype. We applied GCN-BSD to ADHD patients from the ABCD study as the discovery dataset and a validation ADHD dataset with longitudinal medication treatment from Peking University Sixth Hospital.

Findings

We identified two biotypes based on 1069 ADHD patients selected from Adolescent Brain and Cognitive Development (ABCD) study, which were validated on independent ADHD adolescents undergoing longitudinal medication treatment (n = 130). Interestingly, in addition to differences in cognitive performance and hyperactivity/impulsivity symptoms, biotype 1 demonstrated a significantly better recovery rate in psychosomatic problems score (p < 0.05, baseline symptom score adjusted) when treated with methylphenidate than with atomoxetine.

Interpretation

Our results suggested that such an imaging-driven, biotype-guided approaches hold promise for facilitating personalized treatment of ADHD and exploring possible boundaries through innovative deep learning algorithms to improve medication treatment effectiveness.

Funding

Science and Technology Innovation 2030 Major Projects, the National Natural Science Foundation of China, the Startup Funds for Talents at Beijing Normal University, China Postdoctoral Science Foundation, and the National Institutes of Health.

Psychotic-like anomalous self-experiences in feeding and eating disorders: Their role in eating psychopathology through the mediation of body uneasiness and embodiment and identity disorders

BACKGROUND

Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED.

METHODS

Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology.

RESULTS

Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image.

DISCUSSION

Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.

A transdiagnostic prodrome for severe mental disorders: an electronic health record study

Effective prevention of severe mental disorders (SMD), including non-psychotic unipolar mood disorders (UMD), non-psychotic bipolar mood disorders (BMD), and psychotic disorders (PSY), rely on accurate knowledge of the duration, first presentation, time course and transdiagnosticity of their prodromal stages. Here we present a retrospective, real-world, cohort study using electronic health records, adhering to RECORD guidelines. Natural language processing algorithms were used to extract monthly occurrences of 65 prodromal features (symptoms and substance use), grouped into eight prodromal clusters. The duration, first presentation, and transdiagnosticity of the prodrome were compared between SMD groups with one-way ANOVA, Cohen's f and d. The time course (mean occurrences) of prodromal clusters was compared between SMD groups with linear mixed-effects models. 26,975 individuals diagnosed with ICD-10 SMD were followed up for up to 12 years (UMD = 13,422; BMD = 2506; PSY = 11,047; median[IQR] age 39.8[23.7] years; 55% female; 52% white). The duration of the UMD prodrome (18[36] months) was shorter than BMD (26[35], d = 0.21) and PSY (24[38], d = 0.18). Most individuals presented with multiple first prodromal clusters, with the most common being non-specific ('other'; 88% UMD, 85% BMD, 78% PSY). The only first prodromal cluster that showed a medium-sized difference between the three SMD groups was positive symptoms (f = 0.30). Time course analysis showed an increase in prodromal cluster occurrences approaching SMD onset. Feature occurrence across the prodromal period showed small/negligible differences between SMD groups, suggesting that most features are transdiagnostic, except for positive symptoms (e.g. paranoia, f = 0.40). Taken together, our findings show minimal differences in the duration and first presentation of the SMD prodromes as recorded in secondary mental health care. All the prodromal clusters intensified as individuals approached SMD onset, and all the prodromal features other than positive symptoms are transdiagnostic. These results support proposals to develop transdiagnostic preventive services for affective and psychotic disorders detected in secondary mental healthcare.

Quality over quantity: powering neuroimaging samples in psychiatry

Neuroimaging has been widely adopted in psychiatric research, with hopes that these non-invasive methods will provide important clues to the underpinnings and prediction of various mental health symptoms and outcomes. However, the translational impact of neuroimaging has not yet reached its promise, despite the plethora of computational methods, tools, and datasets at our disposal. Some have lamented that too many psychiatric neuroimaging studies have been underpowered with respect to sample size. In this review, we encourage this discourse to shift from a focus on sheer increases in sample size to more thoughtful choices surrounding experimental study designs. We propose considerations at multiple decision points throughout the study design, data modeling and analysis process that may help researchers working in psychiatric neuroimaging boost power for their research questions of interest without necessarily increasing sample size. We also provide suggestions for leveraging multiple datasets to inform each other and strengthen our confidence in the generalization of findings to both population-level and clinical samples. Through a greater emphasis on improving the quality of brain-based and clinical measures rather than merely quantity, meaningful and potentially translational clinical associations with neuroimaging measures can be achieved with more modest sample sizes in psychiatry.

Prevalence of autistic traits and their relationships with other psychopathological domains in young adults seeking psychiatric attention: a cluster analysis

BACKGROUND

Nearly two-thirds of individuals with a mental disorder start experiencing symptoms during adolescence or early adulthood, and the onset of a mental disorder during this critical life stage strongly predicts adverse socioeconomic and health outcomes. Subthreshold manifestations of autism spectrum disorders (ASDs), also called autistic traits (ATs), are known to be associated with a higher vulnerability to the development of other psychiatric disorders. This study aimed to assess the presence of ATs in a population of young adults seeking specialist assistance and to evaluate the study population across various psychopathological domains in order to determine their links with ATs.

METHODS

We recruited a sample of 263 adolescents and young adults referring to a specialized outpatient clinic, and we administered them several self-report questionnaires for the evaluation of various psychopathological domains. We conducted a cluster analysis based on the prevalence of ATs, empathy, and sensory sensitivity scores.

RESULTS

The cluster analysis identified three distinct groups in the sample: an AT cluster (22.43%), an intermediate cluster (45.25%), and a no-AT cluster (32.32%). Moreover, subjects with higher ATs exhibited greater symptomatology across multiple domains, including mood, anxiety, eating disorder severity, psychotic symptoms, and personality traits such as detachment and vulnerable narcissism.

CONCLUSIONS

This study highlights the importance of identifying ATs in young individuals struggling with mental health concerns. Additionally, our findings underscore the necessity of adopting a dimensional approach to psychopathology to better understand the complex interplay of symptoms and facilitate tailored interventions.

Using Electronic Health Records to Facilitate Precision Psychiatry

The use of clinical prediction models to produce individualized risk estimates can facilitate the implementation of precision psychiatry. As a source of data from large, clinically representative patient samples, electronic health records (EHRs) provide a platform to develop and validate clinical prediction models, as well as potentially implement them in routine clinical care. The current review describes promising use cases for the application of precision psychiatry to EHR data and considers their performance in terms of discrimination (ability to separate individuals with and without the outcome) and calibration (extent to which predicted risk estimates correspond to observed outcomes), as well as their potential clinical utility (weighing benefits and costs associated with the model compared to different approaches across different assumptions of the number needed to test). We review 4 externally validated clinical prediction models designed to predict psychosis onset, psychotic relapse, cardiometabolic morbidity, and suicide risk. We then discuss the prospects for clinically implementing these models and the potential added value of integrating data from evidence syntheses, standardized psychometric assessments, and biological data into EHRs. Clinical prediction models can utilize routinely collected EHR data in an innovative way, representing a unique opportunity to inform real-world clinical decision making. Combining data from other sources (e.g., meta-analyses) or enhancing EHR data with information from research studies (clinical and biomarker data) may enhance our abilities to improve the performance of clinical prediction models.

Trauma's distinctive and combined effects on subsequent substance use, mental health, and neurocognitive functioning with the NCANDA sample

PURPOSE

Traumatic brain injury (TBI) and potentially traumatic events (PTEs) contribute to increased substance use, mental health issues, and cognitive impairments. However, there's not enough research on how TBI and PTEs combined impact mental heath, substance use, and neurocognition.

METHODS

This study leverages a subset of The National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) multi-site dataset with 551 adolescents to assess the combined and distinctive impacts of TBI, PTEs, and TBI+PTEs (prior to age 18) on substance use, mental health, and neurocognitive outcomes at age 18.

RESULTS

TBI, PTEs, and TBI+PTEs predicted greater lifetime substance use and past-year alcohol and cannabis use. PTEs predicted greater internalizing symptoms, while TBI+PTEs predicted greater externalizing symptoms. Varying effects on neurocognitive outcomes included PTEs influencing attention accuracy and TBI+PTEs predicting faster speed in emotion tasks. PTEs predicted greater accuracy in abstraction-related tasks. Associations with working memory were not detected.

CONCLUSION

This exploratory study contributes to the growing literature on the complex interplay between TBI, PTEs, and adolescent mental health, substance use, and neurocognition. The developmental implications of trauma via TBIs and/or PTEs during adolescence are considerable and worthy of further investigation.

Development of Prefrontal Circuits and Cognitive Abilities

The prefrontal cortex is considered as the site of multifaceted higher-order cognitive abilities. These abilities emerge late in life long after full sensorimotor maturation, in line with the protracted development of prefrontal circuits that has been identified on molecular, structural, and functional levels. Only recently, as a result of the impressive methodological progress of the last several decades, the mechanisms and clinical implications of prefrontal development have begun to be elucidated, yet major knowledge gaps still persist. Here, we provide an overview on how prefrontal circuits develop to enable multifaceted cognitive processing at adulthood. First, we review recent insights into the mechanisms of prefrontal circuit assembly, with a focus on the contribution of early electrical activity. Second, we highlight the major reorganization of prefrontal circuits during adolescence. Finally, we link the prefrontal plasticity during specific developmental time windows to mental health disorders and discuss potential approaches for therapeutic interventions.

The Effects of Adverse Life Events on Brain Development in the ABCD Study®: A Propensity-weighted Analysis

Longitudinal studies of the effects of adversity on human brain development are complicated by the association of stressful events with confounding variables. To counter this bias, we apply a propensity-weighted analysis of the first two years of The Adolescent Brain Cognitive DevelopmentSM (ABCD) Study® data, employing a machine learning analysis weighted by individuals' propensity to experience adversity. Data included 338 resting-state functional connections from 7190 youth (46% female), divided into a training group (80%) and an independent testing group (20%). Propensity scores were computed using 390 variables to balance across two-year adverse life event exposures. Using elastic net regularization with and without inverse propensity weighting, we developed linear models in which changes in functional connectivity of brain connections during the two-year period served as predictors of the number of adverse events experienced during that same period. Haufe's method was applied to forward-transform the backward prediction models. We also tested whether brain changes associated with adverse events correlated with concomitant changes in internalizing or externalizing behaviors or to academic achievement. In the propensity-weighted analysis, brain development significantly predicted the number of adverse events experienced during that period in both the training group (ρ=0.14, p<0.001) and the independent testing group (ρ=0.10, p<0.001). The predictor indicated a general pattern of decreased functional connectivity between large-scale networks and subcortical brain regions, particularly for cingulo-opercular and sensorimotor networks. These network-to-subcortical functional connectivity decreases inversely associated with the development of internalizing symptoms, suggesting adverse events promoted adaptive brain changes that may buffer against stress-related psychopathology. However, these same functional connections were also associated with poorer grades at the two-year follow-up. Although cortical-subcortical brain developmental responses to adversity potentially shield against stress-induced mood and anxiety disorders, they may be detrimental to other domains such as academic success.

'Whole-Body' Perspectives of Schizophrenia and Related Psychotic Illness: miRNA-143 as an Exemplary Molecule Implicated across Multi-System Dysfunctions

A wide array of biological abnormalities in psychotic illness appear to reflect non-cerebral involvement. This review first outlines the evidence for such a whole-body concept of schizophrenia pathobiology, focusing particularly on cardiovascular disease, metabolic syndrome and diabetes, immunity and inflammation, cancer, and the gut-brain axis. It then considers the roles of miRNAs in general and of miRNA-143 in particular as they relate to the epidemiology, pathobiology, and treatment of schizophrenia. This is followed by notable evidence that miRNA-143 is also implicated in each of these domains of cardiovascular disease, metabolic syndrome and diabetes, immunity and inflammation, cancer, and the gut-brain axis. Thus, miRNA-143 is an exemplar of what may be a class of molecules that play a role across the multiple domains of bodily dysfunction that appear to characterize a whole-body perspective of illness in schizophrenia. Importantly, the existence of such an exemplary molecule across these multiple domains implies a coordinated rather than stochastic basis. One candidate process would be a pleiotropic effect of genetic risk for schizophrenia across the whole body.

Local and long-range input balance: A framework for investigating frontal cognitive circuit maturation in health and disease

Frontal cortical circuits undergo prolonged maturation across childhood and adolescence; however, it remains unknown what specific changes are occurring at the circuit level to establish adult cognitive function. With the recent advent of circuit dissection techniques, it is now feasible to examine circuit-specific changes in connectivity, activity, and function in animal models. Here, we propose that the balance of local and long-range inputs onto frontal cognitive circuits is an understudied metric of circuit maturation. This review highlights research on a frontal-sensory attention circuit that undergoes refinement of local/long-range connectivity, regulated by circuit activity and neuromodulatory signaling, and evaluates how this process may occur generally in the frontal cortex to support adult cognitive behavior. Notably, this balance can be bidirectionally disrupted through various mechanisms relevant to psychiatric disorders. Pharmacological or environmental interventions to normalize or reset the local and long-range balance could hold great therapeutic promise to prevent or rescue cognitive deficits.

Scoping review on mental health standards for Black youth: identifying gaps and promoting equity in community, primary care, and educational settings

BACKGROUND

Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth.

METHODS

Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers.

RESULTS

Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population.

CONCLUSIONS

Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services.

Impacts of risk thresholds and age on clinical high risk for psychosis: a comparative network analysis

One of the main goals for supporting people with a psychotic disorder is early detection and intervention, and the detection of Clinical High Risk (CHR) is a major challenge in this respect. This study sought to compare core symptoms of CHR for psychosis networks based on two CHR self-assessment tools, across different risk thresholds and age groups. This cross-sectional online investigation analyzed 936 individuals for CHR, in France and the UK, with the Prodromal Questionnaire-16 (PQ-16) and the Perceptual and Cognitive Aberrations (PCA). Twelve different symptom networks were constructed, assessing relationships, compactness, centrality, predictability, and comparisons between them, based on different thresholds and age groups. In the above-threshold PQ-16 network, the most central symptom was "Voices or whispers"; in the PCA network, the most central symptom was "Non-relevant thoughts distract or bother". They presented low overall predictability. No significant difference was found between them. This study makes three key contributions. First, this cross-network analyses highlight the relative importance of some central symptoms. Secondly, comparisons between networks demonstrate the unity of the CHR construct across scales, thresholds, and ages, affirming its phenotypic homogeneity, an essential issue for patient care pathways. Thirdly, the low average network predictability suggests the existence of unconsidered symptoms within these CHR networks. These results shed light on the organization of CHR symptoms using routine clinical questionnaires, offering insights for preventive targets in a logic of precision semiology.

The impact of pubertal stress and adult hormone exposure on the transcriptome of the developing hypothalamus

Why individuals suffer negative consequences following stress is a complex phenomenon that is dictated by individual factors, the timing of stress within the lifespan, and when in the lifespan the consequences are measured. Women who undergo adverse childhood experiences are at risk for lasting biological consequences, including affective and stress dysregulation. We have shown that pubertal adversity is associated with a blunted hypothalamic-pituitary-adrenal axis glucocorticoid response in peripartum humans and mice. In mice, our prior examination of the paraventricular nucleus (PVN) of the hypothalamus showed that pubertal stress led to an upregulation of baseline mRNA expression of six immediate early genes (IEGs) in the PVN of adult, pregnant mice. Separately, we showed that the pregnancy-associated hormone allopregnanolone is necessary and sufficient to produce the blunted stress response phenotype in pubertally stressed mice. In the current study, we further examined a potential mechanistic role for the IEGs in the PVN. We found that in pubertally stressed adult female, but not male, mice, intra-PVN allopregnanolone was sufficient to recapitulate the baseline IEG mRNA expression profile previously observed in pubertally stressed, pregnant mice. We also examined baseline IEG mRNA expression during adolescence, where we found that IEGs have developmental trajectories that showed sex-specific disruption by pubertal stress. Altogether, these data establish that IEGs may act as a key molecular switch involved in increased vulnerability to negative outcomes in adult, pubertally stressed animals. How the factors that produce vulnerability combine throughout the lifespan is key to our understanding of the etiology of stress-related disorders.

Psychological well-being and needs of parents and carers of children and young people with mental health difficulties: a quantitative systematic review with meta-analyses

QUESTION

For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents' well-being and psychological need?

STUDY SELECTION AND ANALYSIS

Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023.

INCLUSION CRITERIA

parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.

FINDINGS

32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.

CONCLUSIONS

The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.

PROSPERO REGISTRATION NUMBER

CRD42022344453.

The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse

BACKGROUND

Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA.

OBJECTIVE

We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD.

METHODS, PARTICIPANTS, AND SETTINGS

Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity.

RESULTS

No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group.

CONCLUSIONS

The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.

Editorial: "What say you?" The promise and potential pitfalls of using automated and passive monitoring approaches to assess parenting behaviours from verbal and written communication

Rates of mental health problems in adolescence are rising as highlighted in this current issue of the Journal. It is therefore increasingly important to identify children who may be at risk so that preventive interventions can be deployed before they reach adolescence. Adverse parenting has long been considered a risk factor for poor mental health in adolescence, but the methods traditionally used to assess this are laborious, burdensome and costly. Recently, passive monitoring and automated approaches to collecting and analysing spoken and written forms of parental communication have been proposed. This editorial examines the promise of such technological advances for assessing parenting and provides words of caution from parents and young people that should be heeded before rolling these approaches out at scale.

COVID-19 Pandemic Quarantines and Mental Health Among Adolescents in Norway

Importance

Adolescence is a critical developmental phase when mental health disorders, such as anxiety and depression, often emerge. Stringent public health measures and quarantine mandates during the COVID-19 pandemic could threaten adolescent mental health.

Objective

To investigate the associations of public health measures and quarantine experiences with mental distress among Norwegian adolescents and to explore if certain vulnerability factors moderate these associations.

Design, Setting, and Participants

This longitudinal cohort study used repeated measures to capture variations in mental distress explained by the stringency of public health measures and quarantine experiences. Data from the Norwegian Mother, Father, and Child cohort study were linked to national health registries and a national stringency index from April 1, 2020, to February 17, 2021. Participant included 7787 Norwegian adolescents aged 16 to 18 years. Data were analyzed from October 2022 to October 2023.

Exposures

Stringency index of public health measures and quarantine experiences including recent quarantine (within the last 2 weeks) and quarantine frequency (cumulative number of quarantine episodes).

Main Outcome and Measures

Mental distress was measured using the Hopkins Symptom Checklist across 6 data collection waves.

Results

In this study, 7787 participants were included in the analysis (4473 female [57%]; mean [SD] age, 17.0 [0.6] years). Stringent public health measures (β = 0.18; SE, 0.02; P < .001), recent quarantine (β = 0.11; SE, 0.02; P < .001), and frequent quarantine (β = 0.08; SE, 0.01; P < .001) were associated with higher levels of mental distress. The associations between public health measures and mental distress were not moderated by sex, age, prepandemic anxiety or depression, or genetic liability for mental health conditions. Frequency of quarantine appeared to be more strongly associated with mental distress among younger adolescents (β = -0.04; SE, 0.01; P = .008), those with parents with lower education (β = -0.04; SE, 0.01; P = .007), and those with lower genetic risk for depression (β = -0.03; SE, 0.01; P = .006).

Conclusions and Relevance

In this study, younger adolescents, those with parents with lower education, or those with low genetic liability for depression appeared more vulnerable when being quarantined several times. These findings emphasize the need for targeted support strategies to better protect adolescent well-being during future crises. Adolescents who experienced increased mental distress during the COVID-19 pandemic may be at risk of continued mental health problems and in need of ongoing support.

Trends in adolescent emotional problems in Wales between 2013 and 2019: the contribution of peer relationships

BACKGROUND

Epidemiological evidence shows a substantial increase in adolescent emotional problems in many countries, but reasons for this increase remain poorly understood. We tested change in emotional problems in a national sample of young people in Wales in 2013, 2017 and 2019 using identical symptom screens, and examined whether trends were accounted for by changes in youth friendship quality and bullying.

METHODS

The present study of 230,735 11-16-year olds draws on repeat cross-sectional data obtained on three occasions (2013, 2017 and 2019) in national school-based surveys in Wales (conducted by the School Health Research Network). Emotional problems were assessed with a brief validated symptom screen (the SCL-4).

RESULTS

There was a significant increase in emotional problem scores between 2013 and 2019 (b[95% CI] = 1.573 [1.380, 1.765]). This increase was observed for all ages and was more pronounced for girls than boys (interaction b [95% CI] = 0.229 [0.004, 0.462]) and for young people from less affluent families (interaction b [95% CI] = -0.564[-0.809, -0.319]). Of the total sample, 14.2% and 5.7% reported frequent face-to-face and cyberbullying respectively. There were modest decreases in friendship quality and increases in rates of bullying between 2013 and 2019, but accounting for these changes did not attenuate estimates of the population-level increase in emotional problems.

CONCLUSIONS

This study provides evidence of a substantial increase in emotional problems among young people in Wales, particularly for young people from less affluent backgrounds. Changes in bullying or friendship quality did not explain this increase.

Exploring causal mechanisms of psychosis risk

Robust epidemiological evidence of risk and protective factors for psychosis is essential to inform preventive interventions. Previous evidence syntheses have classified these risk and protective factors according to their strength of association with psychosis. In this critical review we appraise the distinct and overlapping mechanisms of 25 key environmental risk factors for psychosis, and link these to mechanistic pathways that may contribute to neurochemical alterations hypothesised to underlie psychotic symptoms. We then discuss the implications of our findings for future research, specifically considering interactions between factors, exploring universal and subgroup-specific factors, improving understanding of temporality and risk dynamics, standardising operationalisation and measurement of risk and protective factors, and developing preventive interventions targeting risk and protective factors.

Childhood adversities characterize the heterogeneity in the brain pattern of individuals during neurodevelopment

BACKGROUND

Several factors shape the neurodevelopmental trajectory. A key area of focus in neurodevelopmental research is to estimate the factors that have maximal influence on the brain and can tip the balance from typical to atypical development.

METHODS

Utilizing a dissimilarity maximization algorithm on the dynamic mode decomposition (DMD) of the resting state functional MRI data, we classified subjects from the cVEDA neurodevelopmental cohort (n = 987, aged 6-23 years) into homogeneously patterned DMD (representing typical development in 809 subjects) and heterogeneously patterned DMD (indicative of atypical development in 178 subjects).

RESULTS

Significant DMD differences were primarily identified in the default mode network (DMN) regions across these groups (p < 0.05, Bonferroni corrected). While the groups were comparable in cognitive performance, the atypical group had more frequent exposure to adversities and faced higher abuses (p < 0.05, Bonferroni corrected). Upon evaluating brain-behavior correlations, we found that correlation patterns between adversity and DMN dynamic modes exhibited age-dependent variations for atypical subjects, hinting at differential utilization of the DMN due to chronic adversities.

CONCLUSION

Adversities (particularly abuse) maximally influence the DMN during neurodevelopment and lead to the failure in the development of a coherent DMN system. While DMN's integrity is preserved in typical development, the age-dependent variability in atypically developing individuals is contrasting. The flexibility of DMN might be a compensatory mechanism to protect an individual in an abusive environment. However, such adaptability might deprive the neural system of the faculties of normal functioning and may incur long-term effects on the psyche.

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

Aims

To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations.

Methods

We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023.

Results

33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders.

Conclusion

The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries.

Systematic Review Registration

https://osf.io/8mz7a.

Sociodemographic correlates of parent and youth-reported eating disorder symptoms in the Adolescent Brain Cognitive Development Study

Purpose

Eating Disorders (EDs) often start in adolescence, though ED-related concerns in diverse youth samples remain understudied. We leveraged data from the Adolescent Brain Cognitive Development (ABCD) Study to identify the prevalence of parent- and youth-reported ED symptoms and their sociodemographic characteristics.

Methods

Data were drawn from baseline (ages 9-11 years, n=11,868) and 2-year follow-up (ages 11-14 years; n=10,908) from the ABCD Study. A tetrachoric factor analysis summarized clusters of ED symptoms, which were compared between parent and youth reports and across sociodemographic variables.

Results

Three factors emerged reflecting "weight distress", "weight control", and "binge eating" (prevalence range: 1.5-7.3%). Symptoms loaded onto similar factors between reporters. Rates of symptom endorsement were similar between sexes, with disproportionately higher endorsement rates for youth who self-identified as sexual minority, Hispanic, Black, or Mixed race participants, and those from a disadvantaged socioeconomic background, compared to the reference ABCD sample. Youth and parent reports at 2-year showed ~12% overlap.

Conclusions

ED-related concerns among historically understudied racial and sexual minority groups call for greater attention to the detection and treatment of these symptoms in these groups. Applying a transdiagnostic approach to ED symptoms can inform effective detection and intervention efforts.

From developmental neuroscience to policy: A novel framework based on participatory research

Insights from developmental neuroscience are not always translated to actionable policy decisions. In this review, we explore the potential of bridging the gap between developmental neuroscience and policy through youth participatory research approaches. As the current generation of adolescents lives in an increasingly complex and rapidly changing society, their lived experiences are crucial for both research and policy. Moreover, their active involvement holds significant promise, given their heightened creativity and need to contribute. We therefore advocate for a transdisciplinary framework that fosters collaboration between developmental scientists, adolescents, and policy makers in addressing complex societal challenges. We highlight the added value of adolescents' lived experiences in relation to two pressing societal issues affecting adolescents' mental health: performance pressure and social inequality. By integrating firsthand lived experiences with insights from developmental neuroscience, we provide a foundation for progress in informed policy decisions.