The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics

Why is rumination unhelpful in adolescents? Two studies examining the causal role of abstract processing

Rumination is a common feature of depression in adolescents and adults and it is implicated in the maintenance of depression symptoms. In adults, the maladaptive consequences of rumination have been attributed to the abstract processing mode that characterises this thinking style. The question of whether the same is true in adolescents remains unanswered. Here we describe two experimental studies in which adolescents were trained to think in a mode either characteristic of or inconsistent with the abstract processing style observed in depressive rumination, and the effect on social problem-solving and negative future thinking was examined. The two experiments employed a similar design. 11-14 year olds scoring in the upper and lower quartile on a measure of depression were trained to engage in an abstract or concrete processing style and then carry out a social problem-solving (Study 1) or future thinking (Study 2) task. Adolescents were worse at social problem-solving and had more negative (but not fewer positive) future thoughts when engaging in abstract processing compared to concrete processing, regardless of their current level of depressive symptoms. The finding remained when controlling for state mood. Our findings suggest there may be value in targeting abstract ruminative processing as an early treatment for depression.

Trauma and anxiety interactions relate to reward processing in adolescents

Anxiety is highly prevalent among adolescents, often linked to trauma exposure. However, not all youth with trauma develop anxiety, suggesting variability in risk pathways. This study investigates how neural reward system alterations may signal vulnerability to anxiety following trauma. We hypothesized that differences in reward-related connectivity in the ventral striatum and amygdala would distinguish adolescents with higher trauma and higher anxiety (anxiety risk group) from those with higher trauma but lower anxiety (non-anxiety development), as well as from youth with lower trauma and lower anxiety (typical development) and with lower trauma and higher anxiety (non-trauma-related anxiety). We utilized a sample of 44 adolescents (ages 11-19) with varying levels of trauma exposure and anxiety who completed a child-friendly monetary incentive delay task and analyzed their amygdala and ventral striatum functional connectivity during the task to assess the interaction between trauma exposure and anxiety levels. Our findings reveal distinct Trauma x Anxiety neural connectivity patterns in widespread prefrontal, temporal, and occipital clusters, potentially serving as biomarkers for anxiety risk. These results provide insight into potential neurobiological markers associated with anxiety vulnerability, bringing us a step closer to identifying targets for future intervention development. By highlighting unique patterns of reward processing associated with different trauma and anxiety profiles, this study advances our knowledge of the neural mechanisms underlying anxiety risk, laying the groundwork for future research on neurobiologically informed approaches to prevention and treatment.

The Association of Mental Health, Asthma Control and Acute Care Visits Among Rural Adolescents with Poorly Controlled Asthma

Anxiety and depressive symptoms are associated with asthma-related acute care utilization. Few studies include rural adolescents. Asthma control may be the mechanism by which mental health affects acute care. This study explored associations between generalized anxiety, asthma-related anxiety, depressive symptoms, and acute care visits, and tested if asthma control mediates these associations among 197 rural adolescents with asthma. Data analysis included descriptive statistics and regression. Controlling for age, sex and race/ethnicity, asthma-related anxiety was associated with higher odds of acute care visits (OR = 2.09, 95% CI [1.42, 3.07]). Asthma control mediated this relationship: one unit increase in anxiety, on average, increased the odds of having any acute care visit by 5%. Generalized anxiety and depressive symptoms were not associated with acute care visits. Helping adolescents reduce their concerns regarding asthma while improving their self-management skill may potentially to reduce acute care among rural adolescents.

Developmental differences in threat learning are associated with changes in frontal-central theta activity

Major theories link variations in threat learning to the emergence of anxiety symptoms, especially during adolescence. Despite significant neural maturation of threat learning circuitry during this developmental stage, research on adolescence-specific neural responses during threat learning is limited. This study was the first to examine threat learning mechanisms through neural frequency activity among youth, focusing on activity in the theta (4-7 Hz) and alpha (8-12 Hz) frequency bands. Sixty-three adolescents and 65 adults completed a two-day threat acquisition and extinction procedure, while brain activity was measured using electroencephalography (EEG). Analyses focused on developmental differences in high temporal resolution changes in frequency activity, distinguishing between induced and evoked EEG signals. Developmental differences were mainly observed in frontal-central theta activity. During acquisition, adolescents showed higher induced theta activity to both threat and safety cues than adults. During extinction, adults showed decreased evoked theta activity to the conditioned stimulus, indicating effective inhibition of threat representations; in contrast, adolescents exhibited persistent threat contingencies throughout extinction. Both groups showed consistent alpha suppression towards the threat cue, suggesting sustained vigilance even during late extinction. Frontal-central theta activity is a valuable marker for capturing differences between adolescents and adults in threat learning. These findings add to mechanistic research efforts aiming to uncover factors contributing to anxiety vulnerability during adolescence.

Unraveling Youth Trauma and Parental Influence After Twin Earthquakes

Background: Earthquake exposure has been linked with high rates of posttraumatic stress symptoms (PTSS) and comorbid conditions. Familial factors play critical roles in modulating these outcomes. This study examined youth trauma and parental influence following the twin earthquakes in Kefalonia, Greece, in 2014; Methods: A cross-sectional study was conducted with 502 adolescents (aged 11-18 years) and 474 parents from three regions categorized by proximity to the earthquake epicenter. Standardized self-report measures were administered. Data were analyzed using descriptive statistics, correlation analyses, and multiple hierarchical regression analyses to identify key predictors of adverse outcomes; Results: Among children, 5.2% exhibited probable PTSD, with girls reporting significantly higher symptom levels than boys. Higher earthquake exposure was associated with elevated PTSS and anxiety. In parents, 44.3% met criteria for probable PTSD, and those in the epicenter group reported significantly higher levels of stress, anxiety, and sleep disturbances. Earthquake exposure was identified as the strongest predictor of adverse outcomes, with parental psychopathology and diminished social support further contributing to increased symptom severity in children; Conclusions: The study demonstrates that both direct earthquake exposure and familial factors-particularly parental mental health and social support-play critical roles in shaping posttraumatic outcomes in youth, underscoring the need for integrated, family-centered mental health interventions in post-disaster settings.

Adolescent cognitive control processing is associated with anxiety in young adulthood during the COVID-19 pandemic

The COVID-19 pandemic has been associated with widespread increases in levels of stress and anxiety among young adults. Given that responses to stressful life events vary, it is important to understand how pre-pandemic neurocognitive factors shape reactivity to stress and susceptibility to anxiety. The present study examines associations between pre-pandemic brain activation patterns during cognitive control processing and anxiety trajectories during the pandemic. Participants were recruited as part of an ongoing longitudinal study of temperament and socioemotional development (N = 291). Forty-seven participants completed a cognitive control fMRI task and anxiety measures in late adolescence before the pandemic. In young adulthood, anxiety was assessed three times during the COVID-19 pandemic. Multivariate whole-brain models tested whether activation patterns during the conflict and error processing associated with latent anxiety indices derived from a latent growth curve model. Neural response during conflict and error processing related to anxiety in distinct cortical and subcortical regions. Level of anterior cingulate cortex engagement during cognitive control related to anxiety. However, during error processing, level of engagement in the dorsolateral prefrontal, rather than anterior cingulate cortex, related to anxiety. This work provides preliminary evidence for the predictive utility of prestress neurocognitive factors for young adults' anxiety response during a uniquely stressful event. Adolescence is a critical time for early identification of youth at risk to create targeted interventions to enhance stress resilience.

Prevalence of anxiety symptoms among caregivers of children with ADHD attending pediatric and speech therapy departments

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a prevalent mental diagnosis among children. This leads to a persistent pattern of hyperactivity and inattention that hinders functioning and development and places strain on parents. The goal of this study was to assess the incidence of ADHD symptoms in a pediatric population and to measure anxiety, depression, and the burden of caregiving in parents.

METHODS

This study included 44 families with children who were monitored at King Hamad University Hospital's (KHUH) pediatric and speech therapy departments. In addition to sociodemographic questions, parents were required to complete scales including the parental ADHD diagnostic scale, the Screen for Child Anxiety Related Disorders (SCARED), anxiety (GAD7), depression (PHQ9), and burden of care (MCSI).

RESULTS

18% of the young people (n = 8) were formally diagnosed with ADHD. A regression analysis was performed on the population of those with ADHD, considering their sociodemographic traits and the outcomes of other scales. This revealed that children with ADHD and high scores on the SACRED questionnaire had a statistically significant relationship (p value of 0.012). The GAD-7 (p = 0.942), PHQ-9 (p = 0.671), and MCSI (p = 0.167) questionnaires, on the other hand, were not significantly related. The study revealed that although parents did not exhibit any increased level of generalized anxiety, depression, or burden of care, they were more anxious about their children's health.

CONCLUSION

Parents of children with ADHD have more anxiety regarding their children's health, but they do not experience more depression, anxiety, or excessive caregiving burdens because their children have symptoms of ADHD.

Pathways from parental trauma exposure to Syrian and Iraqi refugee youth mental health symptoms: a multi-level mediation analysis

BACKGROUND

Trauma experienced by one generation has potential to impact those that follow. Refugee youth in particular are vulnerable to trauma and its intergenerational effects. By examining trauma subtypes, the impact of parental trauma, and post-/pre-migration stressors, this study investigated pathways linking parental trauma to psychological symptoms in Syrian and Iraqi refugee youth.

METHODS

Participants included 165 minors from Syria and Iraq, and their 107 parents (56 mothers, 51 fathers), all of whom experienced forced migration due to war and resettled as refugees in southeast Michigan. Linear mixed-effects modeling and multi-level mediation analyses were employed to investigate pathways from parental trauma exposure to child symptoms (anxiety, depressive, and somatic), as well as possible explanatory mediators.

RESULTS

Maternal cumulative trauma and death threat trauma were associated with child depressive symptoms (cumulative: b = 1.64, p =.007; death threat: b = 2.70, p =.020) and somatic burden (cumulative: b = 0.56, p =.032; death threat: b = 1.04, p =.041). Anxiety models also revealed an association between maternal cumulative trauma and child anxiety (b = 1.79, p =.034). Maternal post-migration living difficulties fully mediated the observed association between maternal cumulative trauma and child depression, though this effect was trending in sensitivity analyses. No paternal trauma variables were associated with child symptoms.

CONCLUSION

Findings indicate that maternal trauma exposure in particular-as well as elevated post-migration stressors for mothers-may contribute to mental health risk in refugee youth. These insights may be leveraged towards early identification of youth at high risk, and to direct focused intervention towards modifiable targets-including living difficulties (e.g., financial difficulties, access to health care and transportation) experienced by parents post-migration.

CLINICAL TRIAL NUMBER

Not applicable.

A quasiexperimental study of assessing the impact of stress management program on health science students at Kuwait University

The purpose of this research was to study the effectiveness of a stress management program among students at the Health Science Center (HSC), Kuwait University. This study utilized a quasiexperimental research design in which the participants were randomly assigned to one of two groups: (1) the control group or (2) the experimental (intervention) group. The participants received a comprehensive educational seminar relevant to stress management (i.e., a presentation, written hand-outs and a structured home program). The program addressed nine topics pertaining to stress management strategies: breathing and imagery techniques; self-care routines; planning for success; meditation strategies; monitoring mechanisms for coping; seeking help for mental health, exercise and health; cognitive behavioral therapy tips (CBTs); and psychoeducation. The demographic data along with using two validated tools were collected through online google form; the validated tools were: (1) the Perceived Stress Scale and (2) the Depression, Anxiety, and Stress Scale-21. Nonparametric tests, including Wilcoxon signed-rank tests and Kruskal‒Wallis tests, were used to investigate statistically significant differences between the median scores of the control and intervention groups (p values < 0.05). Ninety-eight participants participated in the stress management program (56 participants in the intervention group and 42 in the control group). There was a significant improvement in stress and depression in the intervention group compared with the control group (p values < 0.05). With respect to the value of the stress management program, additional online postintervention survey questions were filled out by the intervention group; 82.1% (n = 46) of the intervention group agreed that the stress management program was useful, and 89.3% (n = 50) agreed that they would recommend that other students utilize this program regularly in the future. In conclusion, in this study, we developed, implemented, and evaluated the effects of a stress management program among HSC students. The program improved HSC students' mental health while reducing their depression and stress levels. Most importantly, the study findings presented here were feasible and could provide important information that can be applied to future studies and used as invaluable mental health resources for students at different university programs. Thus, future studies with larger representative samples and true randomized controlled trials are needed to consolidate our findings concerning the value of such scientifically driven and culturally relevant stress management program.

Gender Moderates the Associations Between Responsiveness to Alarming Oral Sensations, Depressive Symptoms, and Dietary Habits in Adolescents

Background/Objectives: As a peripheral effect of depression-related traits, sensory responses may predispose individuals to depressive symptoms by prompting suboptimal dietary patterns with long-term effects on mood. Mood disturbances in adolescence are strong predictors of adult mental illness, making it crucial to identify factors that may shift transient mood fluctuations into more severe mental health issues during this vulnerable period. Given the substantial gender differences in susceptibility to comorbidities of depression, we examined whether the link between sensory perception and depressive symptoms in nonclinical adolescents varied by gender and was related to dietary habits. Methods: In this cross-sectional study, 232 healthy adolescents (41.8% girls, aged 13-17) reported their diet over the past year using the EPIC Food Frequency Questionnaire and rated their liking and perceived intensity of oral sensations from four grapefruit juices and dark chocolate puddings with varying sucrose levels. Additionally, participants completed assessments of anxiety, neuroticism, pickiness, body dissatisfaction, and the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Results: We found that girls exhibited higher levels of depression, anxiety, neuroticism, and pickiness compared to boys (Wilcoxon Rank Sum Test), and that greater responsiveness to bitterness (e.g., β = 0.264, p = 0.037) and astringency (β = 0.269, p = 0.029) predicted higher depressive symptoms exclusively in girls. PHQ-9 scores were positively associated with alcohol use in both girls (ρ = 0.176, p = 0.003) and boys (ρ = 0.148, p = 0.004) and inversely related to the intake of beneficial nutrients (e.g., fiber, polyunsaturated fats), particularly in girls. Intriguingly, moderation analyses suggested that associations between nutrient intake and acuity for alarming oral sensations were largely moderated by depression-related traits in girls, but not in boys. Conclusions: Our findings suggest that gender moderates the links between depressive symptoms, sensory perception, and dietary habits in healthy adolescents, possibly reflecting gender-specific coping strategies for comorbidities of depression.

Metacognitive Prompts Influence 7- to 9-Year-Olds' Executive Function at the Levels of Task Performance and Neural Processing

To elucidate the role of metacognitive reflection in the development of children's executive function (EF) skills, the current study examined relations among implicit and explicit forms of metacognition in 7- to 9-year-olds during performance based on the Dimensional Change Card Sort (DCCS), while experimentally manipulating the propensity to reflect on the task. Results showed that instructions to reflect led to improved task accuracy and better metacognitive control, but only in younger children, likely because older children were already engaging in reflection. Individual differences in trait mindfulness were related to a similarly reflective mode of responding, characterized by improved task accuracy and metacognitive control. In contrast, articulatory suppression impaired children's task accuracy and metacognitive monitoring. Additionally, simply asking children to make metacognitive judgments without extra instructions decreased the amplitude of event-related potential (ERP) indices of error detection (the error-related negativity; ERN) and conflict detection (the N2). Finally, individual differences in trait anxiety were related to larger Pe amplitudes. Taken together, the current findings reinforce theoretical frameworks integrating metacognition and EF and highlight the shared influence of metacognitive reflection across multiple levels of analysis.

Effects of a Middle School Dating Violence Prevention Program on Depression at 5-Year Follow-Up

PURPOSE

We examined long-term mental health benefits of Fourth R, an intervention designed to teach healthy relationship skills and prevent adolescent relationship abuse. While we previously showed it to prevent relationship violence, the potential crossover effects on broader mental health outcomes, such as depression and anxiety, remain unexplored.

METHODS

We randomized Texas middle schools to receive either Fourth R (n = 12; n = 1,332) or standard health curricula (n = 12; n = 1,533) and assessed racially/ethnically diverse participants at baseline and 5 years postintervention.

RESULTS

After accounting for age, gender, race/ethnicity, adverse childhood experiences, and baseline distress, we found that students receiving the intervention were less likely to be depressed at the 5-year follow-up (odds ratio = 0.69, 95% confidence interval: 0.49, 0.97) compared to students in control schools.

DISCUSSION

Findings suggest that promoting healthy relationship skills in middle school can have enduring benefits for mental health, offering schools a cost-effective way to address multiple behavioral health challenges.

Differences in Reporting Suicide Ideation and Attempt: Implications for Suicide Risk Screening in Pediatric Primary Care

OBJECTIVE

Pediatricians are uniquely positioned to identify suicide-related risk, yet clinical practices as to when, how, and who gets screened may vary due to differences in policy statements on youth suicide risk screening in primary care. To address these differences, we examined agreement between reports of past suicide ideation (SI) and suicide attempt (SA) across multiple assessment methods and over time. We further explored associations across sociodemographic factors and severity of mental health symptoms on reporting patterns on these methods for adolescents at elevated risk.

METHODS

Adolescents (N = 162) with SI and/or SA were recruited from multiple clinical sites in and around New York City. Adolescents completed interviews and self-report measures validated to assess suicide-related risk, depressive symptoms, and anxiety symptoms.

RESULTS

Agreement between questions on verbal interviews over time was fair (κ = 0.38), with adolescents under-reporting lifetime SI as time from a crisis went by. Agreement between questions on self-report measures was moderate (κ = 0.51), with adolescents under-reporting past-month SI on a depression screen compared to a suicide-specific screen. Participants with less severe mental health-related symptoms were significantly less likely to report past-month SI consistently.

CONCLUSIONS

This study highlights important trends in suicide-related reporting patterns among adolescents at elevated risk for suicide and may have important implications for clinical practice guidelines. To capture more adolescents at risk for suicide, results not only support a universal screening approach using suicide-specific tools but may suggest the need to increase screening frequency in pediatric primary care.

Identifying cognitive, affective, and developmental mechanisms linking threat and deprivation with adolescent psychopathology

BACKGROUND

The mechanisms linking early-life adversity with psychopathology over the life-course are complex. In this prospective study, we collectively examined cognitive, affective, and developmental mediators previously found to individually link childhood threat and deprivation experiences to adolescent psychopathology to identify the most potent mechanisms.

METHODS

Data came from a community sample of 227 children (mean child age 11.5 ± 0.5 years, 48.5% female) from the Seattle metro area with recruitment designed to reflect diversity in family income. Candidate mechanisms included self-rated pubertal development and task-measured attention bias to threat, emotion regulation, theory of mind, fear learning, inhibitory control, language ability, reasoning, and reward sensitivity. Using a high-dimensional mediation approach, we determined which mediating pathways linking threat and deprivation to psychopathology persisted after controlling for all candidate mechanisms associated with psychopathology. Models additionally controlled for the child's age, sex, early-childhood emotional and behavioral symptoms, poverty, and maternal depression.

RESULTS

Blunted reward sensitivity mediated the prospective relationship between threat and internalizing psychopathology, explaining 17.25% (95% CI 1.08%, 69.96%) of this association. Advanced pubertal development was associated with increases in internalizing and externalizing symptoms (standardized associations of 0.16 (95% CI 0.03, 0.29) and 0.17 (95% CI 0.05, 0.29), respectively), but not with adversity. Although deprivation was strongly related to psychopathology, no mechanisms were empirically identified.

CONCLUSIONS

In a well-characterized community sample, we isolated reward sensitivity as a robust mediator of the prospective association between early-life threat and adolescent internalizing psychopathology. Interventions aimed at bolstering reward sensitivity may mitigate the impact of early-life threat experiences on internalizing problems.

Dynamic links between daily anxiety symptoms and young adults' daily well-being

BACKGROUND

Anxiety disorders are prevalent among youth and adults. Increasing studies examined the dynamic associations between momentary fluctuations of anxiety and well-being, primarily focusing on the severity of general anxiety. Scant research has explored the co-fluctuations between different anxiety symptoms and mental health outcomes.

METHOD

The current study evaluated the multi-level factor structure and assessed the subclinical symptoms of generalized anxiety disorder (GAD), social phobia (SP), and panic disorder (PD) in a sample of non-clinical young adults (N = 271, Mage = 18 years, 72% female, 68% non-White) who participated in a 30-day daily diary study.

RESULTS

Between persons, GAD, SP, and PD were positively correlated with depressive symptoms, stress, as well as emotional and peer problems. Within persons, both SP and PD were positively associated with stress, peer and emotional problems on the same day. Across days, there was positive reciprocal relation between PD and stress, whereas negative reciprocal link was observed between SP and emotional problems.

CONCLUSIONS

Current findings showed dynamic and distinct patterns in the associations between different anxiety symptoms and several mental health outcomes, which emphasizes the need to disentangle between- and within-person variation of anxiety symptoms with intensive longitudinal designs.

Providing integrated mental health care as a neurologist

Mental health comorbidities are highly prevalent and problematic in epilepsy, making it important for neurologists to be equipped to manage their patients' mental health concerns. This article explores the paradigm shift toward integrated mental health care approaches, aiming to educate early-career neurologists on their role within epilepsy care. We focus on depression and anxiety, how they present in epilepsy, and the role of integrated mental health care in managing these comorbidities. Key areas include the neurologist's role in identifying mental health issues through patient discussions and screening tools, and the basics of neurologist-led management. This covers the selection and adjustment of antiseizure medications and the use of psychopharmacology. Additionally, we emphasize the importance of providing psychoeducation and promoting healthy lifestyle choices that support mental well-being. Finally, we discuss the neurologist's role in facilitating referrals to mental health specialists, including information about the role of psychological interventions and psychiatry. This article aims to provide foundational knowledge to encourage early-career neurologists to actively engage in integrated mental health care approaches with their patients. This care can be flexible in how it incorporates different modalities and is tailored to local resources. It does not have to be extensive but should be meaningful enough to identify mental health concerns and facilitate patient access to appropriate resources and care.

Is oxytocin related to psychiatric symptoms in adolescents with obesity?

OBJECTIVES

We aimed to investigate the relation of oxytocin receptor (OXTR) gene variants (rs53576 and rs2254298) and serum oxytocin (OXT) levels with psychiatric symptoms in healthy adolescents and adolescents with obesity.

METHODS

A total of 250 adolescents with obesity and 250 healthy adolescents were included in this study. Attachment properties, anxiety, and depression were evaluated with self-reports while diagnoses were ascertained with KIDDIE-SADS-PL Turkish version. Serum OXT level was studied with the ELISA method, and OXTR gene variants were studied by quantitative polymerase chain reaction (rs53576) and restriction fragment length polymorphism (RFLP) (rs2254298) methods.

RESULTS

Serum OXT level was significantly lower in adolescents with obesity than in healthy controls. Self-reported symptoms of anxiety and depression were significantly elevated, especially in female adolescents with obesity, whereas parent/peer attachment was significantly lower. The rs53576 G/G genotype was found to be significantly more prevalent among obese youth. About 29.2 % of obese youth were diagnosed with psychopathology, especially anxiety and depression. OXT levels and receptor polymorphisms were not related to self-reported symptoms, attachment, and presence of psychopathology.

CONCLUSIONS

Further studies should evaluate the roles of other constructs (e.g., early adversity, parenting, social supports, coping, temperament, etc.) and discern the roles of parent-child synchrony in elucidating relationships between OXT, pediatric obesity, and psychopathology.

Anxiety in typically developing children with a sibling with a special healthcare need: A concept analysis

BACKGROUND

Anxiety levels among children have been rising. Currently, about 240 million children worldwide live with disabilities, affecting not only their well-being but also that of their siblings and families. Typically developing children aged 8 to 12 with a sibling who has special healthcare needs (SHCN) may experience increased anxiety. This topic requires further investigation to understand its unique factors.

PURPOSE

Examine the determinants of anxiety in children aged 8 to 12 years with a sibling who has SHCN.

METHODS

The concept analysis was carried out using the iterative eight-step method developed by Walker and Avant (2019).

DISCUSSION

Three key attributes of anxiety were identified: psychological, structural, and educational factors.

CONCLUSION

This research provides a foundational understanding of this emerging concept, anxiety in children 8 to 12 years with a sibling with a SHCN. This allows for developing targeted interventions and identifying potential areas for future research.

Performance of an Electronic Universal Mental Health Screening Tool in Pediatric Emergency Departments

OBJECTIVE

Rates of suicide, anxiety, and depression have soared in US youth, and professional organizations strongly urge earlier identification, particularly in pediatric emergency departments (PEDs). However, there are few commonly used suicide screeners that also identify other mental health (MH) problems. A new, electronically administered instrument, the K-CAT, screens for suicide and multiple MH problems. We hypothesized that the K-CAT would enhance suicide identification compared with routine screening and identify significant anxiety and depression in youth presenting with non-MH chief complaints.

METHODS

This observational study was conducted in 2 PEDs. Eligible youth were 7 to 17 accompanied by a caregiver without: severe medical concerns, difficult behaviors, limited verbal language, or only a psychiatric complaint. Of the 341 eligible, 241 (70.7%) were screened, and 228 both presented with a non-MH problem and had complete K-CAT data. A Fisher exact test determined whether suicidal behaviors/ideation rates differed between the K-CAT and retrospective chart review data.

RESULTS

Seventy-four or 32.46% of youth scored positive for suicide, anxiety, and/or depression on the K-CAT. Females were more likely to screen positive (P<0.001). Compared with the retrospective data, more youth were identified with suicide risk by the K-CAT (3.95% vs. 0%; P=0.004). Youth identified by the K-CAT were 62.5% female and 33.3% 7 to 11 years.

CONCLUSIONS

The K-CAT increases the identification of suicidal ideation and behaviors overall and in younger children. It identifies significant rates of depression and anxiety in youth and could be an important first step in identifying MH problems in youth.

Psychometric Properties of the Metacognitions Questionnaire-30 (MCQ-30) in Older Norwegian Adolescents

Dysfunctional metacognitive beliefs have been established as a transdiagnostic correlate of anxiety and depression in adults and are considered a central mechanism of persistent emotional distress according to the metacognitive model of psychological disorders. However, the importance of metacognitions for distress and emotional disorder in adolescence is far less researched, and to investigate this further there is a need for reliable and valid assessment tools. The Metacognitions Questionnaire-30 (MCQ-30) might be a suitable and valid assessment tool in adolescents with the implication that it can be used to research the role of metacognitions in youth mental health and track how metacognitions change and relate to outcomes over time from adolescence to adulthood. We therefore aimed to examine the psychometric properties of the MCQ-30 in an Upper Secondary School-sample of 494 Norwegian adolescents, aged 16- to 18-years old. A confirmatory factor analysis indicated a good fit for the proposed five-factor structure and evidence for measurement invariance was supported across sex and groups of anxiety severity. The factors showed acceptable to good internal consistency and there was support for convergent validity. In conclusion, these findings indicate that the adult version of the MCQ-30 can be applied in Norwegian adolescents from 16-years old.

Brain morphology in adolescent girls with first-onset anorexia nervosa

This study aimed to assess whether a young, first-onset cohort of girls with anorexia nervosa (AN) demonstrate similar findings of reduced gray and white matter volume reductions as reported in older women with chronic AN. We compared adolescents and young adults with first-onset AN to typically developing (TD) girls and investigated associations between brain volume measures and clinical symptoms. Whole-brain T1-weighted structural imaging was performed in 58 young persons with AN and 63 age, sex-, and education-matched TD participants. Participants with AN were further divided into underweight (undAN) and restored weight (restAN) groups based on body mass index length/weight standard deviation score (BMI-SDS). Eating disorder symptoms were measured by the Eating Disorder Examination (EDE) and the Eating Disorder Inventory-3 (EDI-3). Differences in brain volume measures were analyzed using separate linear regression analyses. Within the AN group, associations between brain volumes, BMI-SDS, and EDE/EDI-3 scores were analyzed. The undAN group showed significant reductions in total and cortical gray matter volumes compared to the TD group, primarily in the frontal and parietal cortices. No significant associations were found between brain volume and BMI-SDS or EDE/EDI-3 scores. Frontal and parietal cortices in adolescents and young adults with undAN are particularly affected by malnutrition, showing gray matter volume reductions even in early stages of AN. Longitudinal studies are needed to explore the effects of malnutrition on brain development and its association with clinical features of AN over time.

Psychological interventions for treatment of inflammatory bowel disease

BACKGROUND

Persons with inflammatory bowel disease (IBD) have an increased risk of suffering from psychological problems. The association is assumed to be bi-directional. Psychological treatment is expected to improve quality of life (QoL), psychological issues and, possibly, disease activity. Many trials have tested various psychotherapy approaches, often in combination with educational modules or relaxation techniques, with inconsistent results.

OBJECTIVES

To assess the effects of psychological interventions on quality of life, emotional state and disease activity in persons of any age with IBD.

SEARCH METHODS

We searched Web of Science Core Collection, KCI-Korean Journal Database, Russian Science Citation Index, MEDLINE, Psyndex, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, and LILACS from inception to May 2023. We also searched trial registries and major gastroenterological and selected other IBD-related conferences from 2019 until 2023.

SELECTION CRITERIA

Randomized controlled trials of psychological interventions in children or adults with IBD compared to no therapy, sham (i.e. simulated intervention), or other active treatment, with a minimum follow-up time of two months, were eligible for inclusion, irrespective of publication status and language of publication. Interventions included psychotherapy and other non-pharmacological interventions addressing cognitive or emotional processing, patient education, or relaxation techniques to improve individual health status.

DATA COLLECTION AND ANALYSIS

Two raters independently extracted data and assessed the study quality using the Risk of Bias 2 Tool. Pooled standardized mean differences (SMD) for continuous outcomes and relative risks (RR) for event data were calculated with 95% confidence intervals (CI), based on separate random-effects models by age group, type of therapy and type of control. An SMD of 0.2 was considered a minimally relevant difference. SMD ≥ 0.4 was considered a moderate effect. Group analyses were planned to examine differential effects by type of IBD, disease activity, psychological comorbidity, therapy subtype, and treatment intensity. Statistical heterogeneity was determined by calculating the I2 statistic. Publication bias was assessed by presenting a funnel plot and calculating the Eggers Test. GRADE Profiling was used to describe the certainty of the evidence for relevant results.

MAIN RESULTS

Sixty-eight studies were eligible. Of these, 48 had results reported in sufficient detail for inclusion in the meta-analyses (6111 adults, 294 children and adolescents). Two trials were excluded from the meta-analysis following sensitivity analysis and tests for asymmetry because of implausible results. Most studies used multimodular approaches. The risk of bias was moderate for most outcomes, and high for some. The most common problems in individual trials were the inability to blind participants and investigators and outcome measures susceptible to measurement bias. The main issues leading to downgrading of the certainty of the evidence were heterogeneity of results, low precision and high or moderate risk of bias in the included trials. Publication bias could not be shown for any of the inspected analyses. In adults, psychotherapy was slightly more effective than care-as-usual (CAU) in improving short-term QoL (SMD 0.23, 95% CI 0.12 to 0.34; I2 = 13%; 20 trials, 1572 participants; moderate-certainty), depression (SMD -0.27, 95% CI -0.39 to -0.16; I2 = 0%; 16 trials, 1232 participants; moderate-certainty), and anxiety (SMD -0.29, 95% CI -0.40 to -0.17; I2 = 1%; 15 studies, 1135 participants; moderate-certainty). The results for disease activity were not pooled due to high heterogeneity (I2 = 72%). Interventions which used patient education may also have small positive short-term effects on QoL (SMD 0.19, 95% CI 0.06 to 0.32; I2 = 11%; 12 trials, 1058 participants; moderate-certainty), depression (SMD -0.22, 95% CI -0.37 to -0.07; I2 = 11%; 7 studies, 765 participants; moderate-certainty) and anxiety (SMD -0.16, 95% CI -0.32 to 0.00; I2 = 10%; 6 studies, 668 participants; moderate-certainty). We did not find an effect of education on disease activity (SMD -0.09, 95% CI -0.28 to 0.10; I2 = 38%; 7 studies, 755 participants; low-certainty). Pooled results on the effects of relaxation techniques showed small effects on QoL (SMD 0.25, 95% CI 0.08 to 0.41; I2 = 30%; 12 studies, 916 participants; moderate-certainty), depression (SMD -0.18, 95% CI -0.35 to -0.02; I2 = 0%; 7 studies, 576 participants; moderate-certainty), and anxiety (SMD -0.26, 95% CI -0.43 to -0.09; I2 = 13%; 8 studies, 627 participants; moderate-certainty). Results for disease activity were not pooled due to high heterogeneity (I2 = 72%). In children and adolescents, multimodular psychotherapy increased quality of life (SMD 0.54, 95% CI 0.06 to 1.02; I2 = 19%; 3 studies, 91 participants; moderate-certainty). The results for anxiety were inconclusive (SMD -0.09; 95% CI 0.-64 to 0.46; 2 trials, 51 patients, very low-certainty). Pooled effects were not calculated for depressive symptoms. Disease activity was not assessed in any of the trials compared to CAU. In education, based on one study, there might be a positive effect of the intervention on quality of life (MD 7.1, 95% CI 2.18 to 12.02; 40 patients; low-certainty evidence) but possibly not on depression (MD -6, 95% CI -12.01 to 0.01; 41 patients; very low-certainty). Anxiety and disease activity were not assessed for this comparison. Regarding the effects of relaxation techniques on children and adolescents, all results were inconclusive (very low-certainty).

AUTHORS' CONCLUSIONS

Psychological interventions in adults are likely to improve the quality of life, depression and anxiety slightly. Psychotherapy is probably also effective for improving the quality of life in children and adolescents. The evidence suggests that psychological interventions may have little to no effect on disease activity. The interpretation of these results presents a challenge due to the clinical heterogeneity of the included trials, particularly concerning the type and various components of the common multimodular interventions. This complexity underscores the need for further research and exploration in this area.

Psychometric properties of the Arabic spence children's anxiety scale parent in a sample of Arabic speaking adults

Anxiety, characterized by an unpleasant state of anticipatory unease, manifests in approximately 19% of adolescents and children within the Lebanese population. Given the major influence of traditional mindset and the stigma concerning mental health in Lebanon, children often express anxiety differently that can go unnoticed, and leading to underreported anxiety symptoms. Having a parental perspective in a collectivist culture is important. Lebanon is known to have a strong family-oriented culture where parents have an important role in shaping children's emotional and psychological wellbeing. Therefore, the Spence Children's Anxiety Scale-Parent (SCAS) might be an appropriate tool to aid in the identification of anxiety. This study aims to validate the SCAS-Parent in the Arabic language, assessing reliability, validity and consistency of the scale. This cross-sectional study enrolled 502 adult parents from all over Lebanon. The data was collected through a Google form and using snowball technique during November 2023. The questionnaire included sociodemographic data, the Brief version of the Spence Children's Anxiety Scale for the Parents (SCAS-P- 8) and the Depression Anxiety Stress Scale (DASS- 8). A confirmatory factor analysis (CFA) was conducted; calculated fit indices were the normed model chi-square (χ²/df), the root mean square error of approximation (RMSEA), the standardized root mean square residual (SRMR), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 5 for χ²/df, ≤ 0.08 for RMSEA, ≤ 0.05 for SRMR and ≥ 0.95 for CFI and TLI indicate good fit of the model to the data. CFA results indicated that fit of the one-factor model of the SCAS-P- 8 scale was acceptable: χ2/df = 84.53/20 = 4.23, RMSEA = 0.080 (90% CI 0.063, 0.098), SRMR = 0.035, CFI = 0.966, TLI = 0.952. The standardized estimates of factor loadings were all adequate. The reliability of the scale was good (ω = 0.90/α = 0.90). Higher parental depression (r = 0.61; p < 0.001), anxiety (r = 0.62; p < 0.001) and stress (r = 0.48; p < 0.001) were significantly associated with higher anxiety in the child. The study validates the SCAS-P- 8 for its application in the Lebanese population, demonstrating high internal consistency, reliability, and validity, indicating its potential as a screening tool for anxiety in children in the hands of psychologists and health-care professionals. Anxious parents will most likely have anxious children, leading to a vicious cycle. Early screening of anxiety in children can potentially impact the quality of life and developmental status of children. Additionally, assessing several aspects of anxiety can help prevent its long-term consequences that can affect academic performance, social relationships, and overall well-being.

Relationships between brain activity, tryptophan-related gut metabolites, and autism symptomatology

While it has been suggested that alterations in the composition of gut microbial metabolites may play a causative role in the pathophysiology of autism spectrum disorder (ASD), it is not known how gut microbial metabolites are associated with ASD-specific brain alterations. In this cross-sectional, case-control observational study, (i) fecal metabolomics, (ii) task-based functional magnetic resonance imaging (fMRI), and (iii) behavioral assessments were obtained from 43 ASD and 41 neurotypical (NT) children, aged 8-17. The fMRI tasks used socio-emotional and sensory paradigms that commonly reveal strong evoked brain differences in ASD participants. Our results show that fecal levels of specific tryptophan-related metabolites, including kynurenate, were significantly lower in ASD compared to NT, and were associated with: 1) alterations in insular and cingulate cortical activity previously implicated in ASD; and 2) ASD severity and symptoms (e.g., ADOS scores, disgust propensity, and sensory sensitivities). Moreover, activity in the mid-insula and mid-cingulate significantly mediated relationships between the microbial tryptophan metabolites (indolelactate and tryptophan betaine) and ASD severity and disgust sensitivity. Thus, we identify associations between gut microbial tryptophan metabolites, ASD symptoms, and brain activity in humans, particularly in brain regions associated with interoceptive processing.

Examining the unique contribution of parent anxiety sensitivity on adolescent neural responses during an emotion regulation task

Parent factors impact adolescent's emotion regulation, which has key implications for the development of internalizing psychopathology. A key transdiagnostic factor which may contribute to the development of youth internalizing pathology is parent anxiety sensitivity (fear of anxiety-related physiological sensations). In a sample of 146 adolescents (M/SDage = 12.08/.90 years old) and their parents (98% mothers) we tested whether parent anxiety sensitivity was related to their adolescent's brain activation, over and above the child's anxiety sensitivity. Adolescents completed an emotion regulation task in the scanner that required them to either regulate vs. react to negative vs. neutral stimuli. Parent anxiety sensitivity was associated with adolescent neural responses in bilateral orbitofrontal cortex (OFC), anterior cingulate, and paracingulate, and left dorsolateral prefrontal cortex, such that higher parent anxiety sensitivity was associated with greater activation when adolescents were allowed to embrace their emotional reaction(s) to stimuli. In the right OFC region only, higher parent anxiety sensitivity was also associated with decreased activation when adolescents were asked to regulate their emotional responses. The findings are consistent with the idea that at-risk adolescents may be modeling the heightened attention and responsivity to environmental stimuli that they observe in their parents.

Auricular Allodynia is Associated With Worse Outcomes in Children With Functional Abdominal Pain Disorders Using Neurostimulation

BACKGROUND AND AIMS

Percutaneous electrical nerve field stimulation (PENFS) is a minimally invasive, nonpharmacologic approach to treat children with functional abdominal pain disorders (FAPD). Allodynia refers to pain from a stimulus that does not usually provoke pain. We aimed to characterize auricular allodynia during PENFS and associate it with outcomes.

MATERIALS AND METHODS

We conducted a retrospective cohort study reviewing charts of patients who underwent PENFS for an FAPD. We included demographic data, medical history, and validated questionnaire responses. Allodynia was noted through physician notes of localized ear pain, soreness, or tenderness. Baseline clinical scores and PENFS outcomes were compared in patients with and without allodynia.

RESULTS

Of 219 patients with FAPD (mean age 16.2 ± 2.7 years), 79% were female, and 87% were Caucasian; 28% of patients experienced allodynia with no significant demographic differences. The most common gastrointestinal symptoms were abdominal pain (100%) and nausea (70%), and the most common FAPD diagnoses included irritable bowel syndrome (58%) and functional dyspepsia (54%). Of the 93 total visits with allodynia, 44% of the visits had patients report allodynia once and 34% twice. Common interventions included placing

CONCLUSION

Allodynia in patients with FAPD who underwent PENFS had worse clinical outcomes. Excitation thresholds of rapidly conducting Aβ fibers in the ear are lower than those of nociceptive slowly conducting Aδ and C fibers. Patients with allodynia may require adjustment of nerve fiber stimulation to improve outcomes.

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Key Words

• Functional abdominal pain
• irritable bowel syndrome
• nerve stimulation
• pediatrics
• side effect

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Affiliation(s)

Neha R Santucci Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Umber Waheed Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Jesse Li Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Sherief Mansi Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Kahleb Graham Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Jennifer Hardy Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Megan M Miller Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Rashmi Sahay Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Khalil El-Chammas Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

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Nature-based mind-body intervention for test anxiety in adolescents: a feasibility study

Introduction

Traditional interventions for test anxiety often fall short of addressing the specific needs of adolescents and educational institutions due to issues of stigmatization and professionalization. In contrast, nature-based interventions (NBIs) have gained traction for their potential to enhance mental health, as they are generally accepted and cost-effective, thereby offering a promising alternative for alleviating test anxiety.

Methods

This study seeks to investigate the feasibility of a nature-based mind- body intervention (NMI) designed to reduce test anxiety among adolescents by integrating elements of NBIs and mind-body therapies (MBTs).

Results

The findings suggest that NMI can significantly diminish excessive test anxiety and academic stress, along with alleviating symptoms of general anxiety and depression.

Discussion

This approach presents a low-stigma, low-cost strategy for managing test anxiety in adolescents and offers valuable insights for mental health policymakers. Furthermore, it may enhance academic performance and broaden educational access for disadvantaged populations in developing countries.

Psychosocial Correlates of Suicidal Ideation and Behavior in Adolescents and Preadolescent Children Discharged from an Emergency Department in Israel

OBJECTIVES

Adolescent suicidal behavior is highly prevalent in pediatric psychiatric emergency departments, and there is a growing occurrence of such behavior among preadolescent children. This study aims to examine the psychosocial factors associated with nonfatal suicidal behaviors in children (<12 years old) and adolescents (aged 12-18), to gain insight into unique and shared characteristics of suicidal behavior across these two age groups.

METHOD

This study investigates the psychosocial characteristics associated with suicidal ideation and behaviors in an emergency department sample of 183 children and adolescents aged 7-18 years in Israel. Participants completed a diagnostic interview, and self-report and parent-report questionnaires of psychosocial measures. Cross-sectional correlational and regression analyses were used to determine significant correlates of suicidal outcomes within the two age groups.

RESULTS

Among adolescents, females exhibited a higher prevalence of suicidal thoughts and behaviors, while in children, both boys and girls showed similar rates. Depression correlated with suicidal ideation for both adolescents and children. In children, anxiety and conduct symptoms were associated with suicidal behavior, whereas in adolescents, suicidal behavior was associated with depression and anxiety.

CONCLUSIONS

The present findings contribute to the growing understanding of factors associated with suicidal thoughts and behaviors among children in comparison to adolescents. These findings underscore the importance of targeting specific risk factors when developing assessment and intervention strategies tailored to the two age groups.

Associations Between Neighborhood Resources and Youths' Response to Reward Omission in a Task Modeling Negatively Biased Environments

OBJECTIVE

Neighborhoods provide essential resources (eg, education, safe housing, green space) that influence neurodevelopment and mental health. However, we need a clearer understanding of the mechanisms mediating these relationships. Limited access to neighborhood resources may hinder youths from achieving their goals and, over time, shape their behavioral and neurobiological response to negatively biased environments blocking goals and rewards.

METHOD

To test this hypothesis, 211 youths (aged ∼13.0 years, 48% boys, 62% identifying as White, 75% with a psychiatric disorder diagnosis) performed a task during functional magnetic resonance imaging. Initially, rewards depended on performance (unbiased condition); but later, rewards were randomly withheld under the pretense that youths did not perform adequately (negatively biased condition), a manipulation that elicits frustration, sadness, and a broad response in neural networks. We investigated associations between the Childhood Opportunity Index (COI), which quantifies access to youth-relevant neighborhood features in 1 metric, and the multimodal response to the negatively biased condition, controlling for age, sex, medication, and psychopathology.

RESULTS

Youths from less-resourced neighborhoods responded with less anger (p < .001, marginal R2 = 0.42) and more sadness (p < .001, marginal R2 = 0.46) to the negatively biased condition than youths from well-resourced neighborhoods. On the neurobiological level, lower COI scores were associated with a more localized processing mode (p = .039, marginal R2 = 0.076), reduced connectivity between the somatic-motor-salience and the control network (p = .041, marginal R2 = 0.040), and fewer provincial hubs in the somatic-motor-salience, control, and default mode networks (all pFWE < .05).

CONCLUSION

The present study adds to a growing literature documenting how inequity may affect the brain and emotions in youths. Future work should test whether findings generalize to more diverse samples and should explore effects on neurodevelopmental trajectories and emerging mood disorders during adolescence.

PLAIN LANGUAGE SUMMARY

A growing body of literature suggests that access to resources at the neighborhood level affects the neurodevelopment and mental health of youth. This study explores how access to neighborhood resources shapes the behavioral and neurobiological responses to negatively biased environments in youth. During brain imaging, 211 youth participated in a task where rewards were randomly withheld under the pretense that the youth performed poorly, an "unfair" intervention that elicits frustration. The authors found that youth from less-resourced neighborhoods exhibited less anger and more sadness in response to the unfair condition compared to youth from well-resourced neighborhoods. Limited access to neighborhood resources was also associated with reduced connectivity between the control and motor brain networks. These findings suggest that neighborhood inequity may impact the neurodevelopment and mental health of youth.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

An Ethnic Minority Perspective: Association Between Negative Life Events and Depressive Symptoms in Yi Adolescents in China

OBJECTIVE

This study explored whether anxiety and core self-evaluation mediate the relationship between negative life events and depressive symptoms in adolescents of the Yi ethnic minority in China.

METHODS

In this cross-sectional study, a convenience sample of 627 Yi adolescents 10-19 years old (252 males, 40.2%) from primary, middle and high schools in Liangshan Prefecture in China completed the Adolescent Self-Rating Life Events Checklist (ASLEC) to report on negative life events, the Second Edition of the Beck Depression Inventory (BDI-II) to report on depressive symptoms, the Core Self-Evaluations Scale (CSES) to describe core self-evaluation, and the Screen for Child Anxiety-Related Emotional Disorders (SCARED) to report anxiety symptoms.

RESULTS

In Pearson correlation analysis, total score and dimension subscores on the ASLEC correlated positively with total score and dimension subscores on the SCARED survey as well as with total score on the BDI. Total ASLEC score and dimension subscores correlated negatively with total CSES score. Mediation analysis indicated that negative life events affected depressive symptoms directly, as well as indirectly via core self-evaluation (mediating effect was 0.087; 95% confidence interval [CI], 0.063-0.113; p<0.001). The chain-mediated pathway effect was significant (mediating effect was 0.017; 95% CI, 0.011-0.026; p<0.001).

CONCLUSION

Yi adolescents in Liangshan Prefecture show certain prevalence of anxiety and depression, and they score relatively low on core self-evaluation. In this ethnic group, negative life events can affect depressive symptoms directly as well as indirectly through chain-mediated effects of anxiety and core self-evaluation.

Food allergy-related bullying: Risk factors and psychosocial functioning

BACKGROUND

Food allergy (FA)-related bullying is common, yet little is known about risk factors for FA-related bullying or the relationship between FA-related bullying and psychosocial wellbeing. This study aimed to (1) identify sociodemographic and clinical factors associated with risk of FA-related bullying in children with FA, and (2) evaluate the psychosocial functioning of children and parents reporting FA-related bullying.

METHODS

This was a cross-sectional survey study of children ages 5-17 years with immunoglobulin E (IgE)-mediated FA and their parents, recruited from Boston Children's Hospital (BCH) and through social media outlets. Children and parents with versus without a history of FA-related bullying were compared on sociodemographic and clinical characteristics and FA-related psychosocial outcomes using validated instruments.

RESULTS

In this cohort of 295 child-parent dyads, the median child age was 8.0 years, 53.2% of children were male, and parent respondents were primarily mothers (96.6%). Reported lifetime prevalence of FA-related bullying was 36.6%. FA-related bullying was associated with certain child characteristics, including coming from a household at risk of food insecurity (FI) (12.0% of bullied children v. 2.2% of not bullied children were from food insecure households, p < .001), having coexisting atopic and mental health conditions-particularly anxiety (30.6% of bullied children v. 8.6% of not bullied children carried an anxiety disorder diagnosis, p < .001)-and having a history of more severe FA reactions. FA-related bullying was associated with elevated concerns in child and parental FA-related psychosocial functioning domains.

CONCLUSION

Pediatricians and allergists should screen for FA-related bullying and offer families appropriate guidance around management of FA-related bullying.

Hikikomori (prolonged social withdrawal) and co-occurring psychiatric disorders and symptoms in adolescents and young adults: A scoping review

BACKGROUND

Hikikomori, or prolonged social withdrawal, is a clinical condition usually emerging during adolescence or young adulthood, characterized by severe self-isolation in one's home, and often associated with other psychiatric disorders and symptoms.

OBJECTIVE

The study summarized evidence of hikikomori diagnostic criteria, clinical manifestations, and comorbidity with psychiatric disorders and symptoms in adolescents and young adults.

METHODS

A scoping review was conducted following PRISMA guidelines, with four electronic databases searched for original works in English, French, and Italian published since 2010.

RESULTS

A total of 15 studies were selected, 7 involved adolescents, 4 young adults, and 4 participants from both age groups. Most studies relied on the diagnostic criteria proposed for hikikomori inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Differences in hikikomori and comorbidity profiles were identified between adolescents and young adults.

CONCLUSIONS

Heterogeneity characterized hikikomori diagnostic criteria, comorbidity, demographic and clinical features of the study samples. Studies adopting more homogeneous populations, shared diagnostic criteria, consistent assessment tools and longitudinal designs are needed to better clarify the clinical features of hikikomori in young people.

Evaluation of sluggish cognitive tempo in children and adolescents with obesity and morbid obesity

ObjectiveThis study's primary aim is to evaluate the relationship between obesity and sluggish cognitive tempo (SCT).MethodThe study group consisted of obese (n = 37) and morbidly obese (n = 42) patients. The healthy control group included 38 children and adolescents. SCT was evaluated using the Barkley Child Attention Scale (BCAS). Clinical interviews were supplemented with standardized questionnaires to assess symptoms of depression, anxiety, and ADHD.ResultsBCAS scores were significantly higher in both the morbidly obese and obese groups than in the control group (p < .001). BCAS cutoff point showed that the prevalence of SCT was significantly higher in both the obese and morbidly obese groups compared to the control group (p < .001). Moreover, a logistic regression analysis identified screen time (OR = 1.330), maternal education (OR = 0.164), and BCAS scores (OR = 1.122) as independent risk factors for obesity.ConclusionThe current study found a significant relationship between SCT and obesity in children and adolescents. Given that obesity is a public health issue, our findings underscore the importance of evaluating SCT in morbidly obese and obese children. This understanding can lead to more comprehensive and effective treatment strategies for these children.

The association between screen time trajectories and the comorbidity of depression and anxiety

Depression and anxiety are often comorbid among adolescents. Adolescent screen time changes over time. This study investigates the association between screen time trajectories and the comorbidity of depression and anxiety from a longitudinal perspective. The data were collected from an ongoing prospective puberty cohort which was established in 2014 from Chongqing, China. 838 participants (52.03 % female; wave 1 mean age = 8.62, SD = 1.15) were followed up from 2014 to 2020. Questions about screen time were administered every six months. Trajectories of screen time were identified using latent class growth analysis. Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety. Latent profile analysis was used to identify the subtypes of comorbidity of depression and anxiety. Logistic regression was used to explore the association between screen time trajectory and the comorbidity of depression and anxiety. Three distinct trajectories of screen time were identified: Group Low (68.26 %) had consistently low screen time, Group High (26.37 %) had high screen time and Group Increasing (5.37 %) was characterized by an increasing screen time. Four subtypes of the comorbidity of depression and anxiety were fitted ("High comorbidity", "Low comorbidity", "Low depression symptoms" and "No symptoms"). Group Increasing and Group High were associated with "Low comorbidity" and "Low depression symptoms". Group Increasing was more likely to be the "high comorbidity" both boys and girls. However, Group High was associated with "high comorbidity" only in girls. The results of this study may inform future research and provide possible intervention targets.

Attentional biases for dynamic stimuli in emerging adults with anxiety: A preliminary eye-tracking study

While attentional biases towards negative stimuli have previously been linked to the development and maintenance of anxiety disorders, a current limitation of this research involves the use of static images for stimuli, as they cannot adequately depict the dynamic nature of real-life interactions. Since attentional biases in those with elevated anxiety remain understudied using more naturalistic stimuli, such as dynamic social videos, the purpose of this explorative study was to use novel dynamic stimuli and modern eye-tracking equipment to further investigate negative attentional biases in anxious emerging, female adults. Non-clinical participants (N = 62; mean age = 20.44 years; biologically female) completed validated questionnaires regarding their anxiety symptoms and completed a free-viewing task by watching 30-s video clips while having their eye movements tracked. The video clips were shown in side-by-side pairs (i.e., positive-neutral, negative-neutral, and positive-negative) on a split screen without audio. Overall, participants fixated more quickly on emotional videos (i.e., positive and negative) over neutral ones, with more anxious participants orienting their gaze faster to the videos, regardless of content. Moreover, individuals with greater self-reported anxiety spent more time gazing at negative videos in negative-neutral pairings, highlighting that emerging female adults with increased anxiety symptoms may show a negative attention bias when viewing social interactions. Importantly, by incorporating novel, dynamic stimuli, we expand upon prior research on attentional biases, with the potential to adapt this approach for novel interventions that may ultimately help those suffering from anxiety.

Further validation of the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS) in parents of children with oppositional defiant disorder and anxiety

This study aimed to validate a novel parent-report measure of ADHD symptom inflation, the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS), in a clinical sample. The PRASIS is composed of an Infrequency subscale and an ADHD subscale. Online participants were assigned to one of three groups: mothers of children with diagnosed ADHD (n = 110), mothers of children with diagnosed ODD and/or anxiety (n = 116), and mothers of children without ADHD, ODD, or anxiety. The third group was then randomized to either receive instructions to complete the questionnaire honestly (controls, n = 164) or to complete the questionnaire as if they were trying to convince a provider that their child has ADHD (simulators, n = 141). Results indicated good to excellent internal consistency (INF α = .83, ADHD Total α = .93); strong convergent validity of the PRASIS ADHD scale with the ADHD Rating Scale-5 (r(529) = .85, p < .001); excellent group discrimination of the PRASIS Infrequency scale and the PRASIS ADHD scale (η2 = 0.38-0.42); and specificity of 86.7, sensitivity of 67.4%, and an AUC of .86 for the Infrequency scale. Overall, these outcomes supported the utility of the PRASIS in samples including mothers of children with psychiatric diagnoses of ODD and/or anxiety.

Effects of Maternal Depression on Adolescent Offspring Depression and Anxiety: Mediating Role of Emotional Trauma in a Community-Based Study

Objectives

Maternal depression negatively affects depression and anxiety symptoms in the offspring. This study examined the association between maternal depression and their adolescent offspring depression and anxiety, as well as the mediating role of emotional trauma in determining the association.

Methods

Participants were 237 mothers (46.08±5.00 years) and their adolescent offspring (16.54±1.51 years). The participants completed the Beck Depression Inventory-II, Early Trauma Inventory Self Report-Short Form, Center for Epidemiological Studies Depression Scale for Children, and the Screen for Children's Anxiety Related Disorders. The mediating effect of emotional trauma on offspring was explored using mediation analysis.

Results

Maternal depressive symptoms were significantly correlated with adolescent offspring traumatic experiences, as well as with their depressive and anxiety symptoms. Mediation analysis results showed that emotional trauma of offspring significantly mediated the effect of maternal depression on their depressive and anxiety symptoms.

Conclusion

Findings indicate that maternal depression was significantly associated with depressive and anxiety symptoms in adolescent offspring, mediated by their emotional trauma. Future research is needed to investigate pathways and intervention strategies to prevent the intergenerational transmission of emotional problems.

Efficacy of a parent-based treatment for children and adolescents with obsessive-compulsive disorder: Protocol of a multiple baseline, single-case experimental design study

Background

Pediatric obsessive-compulsive disorder (OCD) is a severely impairing disorder, associated with high levels of family accommodation (FA). Approximately 40 % of youth do not benefit from first-line treatment options (cognitive behavioral therapy or pharmacotherapy). Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment, teaching parents to reduce FA and increase supportive parenting, thereby aiming to improve the child's OCD. This article presents the protocol of a multiple baseline single-case experimental design (SCED) study to test the efficacy of SPACE in reducing OCD severity and FA in youth with OCD.

Methods

This SCED consists of a baseline, treatment, and follow-up phase. In total 25 youth (7-18 years) with OCD, who previously received cognitive behavioral therapy (CBT) unsuccessfully, aborted treatment early, or were not able to receive CBT due to too high levels of OCD/anxiety, and their parents will be included. They will be randomly allocated to one of three baseline phase options (4, 6 or 8 weeks). The treatment phase consists of 12 weekly sessions of SPACE with parents. Throughout all phases, OCD severity and FA will be briefly assessed thrice a week. Standard clinical measurements assessing OCD severity and FA and secondary parameters will be conducted at six timepoints, till 6 months follow-up.

Conclusion

Combining the innovative SPACE treatment with a SCED provides detailed insight into the relationship between OCD and FA over time. Studying this in clinical practice in complex cases that are normally understudied, helps to improve more personalized care for youth with OCD.

Factor Structure and Psychometric Properties of the Spence Children's Anxiety Scale: A 25-Year Systematic Review

The Spence Children's Anxiety Scale (SCAS) is one of the most used instruments to assess anxiety symptoms in children and adolescents. Extensive research has been conducted to examine its psychometric properties and to develop other versions of the scale. The objective of this study was to examine the psychometric properties and factorial structure of the SCAS across different versions and populations. This systematic review followed PRISMA guidelines and was registered. APA PsycINFO, Web of Science (Core Collection) and MEDLINE (PubMed) were searched. Fifty-two studies were included in this systematic review. They examined the factor structure, convergent and divergent validity, and internal consistency of the scale. The most supported model was the original six-factor model, followed by the higher order six-factor model for the long version of the SCAS. Studies provided evidence of convergent validity and internal consistency. It is concluded that the SCAS is a valid and reliable instrument for assessing anxiety symptoms in children and adolescents, with a six-factor model structure well supported in most populations. Further research on the psychometric properties and factor structure of other versions of the scale and its application to clinical populations is warranted.

Friendship in Autism Spectrum Disorder Is Related to Diverse Developmental Changes Between Toddlerhood and Adolescence

PURPOSE

Follow-up studies of children diagnosed with autism spectrum disorder (ASD) in early childhood that focus on friendship formation during adolescence are scarce. The present study focused on exploring characteristics possibly related to the ability to establish friendships during adolescence among children diagnosed with ASD in toddlerhood.

METHODS

The cohort included 43 participants who underwent comprehensive assessments during toddlerhood and adolescence. Participants were divided into two groups [Friendship(+)/Friendship(-)] based on (1) adolescent social insight as assessed by professionals and (2) parental and adolescent self-reports regarding having or not having friends. No differences in IQ, ASD symptoms, or adaptive behavior during early childhood were found between the two groups.

RESULTS

Different and better changes in social communication, adaptive socialization, and daily living skills were observed for the Friendship(+) group. Adolescents with ASD in the Friendship(+) group exhibited greater social independence. Attention-deficit/hyperactivity disorder incidence, anxiety symptom severity, and placement in mainstream or special education classes did not differ between the two groups.

CONCLUSION

This long-term study highlights that for children with ASD, longitudinal growth in social communication and adaptive functioning is possible, highly important for and related to the development of the complex ability to establish friendship.

Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic

BackgroundAdolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce.MethodsData were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined.ResultsWe identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents.ConclusionsAdolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.

Mapping the Relationships between Dimensions of Child Anxiety, Parental Anxiety, and Family Accommodation: A Network Analysis

Parental anxiety and family accommodation have been implicated in the development and maintenance of child anxiety, yet their relationships with specific child anxiety dimensions remain unclear. This study applied network analysis to examine these interconnections in a clinical sample of 433 children with primary anxiety disorders. The estimated network revealed that family accommodation was strongly associated with separation anxiety. Generalized and panic/somatic anxiety were the most interconnected child anxiety dimensions, whereas social anxiety and parental anxiety were the least. Clustering analysis identified two groups: one comprising family accommodation, parental anxiety, and separation anxiety, and another including all other child anxiety dimensions. Stability metrics supported confidence in the network's structure, and network comparisons revealed no significant structural differences across informants or age groups. These findings provide further insight into the relationships between parental factors and child anxiety dimensions, particularly the strong link between family accommodation and separation anxiety.

Girls with higher levels of suicidal ideation experienced less parental reciprocity of eye-contact and positive facial affect during conflictual interactions: A pilot study

Although ample research links social factors and suicidality, there remains a gap in understanding how distinct processes within social communication relate to suicidality. We demonstrate how reciprocity of eye-gaze and facial expressions of happiness differ during parent-adolescent conflict based on adolescents' future suicidal ideation (SI). Facial affect analyses were based on 103 girls (ages 11-13; M = 12.28; 75% White) and their parents. Eye-gaze analyses were conducted in subset of these dyads (N = 70). Participants completed a conflict discussion during which gaze to their partners' eyes was assessed using mobile eye-tracking glasses and facial affect was coded using FaceReader Observer XT. Adolescents' SI was assessed 12-months later. Actor-partner interdependence models tested whether participants' gaze and affect predicted their own and their partners' gaze and affect one second later and if these intra and interpersonal dynamics differed based on adolescents' future levels of SI. Girls from dyads with less parental reciprocity of eye-gaze and happiness reported higher levels of SI 12-months later. During early adolescence, girls whose parents reciprocate their eye-contact or positive affect less during conflict may be at heightened risk for SI. If replicated, social communication could provide a promising intervention target to reduce suicidality prospectively.

Parenting and adolescent anxiety within families: a biweekly longitudinal study

BACKGROUND

Anxiety symptoms among adolescents have been increasing globally. The present study aimed to better understand the role of parenting, which is believed to act as both a risk and protective factor for anxiety while also being impacted by adolescent anxiety. Specifically, this preregistered study examined the bidirectional associations between parental autonomy support, intrusiveness, and symptoms of generalized anxiety in adolescents.

METHODS

We used meso-longitudinal data of Dutch adolescents (N = 256, Mage = 14.4, age range = 12-17, 71.5% female, tmean = 17.7) and their parents (N = 176, Mage = 46.8, 82% female, tmean = 22). They reported biweekly on parental intrusiveness and autonomy support and on adolescent generalized anxiety symptoms. Dynamic structural equation modeling (DSEM) was used to examine the associations at the between- and within-family levels.

RESULTS

The between-family level associations indicated that adolescents from families with lower levels of parental autonomy support and higher levels of parental intrusiveness exhibited higher levels of generalized anxiety symptoms. Within families, during weeks when parents were less autonomy supportive or more intrusive, adolescents also experienced more generalized anxiety symptoms. Regarding the bidirectional time-lagged effects, adolescent-driven, but not parent-driven, effects emerged. Specifically, when adolescents experienced more generalized anxiety symptoms than usual, their parents were less autonomy supportive and more intrusive 2 weeks later.

CONCLUSIONS

Although further research is needed, these findings underscore the negative impact of adolescents' mental health issues on parenting. To prevent the further escalation of family problems, it seems vital to promote positive and adaptive parent-child interactions when adolescents face mental health issues.

Integrating parent report, observed behavior, and physiological measures to identify biomarkers of sensory over-responsivity in autism

BACKGROUND

Sensory over-responsivity (SOR) is a heightened reaction to environmental stimuli commonly seen in autism spectrum disorder (ASD) which impacts daily functioning. Parent-reported and observed behavioral assessments are used to study SOR, but show limited associations with each other, possibly because they measure different aspects of SOR or because children inhibit their responses during standardized assessments. Physiological measures provide an objective measure of sensory reactivity, and atypical heart rate (HR) responses to aversive stimuli have been shown to be related to SOR in ASD youth. This study aimed to compare how reported and observed measures of SOR predict HR and to examine if the level of reported behavioral inhibition in ASD youth affects how observed SOR behaviors correlate with physiological reactivity.

METHODS

Participants were 54 typically developing (TD) and 83 ASD youth, ages 8-17, who completed a standardized behavioral assessment of SOR while electrocardiogram recordings were collected. Participants' parents also reported on their child's SOR symptoms and behavioral inhibition.

RESULTS

ASD youth showed lower inter-beat-intervals (IBI; higher HR) across all auditory and tactile stimuli. For ASD youth, parent-reported SOR interacted with observed SOR to predict HR changes across the stimulation periods, indicating that ASD participants whose parents reported they had high SOR in their daily life, and showed high observed SOR in the lab assessment, exhibited reduced HR deceleration (orienting) after the onset of the stimulus and subsequent increased HR acceleration. Finally, we found that ASD participants who had lower parent-reported behavioral inhibition had a stronger correlation between observed SOR behavior and atypical HR responses.

CONCLUSIONS

Results support prior findings that increased HR responses to aversive stimuli is related to both ASD and SOR. Furthermore, observed and parent-reported SOR interacted to predict HR, suggesting that a multi-method approach may best capture the extent of SOR for an individual. However, observed SOR measures may be most accurate for ASD youth who are less likely to inhibit their behavioral responses. This study illustrates the importance of integrating multiple measures of sensory reactivity to identify SOR. HR measures of sensory reactivity have the potential to serve as a biomarker of SOR across a diverse range of individuals.

Longitudinal network analysis of depression, anxiety, and post-traumatic stress disorder comorbidities among adolescents in regional China

Purpose

The network theory of mental disorders offers a new perspective for the understanding of comorbidities, but the research on the comorbidities among depression, anxiety, and post-traumatic stress disorder (PTSD) is still insufficient. The aim of this study was to explore the internal relationship by establishing and analyzing the comorbidity networks, and to provide suggestions for the intervention after traumatic events.

Methods

We utilized data from the second and third wave of the Chengdu Positive Child Development cohort (N = 3,189, 47.79% female), we estimated to network models of depression, anxiety and PTSD. To assess difference in global connectivity between the two networks, we conducted invariance test.

Results

K27 (Somatic 10), K37 (Generalized Anxiety 9), K15 (Somatic 5), K33 (Generalized Anxiety 7), K24 (Somatic 9) were the most central nodes in both networks, P13 (Sleep problem) had the highest Bridge Expected Influence value. The structural difference between the two networks was statistically significant (M = 0.229, p = 0.010), and the global strength of the network at wave 2 was higher than the network at wave 3 (35.1 vs. 33.9, S = 1.20, p = 0.010).

Conclusion

The correlation in symptoms of the three disorders underscores the need for more comprehensive treatment options for intervention after traumatic events. Central and bridge nodes could inform targeted interventions or policy decisions. Anxiety disorders, especially Som and Gen dimensions, should be the focus of intervention. The Arousal dimension in PTSD, especially sleep disorders, may contribute to the comorbidities. In addition, this study highlights the importance of staged post-traumatic interventions.

Parsing the heterogeneity of social motivation in autism

BACKGROUND

Social motivation is posited as a key factor in the expression of the autism phenotype. However, lack of precision in both conceptualization and measurement has impeded a thorough understanding of its diverse presentation and associated outcomes. This study addresses this gap by identifying subgroups of autism characterized by deficits in distinct facets of social motivation, relative to normative benchmarks.

METHODS

Data were from 509 participants with autism, aged 5-to-21 years (M = 10.43, SD = 3.67; 81% male), enrolled in the Healthy Brain Network. Latent profile analysis was employed to identify subgroups characterized by unique configurations of reticence, seeking, and maintaining facets of social motivation, derived from a comprehensive multi-instrument factor analysis of symptom and screening measures. Pearson's chi-square tests and one-way analysis of variance were performed to explore subgroup differences in demographic characteristics, cognitive abilities, co-occurring psychopathologies, and other aspects of social functioning.

RESULTS

Four distinct subgroups were identified: Engaged (n = 247), exhibiting the fewest challenges across each area; Inhibited (n = 143), characterized by high reticence, mild challenges in seeking, and few challenges in maintaining; Aloof (n = 68), characterized by challenges with seeking and maintaining but relatively low reticence; and Avoidant (n = 52), characterized by the highest challenges across all areas. Subgroups did not differ in terms of chronological age or sex. The Engaged subgroup exhibited the fewest challenges in other aspects of social functioning and co-occurring psychopathologies, while the Avoidant subgroup exhibited the greatest challenges, and with the Inhibited and Aloof profiles falling in between.

CONCLUSIONS

This study highlights the heterogeneous nature of deficits in social motivation in autism relative to normative benchmarks, suggesting potential avenues for tailored interventions aimed at addressing the specific challenges experienced by individuals within each subgroup. Nevertheless, there remains a need to develop more refined measurement tools capable of capturing even finer-grained aspects and diverse expressions of social motivation, facilitating further characterization of individual differences across diagnostic boundaries.

Gender-affirming hormone therapy and impacts on quality of life: a narrative review

Background –

Transgender and gender-nonconforming (TGNC) people often face significant disparities in health education and access to quality medical management. This narrative literature review examines the relationship between TGNC patients seeking hormone replacement therapy and resulting improved health outcomes.

Methods –

Our search identified papers through the databases PubMed, PsycINFO, CINAHL, Embase, and Web of Science including search terms relating to gender-affirming hormone therapy (GAHT), transgender identities, and patient healthcare experiences and outcomes. Further inclusion criteria required papers published after 1979 with a majority of participants located in the United States. Data extraction and quality assessment of the selected papers were completed using the JBI Manual for Evidence Synthesis, a quality assessment tool created based on the Mixed Methods Appraisal Tool, and Covidence software. Common themes were narratively reviewed.

Results –

The search yielded 19,482 results across five databases and 51 papers were included in data extraction and quality assessment. Most papers were published between 2020-2024 and enrolled young adults in cross-sectional studies. Recurrent themes observed from data synthesis include improved mental health and quality of life outcomes associated with GAHT use. Distance to clinics, cost of care, insurance coverage, and governmental policies were commonly identified barriers to obtaining gender-affirming care.

Conclusions –

The identified gaps in information reflect the importance of additional research in TGNC health-related disparities including diverse participant populations and rigorous longitudinal methods. With these changes, we expect improved quality of care, patient satisfaction, and health outcomes for these individuals.

Impact of family environment on mental disorders and quality of life in children with type 1 diabetes mellitus: a cross-sectional study and intervention policy analysis

Background

Type 1 diabetes mellitus (T1DM) is common in adolescents and negatively affects their quality of life and mental health. This study examines the impact of family environment on mental disorders and quality of life in adolescents with T1DM and analyzes related intervention policies.

Methods

A retrospective analysis was conducted on 75 adolescents with T1DM admitted between October 2020 and December 2023, with 75 healthy adolescents as a control group. Assessments included SCARED, DSRSC, FES, SCL-90, and PedsQL 4.0. Correlation analysis explored the relationships between family environment, anxiety, depression, quality of life and glycosylated haemoglobin (HbA1C).

Results

Significant differences (P < 0.05) were found between the T1DM and control groups in family conflict, independence, harmony, and emotional expression. The T1DM group had higher anxiety, depression, and poorer quality of life. Family cohesion was negatively correlated with mental state, anxiety, depression, and HbA1C, while emotional expression was positively correlated with role functioning.

Conclusion

The family environment significantly impacts the mental health and quality of life of adolescents with T1DM. Enhancing emotional expression and family cohesion can improve outcomes, highlighting the need for targeted interventions.