Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003-2018

Age-period-cohort analysis of different mental wellbeing measures in Scotland from 2008 to 2021: The U-shaped curve of mental wellbeing over the life course

BACKGROUND

Common mental disorders are increasingly recognized as a serious public health concern globally. This study reports an age-period-cohort (APC) analysis of mental wellbeing to help identify high-risk groups.

METHOD

Data from Scottish Health Survey from 2008 to 2021 for adults aged 16+ was used with mental wellbeing measured with three different tools: the General Health Questionnaire-12 (GHQ-12), the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and the Revised Clinical Interview Schedule (CIS-R). A graphical analysis was performed using hexamap and Intrinsic Estimator models were employed to estimate the separate effects for age, period and birth cohorts on mental wellbeing.

RESULTS

Age evidenced the most pronounced pattern with a U-shape curve indicative of a deterioration of mental health as individuals enter adulthood, reaching a nadir in their late 50s/ early 60s before gradually improving thereafter. Mental health trends across cohorts were largely stable, although there was a noticeable, albeit non-significant, increase in mental health issues among people born in late 1990s-to mid-2000s. After adjusting for APC effects, better mental health was found for males, people with higher incomes, employed and those currently married. Medium to high level of physical activity were also associated with better mental wellbeing.

CONCLUSION

The study supports arguments for greater attention to mental health among those are working-age adults and for younger generations born after the 1980s. Associations with sex, socio-economic factors may help guide targeting of public health measures while associations with a healthy physical lifestyle support arguments at measures intended to promote a mental health through physical activity.

Indicators of improved emotion behavior in 6-14-year-old children following a 4-week placebo controlled prebiotic supplement intervention at home with a parent

BACKGROUND

In this double-blind placebo-controlled randomised intervention we investigated the potential benefits of a prebiotic supplement on children's well-being in a home setting. The primary aim was to determine if this supplement could effectively reduce anxiety, improve mood, and enhance cognitive function, similar to findings in young adults.

METHODS

Fifty-three healthy children, aged 6 to 14, participated in an 8-week trial. The trial consisted of three testing time points; day zero marked the baseline measurement (T1) followed by a 28-day supplement intervention period during which they consumed 5.5 g of the prebiotic galactooligosaccharides (GOS) daily under parental guidance. Endline measures (T2) were conducted on the last day of supplement consumption, with a final follow-up testing session (T3) on day 56. Primary outcomes were trait anxiety using a questionnaire and emotional behavior in a dot-probe task on responses to positive and negative images. Secondary outcomes encompassed depression levels, cognitive function tests, and dietary intake recorded in a 4-day food diary. Additionally, we explored whether parents' emotional behavior had an impact on children's responses.

RESULTS

While our statistical analysis did not reveal significant effects of GOS, there were noteworthy trends. Trait anxiety levels decreased over time in both groups, with a more pronounced decrease in the GOS group (after intervention, p =.090; after follow-up, p =.031). The GOS group exhibited reduced negative emotional responses compared to the placebo group (p =.105), and post-trial depression levels decreased in the GOS group over time (p =.015). Although parental emotional responses correlated with various emotional outcomes in children, they did not influence the intervention effects.

CONCLUSIONS

These findings suggest positive trends in line with our hypotheses, however further investigation with greater statistical power would be beneficial.

TRIAL REGISTRATION

Retrospectively registered on https://clinicaltrials.gov/ [NCT06258135] on February 6, 2024.

Increases in suicidal thoughts disclosure among adults in France from 2000 to 2021

BACKGROUND

The objective of the study was to investigate the prevalence of suicidal ideation disclosure over the past two decades in nationally representative samples of the general population, and to identify factors associated with disclosure.

METHODS

Data were drawn from consecutive nationally representative cross-sectional Health Barometer surveys. The 2000, 2005, 2010, 2014, 2017, and 2021 waves were pooled to examine disclosure among those who reported 12-month suicidal ideation. Logistic regressions were performed to identify factors associated with the odds of disclosure.

RESULTS

Across all waves (n = 124,124), 6014 of adults (4.7 %) reported 12-month suicidal ideation, and among them, 49.7 % talked to someone about it. Disclosure was 39 % in 2000, 44.6 % in 2005, 49.9 % in 2010, 52.8 % in 2014, 47.2 % in 2017, and 64.8 % in 2021. Female gender, a prior suicide attempt, higher education, inactive status, and younger age were associated with significantly greater odds of disclosure. Each survey wave was also associated with a greater likelihood of disclosure when compared to 2000, 1.31 (95 % CI, 1.08-1.59) in 2005, 1.69 (95 % CI, 1.38-2.07) in 2010, 1.89 (95 % CI, 1.52-2.34) in 2014, 1.47 (95 % CI, 1.21-1.79) in 2017, and 2.99 (95 % CI, 2.43-3.68) in 2021.

LIMITATIONS

Cross-sectional surveys.

CONCLUSIONS

In the general population of France, adults with suicidal ideation were increasingly more likely to disclose their ideation to someone in recent years. Factors associated with odds of disclosure should inform national suicide prevention strategies to identify subgroups who remain less likely than others to disclose their ideation.

Childhood allergy and anxiety/depression in early adulthood: A longitudinal study in the ALSPAC birth cohort

BACKGROUND

Allergic disease and common mental disorders frequently co-occur. However, little is known about the longitudinal impact of childhood allergy on the subsequent risk of developing anxiety or depression, and the possible biological mechanisms for this.

METHODS

We performed longitudinal analyses of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. The baseline sample comprised n = 5256 children with allergy data available at age 7yrs. We used multivariable regression to test associations between childhood allergy at age 7yrs and: a) four inflammatory markers at age 9yrs; b) depression and anxiety measures between ages 10-24yrs. Allergy measures included biological markers (total serum immunoglobulin E (tIgE), number of positive skin prick tests (SPTs)), and presence of eczema, asthma and/or food allergy (mother reported). Inflammatory markers were interleukin-6 (IL-6), C-reactive protein (CRP), IL-4 and IL-13. We used structural equation modelling to test whether inflammatory markers mediated the association between tIgE and depression/anxiety.

RESULTS

tIgE and having ≥ 1 positive SPT at age 7 were associated with IL-6 levels at age 9 (adjusted β = 0.09; 95 % CI 0.06-0.13; p < 0.001 and adjusted β = 0.06; 95 % CI 0.03-0.09; p < 0.001 respectively), but not with CRP, IL-4 or IL13 levels. We found no strong evidence of an association between childhood allergy and subsequent depression/anxiety during adolescence and early adulthood. This finding was consistent across biological and mother-reported allergy measures.

CONCLUSIONS

Biological markers of childhood allergy are associated with IL-6, a key inflammatory cytokine. However, childhood allergy may not have a large long-term effect on subsequent depression/anxiety.

Twenty-year changes of adolescent mental health and substance use: a Finnish population-based time-trend study

This time-trend study assesses changes in mental health and substance use among Finnish adolescents from 1998 to 2018. Representative samples of adolescents (N = 6,600) aged 13-16 years participated in school-based, almost identical cross-sectional studies in 1998 (n = 1,446), 2008 (n = 2,009), 2014 (n = 1,800) and 2018 (n = 1,345), respectively. The Strengths and Difficulties Questionnaire was used to assess mental health. When comparing mental health in the clinical range between 1998 and 2018, the main finding was the significant increase of emotional symptoms among females. The percentage of females in the clinical range increased from 17.5 to 30.1% during the twenty-year period. When psychopathology measures were analyzed as continuous variables, the finding of increased emotional problems was confirmed. The study clearly illustrates a linear trend, with a consistent increase in emotional problems among females and decrease in substance use among both genders. An alarming finding of steady increase of self-reported emotional problems indicates the importance of early detection and evidence-based interventions for adolescent with anxiety and depression to prevent adversities associated with these disorders.

Mental Health Disorder Trends in Denmark According to Age, Calendar Period, and Birth Cohort

Importance

Research suggests an increase in mental disorder incidence in recent years, but this trend remains unexplained, and there is a lack of large studies based on a representative sample that investigate mental disorders over the full spectrum.

Objective

To explore sex- and age-specific incidence of any mental disorder and 19 specific disorders according to birth cohort and calendar period.

Design, Setting, and Participants

This was a population-based cohort study among 5 936 202 individuals aged 1 to 80 years living in Denmark at some point between January 1, 2004, and December 31, 2021. Data were derived from the Danish Civil Registration System and analyzed from February to August 2024.

Exposures

Birth cohort (8 categories from 1924 to 2011) and calendar period (six 3-year categories from 2004 to 2021).

Main Outcomes and Measures

Incidence rates of mental disorders from 2004 to 2021 by sex and age, according to birth cohort and calendar period, including the first years of the COVID-19 pandemic, using Danish health register data.

Results

The population comprised 2 933 857 female individuals and 3 002 345 male individuals, who were followed up for 83.8 million person-years, with median ages at start and end of follow-up of 30.2 and 46.2 years, respectively. There was an overall mental disorder incidence rate of 55.27 every 10 000 person-years. For diagnoses of any mental disorder, higher incidence rates were observed for more recent birth cohorts and calendar periods in the younger ages. Over older ages, incidence rates did not vary so greatly. An increase was observed in rates of most types of mental disorders, especially among young people, and decreases for other types (eg, substance use disorders). Prominent sex differences were also observed. For example, for schizophrenia, a large increase was seen in incidence rates for female individuals in more recent birth cohorts at younger ages, but no change for male individuals, leading to a higher peak incidence for female individuals than for male individuals in the most recent periods. For personality disorders, a large increase was observed in incidence for female individuals over time and a slight decrease for male individuals.

Conclusions and Relevance

This comprehensive investigation of mental disorders incidence in Denmark indicates sex- and age-specific patterns according to birth cohorts and calendar periods. While trends may partly be explained by increases in incidence, several other factors may contribute, such as diagnostic practices, health sector capacity, and risk factors for mental disorders.

Motivations for Self-Harm in Young People and Their Correlates: A Systematic Review

Self-harm in young people is associated with increased risk of suicide and other negative long-term outcomes. Understanding the motivations driving self-harm behaviours among young people can help to inform the development of preventative and treatment interventions. Self-harm rates have been rising, but reviews of the recent quantitative literature have not been undertaken. PsycInfo, Embase and Medline were systematically searched in September 2024 for studies published in the past ten years. Quantitative studies that examined motivations for self-harm (including prevalence and/or correlates) among young people (aged 10 to 24 years) with a history of self-harm were included in the review. The review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42023429568). One hundred and seventeen studies met inclusion criteria. Intrapersonal motivations for self-harm (particularly emotion regulation, anti-dissociation and self-punishment) were more common than interpersonal motivations (e.g. peer bonding, communication). Intrapersonal motivations correlated with female gender, higher self-harm severity, current, repetitive and persistent self-harm, suicidality, poorer mental health and poorer emotion regulation. There was evidence to suggest that interpersonal motives are associated with younger age and some mental health difficulties (e.g. anxiety). Young people predominantly self-harm for intrapersonal reasons. Given that self-harm for intrapersonal reasons is associated with greater self-harm severity, suicidality and poor mental health, steps should be taken to prevent and reduce self-harm. Interventions for self-harm require a multifaceted approach that not only provides young people with alternate ways of regulating their emotions, but also targets risk factors that contribute to self-harm.

Depression in adolescence and the understanding of health-A phenomenographic study

Health is multifaceted, with divergent interpretations in diverse cultures and groups of individuals. The ways individuals understand health might aid in developing future interventions. There is scant knowledge on how adolescents with depression conceptualise health. A descriptive qualitative design with a phenomenographic approach was used to describe the different ways adolescents with depression conceptualise health. Interviews were performed with adolescents 13-17 years old (n = 33) who participated in a randomised controlled trial evaluating the effects of aerobic group exercise versus leisure group activities for adolescents with depression. The results were interpreted into four metaphors to embody the understanding of health as described by adolescents with depression: 1) establishing sound routines by managing everyday life, 2) connecting to others by having access to social resources, 3) managing depression symptoms by having control over the mental illness, and 4) attaining inner drive by experiencing joy in everyday life. The various conceptions of health among adolescents with depression provide valuable insights for enhancing evidence-based treatments with person-centred care. Key aspects include establishing routines, fostering connections, finding strategies for symptom control, and incorporating joy through exercise. Given that adolescents highlighted these aspects as essential to health, future research could explore individualised health promotion, particularly focusing on routine-building, social connections, or finding an inner drive as an add-on to evidence-based treatments for adolescent depression.

Contact patterns in health care before and after first registered suicide attempt or self-harm: A nationwide register study

This study aimed to identify possible missed opportunities for suicide prevention by investigating health care utilization two years before and after the first recorded suicide attempt or self-harm (SA/SH). The SA/SH group was identified in 2010-2021 and was matched 1:10 with a reference group using risk set sampling on sex, birth year, and time of SA/SH diagnosis. Incidence rates for contacts to general practitioner, somatic hospital, or psychiatric hospital were estimated within quarters (i.e. three-month intervals). Negative binomial regression was used to determine incidence rate ratios for contact patterns in the SA/SH group compared to the two years prior to their first event. Underlying causes for health care contacts were also examined. The SA/SH group included 29,439 individuals. Contact to health care facilities changed markedly in the three months before SA/SH. The underlying causes for these encounters were often related to poisoning, injuries, abnormal or unspecific causes influencing health status, or neurotic, stress-related and somatoform disorders. This study provides health care professionals with useful insight into changing health care contact patterns among individuals with SA/SH.

Research Review: Sex differences in the clinical correlates of nonsuicidal self-injury in adolescents - a systematic review

BACKGROUND

Nonsuicidal self-injury (NSSI), or 'the deliberate, self-inflicted destruction of body tissue…without suicidal intent and for purposes not culturally sanctioned', is a robust predictor of future suicide-related behavior and therefore a modifiable target for suicide prevention. The prevalence of NSSI is rising in adolescents, particularly among females; however, it is unknown whether sex differences also exist in the clinical and psychosocial factors associated with NSSI. Understanding how the correlates of NSSI differ by sex is important for developing tailored treatments. This study systematically reviews sex differences in the clinical and psychosocial correlates of NSSI among adolescents.

METHODS

MEDLINE and PsycINFO were searched using the keywords 'adolescents', 'self-injury', and 'sex factors' and synonyms for English-language articles published between January 1, 2000 and May 10, 2022. We included studies that presented original data on NSSI, included adolescents ages 10-19, reported sex differences, and explicitly defined self-injury as that done without suicidal intent. Fifty-seven studies containing 54 unique samples were included. Data were summarized by sex and recorded by: (a) characteristics of NSSI, (b) clinical and psychosocial correlates of NSSI, and (c) associations with suicide.

RESULTS

We used data on NSSI from 54 unique samples of adolescents worldwide. Males more commonly used violent methods of NSSI, such as burning, and were more likely to be physically aggressive and experience substance abuse. Females more commonly self-injured by cutting, and their NSSI was more likely to be repetitive and associated with emotional distress. In both sexes, NSSI was associated with adverse childhood experiences (ACEs) such as sexual abuse/violence and bullying. NSSI was predictive of suicide in females but not males.

CONCLUSIONS

Data from 22 countries and 352,516 participants suggest important sex differences in the clinical and psychosocial factors associated with NSSI among adolescents that future assessment and treatment strategies ought to consider.

The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK

BACKGROUND

This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.

METHODS

A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance.

RESULTS

A total of 643 322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16-17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of 'all' antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both 'all' antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward.

CONCLUSIONS

Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.

Resilience in Families of Autistic Children and Children With Intellectual Disability During the COVID-19 Pandemic

Resilience in families of autistic children and children with intellectual disability is associated with factors such as family functioning, social support, and financial strain. Little is known about family resilience during the COVID-19 pandemic when many resources were limited. This study examined the association of family resilience with child characteristics, family resources, and socioecological factors during the pandemic. Data collected during the COVID-19 pandemic from 734 United Kingdom parents/caregivers of children who are autistic and/or have intellectual disability were analyzed using path analysis. Greater family resilience was significantly associated with fewer child behavior problems, absence of intellectual disability, higher financial status, and greater family functioning, though not school support. These factors might guide future research and practices to support vulnerable families at risk of low resilience.

Temporal trends and social inequities in adolescent and young adult mental health disorders in Catalonia, Spain: a 2008-2022 primary care cohort study

BACKGROUND

The prevalence of mental health disorders in children, teens, and young adults is rising at an alarming rate. This study aims to explore time trends in the incidence of mental disorders among young people in Catalonia, Spain from 2008 to 2022, focusing on the effects of the COVID-19 pandemic and from the perspective of social inequities.

METHODS

A cohort study using primary care records from the SIDIAP database was conducted. It included 2,088,641 individuals aged 10 to 24 years. We examined the incidence of depressive, anxiety, eating, and attention deficit/hyperactivity disorders, stratified by sex, age, deprivation, and nationality.

RESULTS

All disorders reflected an increasing trend throughout the study period: depressive disorders (IRR: 2.44, 95% CI: 2.31-2.59), anxiety disorders (IRR: 2.33, 95% CI: 2.27-2.39), ADHD (IRR: 2.33, 95%CI: 2.17-2.50), and eating disorders (IRR: 3.29, 95% CI: 3.01-3.59). A significant increase in incidence was observed after the outbreak of the COVID-19 pandemic. In 2022, anxiety disorders were most frequent, with an incidence rate (IR) of 2,537 per 100,000 persons-year (95% CI: 2,503-2,571). Depressive disorders followed with an IR of 471 (95% CI: 458-486), ADHD with an IR of 306 (95% CI: 295-317) and eating disorders with an IR of 249 (95% CI: 239-259). Significant associations were reported with sex, age, deprivation, and nationality.

CONCLUSION

The incidence of all studied disorders has steadily increased, reaching unprecedented levels during the pandemic. Understanding these trends is essential for an appropriate healthcare response, while addressing the non-medical determinants, requires action across all sectors of society.

Sex differences in clinically diagnosed psychiatric disorders over the lifespan: a nationwide register-based study in Sweden

Background

Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan.

Methods

We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated.

Findings

During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status.

Interpretation

Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies.

Funding

Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.

Increased threat learning after social isolation in human adolescents

In animal models, social isolation impacts threat responding and threat learning, especially during development. This study examined the effects of acute social isolation on threat learning in human adolescents using an experimental, within-participant design. Participants aged 16-19 years underwent a session of complete isolation and a separate session of isolation with virtual social interactions, counterbalanced between participants, as well as a baseline session. At baseline and following each isolation session, participants reported their psychological state and completed a threat learning task in which self-report ratings and physiological responses to learned threat and safety cues were measured. Threat learning increased after both isolation sessions in two ways. First, participants found the learned threat cue more anxiety-inducing and unpleasant after isolation compared with baseline. Second, during threat extinction, electrodermal activity was partially elevated after isolation compared with baseline. Further, the results suggested that isolation influenced threat learning through state loneliness. Threat learning is central to threat-related disorders including anxiety, phobias, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), and our findings suggest that isolation and loneliness in adolescence might increase vulnerability to the emergence of these disorders through increased threat learning.

The CO-produced Psychosocial INtervention delivered by GPs to young people after self-harm (COPING): protocol for a feasibility study

Background

Self-harm in young people is a growing concern and reducing rates a global priority. Rates of self-harm documented in general practice have been increasing for young people in the UK in the last two decades, especially in 13-16-year-olds. General practitioners (GPs) can intervene early after self-harm but there are no effective treatments presently available. We developed the GP-led COPING intervention, in partnership with young people with lived experience and GPs, to be delivered to young people 16-25 years across two consultations. This study aims to examine the feasibility and acceptability of conducting a fully powered effectiveness trial of the COPING intervention in NHS general practice.

Methods

This will be a mixed-methods external non-randomised before-after single arm feasibility study in NHS general practices in the West Midlands, England. Patients aged 16-25 years who have self-harmed in the last 12 months will be eligible to receive COPING. Feasibility outcomes will be recruitment rates, intervention delivery, retention rates, and completion of follow-up outcome measures. All participants will receive COPING with a target sample of 31 with final follow-up data collection at six months from baseline. Clinical data such as self-harm repetition will be collected. A nested qualitative study and national survey of GPs will explore COPING acceptability, deliverability, implementation, and likelihood of contamination.

Discussion

Brief GP-led interventions for young people after self-harm are needed to address national guideline and policy recommendations. This study of the COPING intervention will assess whether a main trial is feasible.

Registration

ISRCTN (ISRCTN16572400; 28.11.2023).

Mental health among school children and adolescents in China: A comparison of one-child and multiple-children families from a nationwide survey

The influence of China's "one-child" policy on the mental health of children and adolescents is still unclear. This study examined the associations between number of children and children's mental health using data from the national school children and adolescents survey of China. Mental health was measured using the Achenbach's Child Behavior Checklist (CBCL). Linear regression models were used to explore the relationship between number of children per family and children's mental health. A total of 64,017 students were enrolled, with 68.60 % from one-child families. Compared with children from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales (all P<0.001). Analyses suggested children from multiple-child families have a higher risk of mental health problems (total problems on the CBCL: adjusted B=2.217, 95 %CI=1.883-2.550, P<0.001). Regular mental health assessments should be implemented and effective interventions should be developed for those in need.

"I can't escape my scars, even if I do get better": A qualitative exploration of how adolescents talk about their self-harm and self-harm scars during cognitive behavioural therapy for depression

Emerging evidence indicates that perceptions of self-harm behaviours and self-harm scars may thwart recovery from depression, yet limited research has explored adolescent accounts of their self-harm and scars during therapy. This study sought to explore how adolescents describe their self-harm behaviours and scars during Cognitive Behavioural Therapy (CBT) and explore the sociocultural discourses that may influence these descriptions. The participants were six female adolescents (aged 14-17 years old) with clinical depression, who were engaging in self-harm. All participants accessed CBT as part of clinical trial evaluating three psychological treatments for major depressive disorder in Child and Adolescent Mental Health Services. Audio-taped CBT sessions were analyzed using discourse analysis. Within CBT sessions, adolescents drew upon stigma discourses in talking about their self-harm. Adolescent also described their self-harm scars as shameful and stigmatizing, and as "proof" of the legitimacy of their depression. It is important for CBT practitioners to understand the context of sociocultural discourses around self-harm behaviours and self-harm scars, which are reflected in how adolescents with depression describe these within therapy and may serve to maintain distress. The study indicates that awareness of use of language and intersecting sociocultural discourses can inform CBT practice.

Pediatric Hospitalizations and Emergency Department Visits Related to Mental Health Conditions and Self-Harm

Importance

Mental disorders among the pediatric population are a major area of public health concern. Little is known regarding changes in pediatric hospital resource use related to mental health (MH) long after the onset of the COVID-19 pandemic in March 2020.

Objective

To assess rates and trends of hospitalizations and emergency department (ED) visits related to MH and self-harm (SH) among children before and during the 3 years following the pandemic onset.

Design, Setting, and Participants

This cross-sectional study used national hospital data. The study sample included all MH- and SH-related hospitalizations and ED visits among children aged 6 to 17 years in France between January 1, 2016, to May 31, 2023.

Main Outcomes and Measures

Interrupted time-series analysis of monthly rates of MH- and SH-related hospitalizations and ED visits per 100 000 children was conducted to assess changes before and every year after the pandemic onset. Rate ratios (RRs) between estimated and expected rates were calculated.

Results

Overall, 583 244 hospitalizations (81.4% for MH and 18.6% for SH) and 432 725 ED visits (79.9% for MH and 20.1% for SH) were analyzed. The mean (SD) age of the children was 13.7 (2.9) and 14.8 (1.7) years for MH-related and SH-related hospitalizations, respectively, and 14.2 (2.6) and 14.6 (2.1) years for MH-related and SH-related ED visits, respectively. For MH-related hospitalizations, 52.6% were female and 47.4% were male; for SH-related hospitalizations, 83.1% were female and 16.9% were male. For MH-related ED visits, 62.8% were female and 37.2% were male; for SH-related ED visits, 77.4% were female and 22.6% were male. Before the pandemic, an increasing trend in all monthly rates, except that of MH-related hospitalizations, was observed. After an immediate decrease in hospitalization and ED visit rates during the initial pandemic period (March 1 to May 31, 2020), trends increased in the first 2 years following the pandemic onset and decreased thereafter. Overall, rates of MH-related hospitalizations and ED visits exceeded expected rates in only the second year after the pandemic onset, with increases of 6.0% (RR, 1.06 [95% CI, 1.05-1.06]) and 5.0% (RR, 1.05 [95% CI, 1.04-1.05]), respectively. However, rates of hospitalizations and ED visits for behavioral syndromes (mainly eating and sleeping disorders) persistently exceeded expected rates, with increases of 29.0% (RR, 1.29 [95% CI, 1.25-1.34]) and 26.0% (RR, 1.26 [95% CI, 1.21-1.31]) in the third year, respectively. Likewise, rates of SH-related hospitalizations and ED visits persistently rose above expected rates, with increases of 29.0% (RR, 1.29 [95% CI, 1.26-1.32]) and 43.0% (RR, 1.43 [95% CI, 1.40-1.47]) in the third year, respectively.

Conclusions and Relevance

In this cross-sectional study, persistent increases in the use of hospital resources to treat eating and sleeping disorders and intentional SH among pediatric patients were observed long after the onset of the COVID-19 pandemic. These findings warrant future research to identify persistent stress factors in children.

Towards reliable forecasting of healthcare capacity needs: A scoping review and evidence mapping

BACKGROUND

The COVID-19 pandemic has highlighted the critical importance of robust healthcare capacity planning and preparedness for emerging crises. However, healthcare systems must also adapt to more gradual temporal changes in disease prevalence and demographic composition over time. To support proactive healthcare planning, statistical capacity forecasting models can provide valuable information to healthcare planners. This systematic literature review and evidence mapping aims to identify and describe studies that have used statistical forecasting models to estimate healthcare capacity needs within hospital settings.

METHOD

Studies were identified in the databases MEDLINE and Embase and screened for relevance before items were defined and extracted within the following categories: forecast methodology, measure of capacity, forecast horizon, healthcare setting, target diagnosis, validation methods, and implementation.

RESULTS

84 studies were selected, all focusing on various capacity outcomes, including number of hospital beds/ patients, staffing, and length of stay. The selected studies employed different analytical models grouped in six items; discrete event simulation (N = 13, 15 %), generalized linear models (N = 21, 25 %), rate multiplication (N = 15, 18 %), compartmental models (N = 14, 17 %), time series analysis (N = 22, 26 %), and machine learning not otherwise categorizable (N = 12, 14 %). The review further provides insights into disease areas with infectious diseases (N = 24, 29 %) and cancer (N = 12, 14 %) being predominant, though several studies forecasted healthcare capacity needs in general (N = 24, 29 %). Only about half of the models were validated using either temporal validation (N = 39, 46 %), cross-validation (N = 2, 2 %) or/and geographical validation (N = 4, 5 %).

CONCLUSION

The forecasting models' applicability can serve as a resource for healthcare stakeholders involved in designing future healthcare capacity estimation. The lack of routine performance validation of the used algorithms is concerning. There is very little information on implementation and follow-up validation of capacity planning models.

The diminishing association between adolescent mental disorders and educational performance from 2006-2019

Background

A rising prevalence of adolescent mental disorders in the Western world has been widely reported, raising concerns for adolescent development and well-being. Mental disorders are known to negatively impact educational performance. Yet it remains uncertain whether the relationship between mental disorders and educational outcomes has also changed over time and if the change is more pronounced among high compared to low performing students. The aims of this paper are to (1) describe the change over time in the prevalence of common mental disorders in adolescence; (2) determine whether the change in prevalence of common mental disorders differs between high and low performing students; and (3) assess whether the associations between mental health disorders and educational performance have changed over time.

Methods

To address these issues, this study examines potential shifts in the associations between diagnoses of ADHD and internalizing disorders and educational performance among 843,692 Norwegian students graduating from lower secondary education between 2006 and 2019. We utilize population-wide register data on ADHD and internalizing disorders from primary and specialist care combined with educational outcomes.

Results

Our analysis revealed a marked rise in ADHD prevalence, from 1.0% in 2006 to 2.6% in 2019. Concurrently, diagnoses of internalizing disorders also increased from 1.9% to 4.2%. This increasing trend in diagnoses spanned across all high school grade point average (GPA) categories, thereby not supporting the notion that the rise is predominantly observed among high-performing adolescents. Importantly, the strength of the associations of internalizing disorders and ADHD with GPA diminished significantly over time. For instance, the difference between the average GPA standardized score for boys with and without an ADHD diagnosis shrunk from 1.0 in 2006 to 0.73 in 2019.

Conclusions

We discuss various potential explanations for this observation and suggest that changes in diagnostic thresholds is a contributing factor.

Self-harm and suicidal behaviors in children: perspectives of mental health clinicians

OBJECTIVE

Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children.

METHODS

26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis.

RESULTS

Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem.

CONCLUSIONS

Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.

Changing patterns of health risk in adolescence: implications for health policy

Adolescence is a time of physical, cognitive, social, and emotional development. This period is a very sensitive developmental window; environmental exposures, the development of health behaviours (eg, smoking and physical activity), and illness during adolescence can have implications for lifelong health. In the UK and other high-income countries, the experience of adolescence has changed profoundly over the past 20 years. Smoking, drug use, and alcohol consumption have all been in long-term decline. At the same time, obesity and mental ill health have increased and are now common among adolescents, with new risks (ie, vaping, psychoactive substances, and online harms) emerging. In this Viewpoint, we describe these and related trends in England and the UK. Although previous work has explored these changes in isolation, in this Viewpoint we consider them collectively. We explore what might be driving the changes and consider the implications for practice, policy, and research.

'There's more to life than staring at a small screen': a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13-16 years old in the UK

BACKGROUND

Depression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous.

OBJECTIVES

The study aim was to assess the association between problematic smartphone usage (PSU) and anxiety.

METHODS

Using a prospective mixed methods cohort study design, students aged 13-16 year old from two schools were enrolled regarding their smartphone use, mood and sleep via a semistructured questionnaire at baseline and week 4. The primary outcome was symptoms of anxiety (Generalised Anxiety Disorder Questionnaire, GAD-7) and exposure was PSU (Smartphone Addiction Scale Short Version). A linear regression was fitted to assess the change in anxiety. Thematic analysis of free-text responses was conducted.

FINDINGS

The sample included 69 participants that were enrolled and followed up between 28 March and 3 June 2022. Of those with PSU, 44.4% exhibited symptoms of moderate to severe anxiety compared with 26.4% of those without PSU. There was a linear association between change in symptoms of anxiety and PSU β=0.18 (95% CI 0.04 to 0.32, p=0.013). Several themes were found: both positive and negative effects of smartphones on relationships; negative effects on school performance and productivity; mixed effects on mood; a desire to reduce the amount of time spent on smartphones.

CONCLUSIONS

Increased anxiety, depression and inability to sleep were seen in participants as their PSU score increased over time. Participants reported both positive and negative effects of smartphones and almost all used strategies to reduce use.

CLINICAL IMPLICATIONS

Interventions need to be developed and evaluated for those seeking support.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Exploring the research needs, barriers and facilitators to the collection of biological data in adolescence for mental health research: a scoping review protocol paper

INTRODUCTION

While research into adolescent mental health has developed a considerable understanding of environmental and psychosocial risk factors, equivalent biological evidence is lacking and is not representative of economic, social and ethnic diversity in the adolescent population. It is important to understand the possible barriers and facilitators to conduct this research. This will then allow us to improve our understanding of how biology interacts with environmental and psychosocial risk factors during adolescence. The objective of this scoping review is to identify and understand the needs, barriers and facilitators related to the collection of biological data in adolescent mental health research.

METHODS AND ANALYSIS

Reviewers will conduct a systematic search of PubMed, Medline, Scopus, Cochrane, ERIC, EMBASE, ProQuest, EBSCO Global Health electronic databases, relevant publications and reference lists to identify studies published in the English language at any time. This scoping review will identify published studies exploring mental health/psychopathology outcomes, with biological measures, in participants between the ages of 11 and 18 and examine the reported methodology used for data collection. Data will be summarised in tabular form with narrative synthesis and will use the methodology of Levac et al, supplemented by subsequent recommendations from the Joanna Briggs Institute Scoping Review Methodology.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review. The scoping review will be conducted with input from patient and public involvement, specifically including young people involved in our study ('Co-producing a framework of guiding principles for Engaging representative and diverse cohorts of young peopLE in Biological ReseArch in menTal hEalth'-www.celebrateproject.co.uk) Youth Expert Working Group. Dissemination will include publication in peer-reviewed journals, academic presentations and on the project website.

Interventions through Art Therapy and Music Therapy in Autism Spectrum Disorder, ADHD, Language Disorders, and Learning Disabilities in Pediatric-Aged Children: A Systematic Review

Traditional pharmacological treatments, although effective, often carry potential side effects, which positions art therapy and music therapy as promising non-pharmacological alternatives to alleviate symptoms and improve social, cognitive, and emotional skills without the associated risks. Through a review in the SCOPUS and WOS databases following the PRISMA protocol, a total of 80 articles were analyzed through a series of determined categories and subcategories of analysis. The aim of this study is to evaluate and synthesize the existing evidence on the efficacy and applicability of art therapy and music therapy in the treatment of children with autism spectrum disorder (ASD), hyperactivity disorder (HSDD), developmental language disorders, and language learning difficulties, identifying best practices and key areas for future research. Among the main findings is that art therapy and music therapy have a significant impact on symptomatology, behavior, and communication as well as social, cognitive, and emotional skills in the pediatric populations studied. These therapies are highly valued by the participants with a large majority recognizing their adaptability to different educational and clinical contexts. It is concluded that these therapies have a high potential as viable alternatives or complements to traditional pharmacological treatments, justifying their application and further study in broader therapeutic contexts.

Effects of mental health status during adolescence on primary care costs in adulthood across three British cohorts

PURPOSE

This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK.

METHODS

We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability).

RESULTS

Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males.

CONCLUSION

Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced.

TRIAL REGISTRATION

Not applicable.

The Association between Cyberbullying Victimization and Depression among Children: A Moderated Mediation Model

Cyberbullying victimization is becoming more prevalent and adversely affects mental health. This research explores the relationship between the two variables and the underlying mechanism, especially for children, as the impact of mental health in childhood might last a lifetime. Primary school students (N = 344; Mage = 9.90; 43.90% girls) completed self-report questionnaires regarding cyberbullying victimization, self-perceived social competence, optimism, and depression at school. Gender and grade were controlled as covariates. Depression was positively predicted by cyberbullying victimization, while self-perceived social competence played a partially mediating role. In addition, optimism directly and indirectly moderated the effects of cyberbullying victimization on depression. Specifically, the effects were stronger for children with low levels of optimism. Therefore, efforts to enhance children's self-perceived social competence and optimism may reduce their depression resulting from cyberbullying victimization.

The role of intraamygdaloid oxytocin in spatial learning and avoidance learning

The goal of the present study is to investigate the role of intraamygdaloid oxytocin in learning-related mechanisms. Oxytocin is a neuropeptide which is involved in social bonding, trust, emotional responses and various social behaviors. By conducting passive avoidance and Morris water maze tests on male Wistar rats, the role of intraamygdaloid oxytocin in memory performance and learning was investigated. Oxytocin doses of 10 ng and 100 ng were injected into the central nucleus of the amygdala. Our results showed that 10 ng oxytocin significantly reduced the time required to locate the platform during the Morris water maze test while significantly increasing the latency time in the passive avoidance test. However, the 100 ng oxytocin experiment failed to produce a significant effect in either of the tests. Wistar rats pretreated with 20 ng oxytocin receptor antagonist (L-2540) were administered 10 ng of oxytocin into the central nucleus of the amygdala and were also subjected to the aforementioned tests to highlight the role of oxytocin receptors in spatial- and avoidance learning. Results suggest that oxytocin supports memory processing during both the passive avoidance and the Morris water maze tests. Oxytocin antagonists can however block the effects of oxytocin in both tests. The results substantiate that oxytocin uses oxytocin receptors to enhance memory and learning performance.

5-year mental health outcomes for children and adolescents presenting with psychiatric symptoms to general practitioners in England: a retrospective cohort study

BACKGROUND

Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses.

METHODS

In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3-18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress.

FINDINGS

We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4-16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000-2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio vs low-contact group 2·19 [95% CI 2·03-2·36]) and suicide (2·67 [1·72-4·14]).

INTERPRETATION

Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents.

FUNDING

National Institute for Health and Care Research and the Wellcome Trust.

Global trends in youth suicide from 1990 to 2020: an analysis of data from the WHO mortality database

Background

Suicide is a serious but preventable public health concern at the global level, showing relevant geographical differences. This study aims to monitor global temporal and geographical patterns in suicide mortality in pre-adolescents, adolescents, and young adults (i.e., aged 10-24 years), from 1990 to 2020 or the most recent available year.

Methods

Using the World Health Organisation mortality database, we conducted an analysis on a subset of 52 countries with valid and high-quality data. We computed age-standardised suicide rates (ASR) by sex, country, and calendar year, and performed a joinpoint regression analysis to identify significant changes in the temporal suicide trends over the studied period.

Findings

High variability in suicide rates and trends was observed, with a male-to-female ratio of two to five. Between 1990 and 2020, most European countries reported declining suicide trends, with some exceptions. In particular, alarming trends emerged in the United Kingdom, with annual rises of 2.5% (95% CI: 1.6-3.5) since 2005 among males and 8.5% (95% CI: 4.7-12.6) since 2012 among females. The most favorable trends and lowest suicide rates were in Southern Europe, with 3.1/100,000 persons in Italy (2020) and 3.5/100,000 persons in Spain (2021) among males, and 0.9/100,000 persons in Italy (2020) and 1.1/100,000 persons in Romania (2019) among females. Conversely, the highest rates were in Central-Eastern Europe, with 10.2/100,000 males in the Russian Federation (2019) and 10.0/100,000 males in Poland (2002). Higher suicide rates and significant increases were reported in not European areas. The highest ASR was 15.5/100,000 males in the United States of America, with an annual increase of 3.8% (95% CI: 3.1-4.5) among males in 2009-2020 and 6.7% (95% CI: 5.6-7.8) among females in 2007-2017, followed by a levelling off.

Interpretation

Temporal and geographical comparisons of suicide mortality should be interpreted with caution due to potential misclassification or under-reporting of suicide deaths in some countries.

Funding

None.

Impact of social media "challenges" on poison center case volume for intentional ingestions among school-aged children: an observational study

INTRODUCTION

Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including "challenges" urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances.

METHODS

We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America's Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children.

RESULTS

There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance.

DISCUSSION

We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1-2 months later, suggesting a public health opportunity for intervention.

LIMITATIONS

This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts.

CONCLUSIONS

Additional research is needed on the relationship between social media and youth mental health, particularly around "challenges" that place youths' health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.

Temporal patterns in the recorded annual incidence of common mental disorders over two decades in the United Kingdom: a primary care cohort study

BACKGROUND

Common mental disorders (CMDs) including depression, anxiety, and stress are very common, but it is unclear whether the last decades of social, economic, and political change have impacted incidence of CMD. This study explored temporal trends in the recorded incidence of CMD in the United Kingdom.

METHODS

We used data from general practices in the United Kingdom (Clinical Practice Research Datalink) to estimate the annual recorded incidence of CMD for 2000-2020, including symptoms, diagnosis, or pharmaceutical treatment. Trends were explored by sex, age, ethnicity, region, deprivation, and comorbidity.

RESULTS

We included 29 480 164 individuals who were followed up for 12.5 years on average (s.d. = 6.4 years). The recorded incidence of CMD episodes was 55.9 per 1000 person-years in 2000 [95% confidence interval (CI) 55.8-56.1], increasing to 79.6 per 1000 person-years in 2019 (95% CI 79.5-79.8). Females had higher recorded incidence rates, as did those living in more deprived areas. We observed striking patterns by age over time, with rates in ages 16-24 increasing from 40.2 per 1000 in 2000 (95% CI 39.8-40.5), to 107.8 per 1000 in 2019 (95% CI 107.0-108.6). In contrast, the rates in those aged ≥55 years decreased since 2014. There were differing patterns of incidence by ethnic group, with a steeper increase in Asian, Black, and mixed groups in recent years.

CONCLUSIONS

Overall, the incidence of recorded CMD in the UK general practice increased between 2000 and 2019 with a small decrease in 2020. The overall trends obscured important differences across population subgroups, which may have implications for prevention.

Mental health of social media influencers

There is a wide body of research on the effects of social media use on mental health, particularly focusing on young people. However, very little is known about the mental health of social media influencers (SMIs), who also tend to be quite young. This is of growing significance as more of our daily lives is conducted online, and in the context of poor population mental health globally, which declined further as a result of the COVID-19 pandemic. We therefore set out to review the mental health of SMIs and, in the absence of literature on SMIs, drew on other similar but more traditional occupational groups, such as the self-employed, to draw conclusions and identify directions for future research.

Comparison of Rheumatoid Arthritis Information Recorded in UK CPRD Aurum and CPRD GOLD Databases (Companion Paper 3)

Purpose

To report distribution of codes associated with a rheumatoid arthritis (RA) diagnosis recorded in Clinical Practice Research Datalink (CPRD) Aurum compared to the previously validated CPRD GOLD database as a critical step toward making decisions about CPRD Aurum's suitability for medical research.

Patients and Methods

We analyzed the distribution of codes for RA diagnoses, labs, and treatments in the new CPRD Aurum database, compared to the CPRD GOLD database by selecting relevant indicators of RA diagnosis, treatment, and clinical care. We included all patients in England in CPRD Aurum and CPRD GOLD with an incident diagnosis code for RA on or after 1 January 2005 and at least two years recorded data before first RA diagnosis.

Results

We found 53,083 and 18,167 patients with a new diagnosis code for RA in CPRD Aurum and CPRD GOLD, respectively. In both databases approximately 67% were female with similar mean ages at first diagnosis. There were few differences in RA-related recording patterns between the two data sources. Before first RA diagnosis, CPRD Aurum patients had more RA-specific labs and other supporting clinical codes. After diagnosis, CPRD Aurum patients had more RA diagnoses coded and more often had 10+ general RA labs than patients in CPRD GOLD. More CPRD GOLD patients had 10+ prescriptions for conventional disease-modifying antirheumatic drugs (cDMARD) compared to CPRD Aurum. Otherwise, the distribution of drugs used to treat RA was similar between databases. The standardized incidence of RA was similar between databases.

Conclusion

Overall, among patients with a diagnosis code for RA, recording of diagnoses, prescription drugs, and labs were similar between CPRD Aurum and CPRD GOLD. Slight differences were found for a few variables, but overall, we found consistency between the databases. In addition, standardized incidence of RA was similar between databases.

Online and school bullying roles: are bully-victims more vulnerable in nonsuicidal self-injury and in psychological symptoms than bullies and victims?

BACKGROUND

Bullying leads to adverse mental health outcomes and it has also been linked to nonsuicidal self-injury (NSSI) in community adolescents. It is not clear whether different roles of bullying (bully, victim, bully-victim) are associated with NSSI, furthermore the same associations in cyberbullying are even less investigated.

METHODS

The aim of the current study was to test whether students involved in school or online bullying differed from their not involved peers and from each other in psychological symptoms (externalizing and internalizing problems) and in NSSI severity (number of episodes, number of methods). Furthermore, mediation models were tested to explore the possible role of externalizing and internalizing problems in the association of school and online bullying roles with NSSI. In our study, 1011 high school students (66.07% girls; n = 668), aged between 14 and 20 years (Mage = 16.81; SD = 1.41) participated.

RESULTS

Lifetime prevalence of at least one episode of NSSI was 41.05% (n = 415). Students involved in bullying used more methods of NSSI than not involved adolescents. In general, victim status was associated mostly with internalizing symptoms, while bully role was more strongly associated with externalizing problems. Bully-victims status was associated with both types of psychological problems, but this group did not show a significantly elevated NSSI severity compared to other bullying roles. Externalizing and internalizing problems mediated the relationship between bullying roles and NSSI with different paths at different roles, especially in case of current NSSI that happened in the previous month.

CONCLUSIONS

Results highlight that students involved in bullying are more vulnerable to NSSI and to psychological symptoms compared to their peers who are not involved in bullying. It is suggested that bullying roles, especially bully-victim status, need to be identified in school and online settings and thus special attention should be addressed to them to reduce psychological symptoms and NSSI, for example by enhancing adaptive coping skills.

Replicability and reproducibility of predictive models for diagnosis of depression among young adults using Electronic Health Records

BACKGROUND

Recent advances in machine learning combined with the growing availability of digitized health records offer new opportunities for improving early diagnosis of depression. An emerging body of research shows that Electronic Health Records can be used to accurately predict cases of depression on the basis of individual's primary care records. The successes of these studies are undeniable, but there is a growing concern that their results may not be replicable, which could cast doubt on their clinical usefulness.

METHODS

To address this issue in the present paper, we set out to reproduce and replicate the work by Nichols et al. (2018), who trained predictive models of depression among young adults using Electronic Healthcare Records. Our contribution consists of three parts. First, we attempt to replicate the methodology used by the original authors, acquiring a more up-to-date set of primary health care records to the same specification and reproducing their data processing and analysis. Second, we test models presented in the original paper on our own data, thus providing out-of-sample prediction of the predictive models. Third, we extend past work by considering several novel machine-learning approaches in an attempt to improve the predictive accuracy achieved in the original work.

RESULTS

In summary, our results demonstrate that the work of Nichols et al. is largely reproducible and replicable. This was the case both for the replication of the original model and the out-of-sample replication applying NRCBM coefficients to our new EHRs data. Although alternative predictive models did not improve model performance over standard logistic regression, our results indicate that stepwise variable selection is not stable even in the case of large data sets.

CONCLUSION

We discuss the challenges associated with the research on mental health and Electronic Health Records, including the need to produce interpretable and robust models. We demonstrated some potential issues associated with the reliance on EHRs, including changes in the regulations and guidelines (such as the QOF guidelines in the UK) and reliance on visits to GP as a predictor of specific disorders.

The influence of peer non-suicidal self-harm on young adults' urges to self-harm: experimental study

OBJECTIVE

To test the hypothesis that exposure to peer self-harm induces adolescents' urges to self-harm and that this is influenced by individual suggestibility.

METHODS

We recruited 97 UK-based adults aged 18-25 years with a recent history of self-harm, measuring baseline suggestibility (Resistance to Peer Influence; RPI) and perceived ability to control urges to self-harm (using an adapted item from the Self-Efficacy to Resist Suicidal Action scale; SEASA) before and after two self-harm vignettes featuring named peers from the participant's social network (to simulate exposure to peer non-suicidal self-harm) and after a wash-out exposure. We used paired t-tests to compare mean SEASA scores pre- and post-exposure, and linear regression to test for an association between RPI and change in SEASA scores pre- and post-exposure.

RESULTS

Perceived ability to control urges to self-harm was significantly reduced following exposure to peer self-harm (t(96) = 4.02, p < 0.001, mean difference = 0.61; 95% CI = 0.31, 0.91), but was not significantly different from baseline after exposure to a wash-out. We found no association between suggestibility and change in urges to self-harm after exposure to peer self-harm.

CONCLUSION

Our findings support social influences on self-harm in a sample of young adults, regardless of their individual degree of suggestibility.

Prevalence of mental disorders among Norwegian college and university students: a population-based cross-sectional analysis

Background

Self-report data indicate a sharp increase in mental health problems among college and university students in recent years, but accurate prevalence estimates of mental disorders are lacking. The current study used a validated psychiatric diagnostic survey, developed into a self-administered electronic version, to examine the prevalence of common mental disorders in a large national sample of college and university students in Norway.

Methods

Participants (aged 18-35 years) from the national Students' Health and Wellbeing (SHOT) Study in 2022 were recruited to a follow-up online survey of mental disorders from January to February 2023 (n = 10,460). Current (30-days), 12-months and lifetime prevalence of common mental disorders were examined using a newly developed self-administered electronic version of the Composite International Diagnostic Interview (CIDI 5.0).

Findings

The prevalence of a current mental disorder was high for both women (39.7% [2737/6886], 95% CI 38.6-40.9) and men (25.7% [751/2918], 95% CI 24.2-27.4). The most common disorders were major depressive episode (females 17.1% [1250/7329] and males 10.8% [331/3059]) and generalized anxiety disorder (females 16.0% [1157/7221] and males 8.2% [250/3032]), while 5.6% [387/6948] and 7.7% [228/2963] of the females and male students, respectively, fulfilled the criteria for an alcohol use disorder. The prevalence estimates for 12-month and lifetime were, as expected, even higher.

Interpretation

The findings suggest an alarmingly high prevalence of several mental disorders among Norwegian college and university students. Implications and potential methodological and contextual explanations of these findings are discussed.

Funding

Norwegian Ministry of Education and Research.

Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data

BACKGROUND

There is an increasing demand for mental health services for young people, which may vary across the year.

OBJECTIVE

To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.

METHODS

This cohort study used anonymised electronic health records from general practices in England contributing to QResearch. It included 5 081 263 males and females aged 14-18 (adolescents), 19-23 and 24-28 years between 2006 and 2019. The incidence rates per 1000 person-years and the incidence rate ratios (IRRs) were calculated for the first records of a selective serotonin reuptake inhibitor (SSRI) prescription, depression, anxiety and self-harm. The IRRs were adjusted for year, region, deprivation, ethnic group and number of working days.

FINDINGS

There was an increase in SSRI prescribing, depression and anxiety incidence in male and female adolescents in the autumn months (September-November) that was not seen in older age groups. The IRRs for SSRI prescribing for adolescents peaked in November (females: 1.75, 95% CI 1.67 to 1.83, p<0.001; males: 1.72, 95% CI 1.61 to 1.84, p<0.001, vs in January) and for depression (females: 1.29, 95% CI 1.25 to 1.33, p<0.001; males: 1.29, 95% CI 1.23 to 1.35, p<0.001). Anxiety peaked in November for females aged 14-18 years (1.17, 95% CI 1.13 to 1.22, p<0.001) and in September for males (1.19, 95% CI 1.12 to 1.27, p<0.001).

CONCLUSIONS

There were higher rates of antidepressant prescribing and consultations for depression and anxiety at the start of the school year among adolescents.

CLINICAL IMPLICATIONS

Support around mental health issues from general practitioners and others should be focused during autumn.

School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need

Background

The Covid-19 pandemic has brought into sharp focus a school attendance crisis in many countries, although this likely pre-dates the pandemic. Children and young people (CYP) struggling to attend school often display extreme emotional distress before/during/after school. We term this School Distress. Here we sought to elucidate the characteristics of the CYP struggling to attend school in the United Kingdom.

Methods

Using a case-control, concurrent embedded mixed-method research design, 947 parents of CYP with experience of School Distress completed a bespoke online questionnaire (February/March 2022), alongside an age-matched control group (n = 149) and a smaller group of parents who electively home-educate (n = 25).

Results

In 94.3% of cases, school attendance problems were underpinned by significant emotional distress, with often harrowing accounts of this distress provided by parents. While the mean age of the CYP in this sample was 11.6 years (StDev 3.1 years), their School Distress was evident to parents from a much younger age (7.9 years). Notably, 92.1% of CYP currently experiencing School Distress were described as neurodivergent (ND) and 83.4% as autistic. The Odds Ratio of autistic CYP experiencing School Distress was 46.61 [95% CI (24.67, 88.07)]. Autistic CYP displayed School Distress at a significantly earlier age, and it was significantly more enduring. Multi-modal sensory processing difficulties and ADHD (among other neurodivergent conditions) were also commonly associated with School Distress; with School Distress CYP having an average of 3.62 NDs (StDev 2.68). In addition, clinically significant anxiety symptomology (92.5%) and elevated demand avoidance were also pervasive. Mental health difficulties in the absence of a neurodivergent profile were, however, relatively rare (6.17%). Concerningly, despite the striking levels of emotional distress and disability reported by parents, parents also reported a dearth of meaningful support for their CYP at school.

Conclusion

While not a story of exclusivity relating solely to autism, School Distress is a story dominated by complex neurodivergence and a seemingly systemic failure to meet the needs of these CYP. Given the disproportionate number of disabled CYP impacted, we ask whether the United Kingdom is upholding its responsibility to ensure the "right to an education" for all CYP (Human Rights Act 1998).

Electronic health records identify timely trends in childhood mental health conditions

BACKGROUND

Electronic health records (EHRs) data provide an opportunity to collect patient information rapidly, efficiently and at scale. National collaborative research networks, such as PEDSnet, aggregate EHRs data across institutions, enabling rapid identification of pediatric disease cohorts and generating new knowledge for medical conditions. To date, aggregation of EHR data has had limited applications in advancing our understanding of mental health (MH) conditions, in part due to the limited research in clinical informatics, necessary for the translation of EHR data to child mental health research.

METHODS

In this cohort study, a comprehensive EHR-based typology was developed by an interdisciplinary team, with expertise in informatics and child and adolescent psychiatry, to query aggregated, standardized EHR data for the full spectrum of MH conditions (disorders/symptoms and exposure to adverse childhood experiences (ACEs), across 13 years (2010-2023), from 9 PEDSnet centers. Patients with and without MH disorders/symptoms (without ACEs), were compared by age, gender, race/ethnicity, insurance, and chronic physical conditions. Patients with ACEs alone were compared with those that also had MH disorders/symptoms. Prevalence estimates for patients with 1+ disorder/symptoms and for specific disorders/symptoms and exposure to ACEs were calculated, as well as risk for developing MH disorder/symptoms.

RESULTS

The EHR study data set included 7,852,081 patients < 21 years of age, of which 52.1% were male. Of this group, 1,552,726 (19.8%), without exposure to ACEs, had a lifetime MH disorders/symptoms, 56.5% being male. Annual prevalence estimates of MH disorders/symptoms (without exposure to ACEs) rose from 10.6% to 2010 to 15.1% in 2023, a 44% relative increase, peaking to 15.4% in 2019, prior to the Covid-19 pandemic. MH categories with the largest increases between 2010 and 2023 were exposure to ACEs (1.7, 95% CI 1.6-1.8), anxiety disorders (2.8, 95% CI 2.8-2.9), eating/feeding disorders (2.1, 95% CI 2.1-2.2), gender dysphoria/sexual dysfunction (43.6, 95% CI 35.8-53.0), and intentional self-harm/suicidality (3.3, 95% CI 3.2-3.5). White youths had the highest rates in most categories, except for disruptive behavior disorders, elimination disorders, psychotic disorders, and standalone symptoms which Black youths had higher rates. Median age of detection was 8.1 years (IQR 3.5-13.5) with all standalone symptoms recorded earlier than the corresponding MH disorder categories.

CONCLUSIONS

These results support EHRs' capability in capturing the full spectrum of MH disorders/symptoms and exposure to ACEs, identifying the proportion of patients and groups at risk, and detecting trends throughout a 13-year period that included the Covid-19 pandemic. Standardized EHR data, which capture MH conditions is critical for health systems to examine past and current trends for future surveillance. Our publicly available EHR-mental health typology codes can be used in other studies to further advance research in this area.

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys

BACKGROUND

Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends.

METHODS

We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010.

RESULTS

Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall.

CONCLUSION

Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.

Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study

BACKGROUND

Self-harm and eating disorders share multiple risk factors, with onset typically during adolescence or early adulthood. We aimed to examine the incidence rates of these psychopathologies among young people in the UK in the 2 years following onset of the COVID-19 pandemic.

METHODS

We conducted a population-based study using the primary care electronic health records of patients aged 10-24 years in the UK Clinical Practice Research Datalink (CPRD). The observation period was from Jan 1, 2010, to March 31, 2022. We calculated the monthly incidence rates of eating disorders and self-harm according to the first record of each outcome. On the basis of antecedent trends between January, 2010, and February, 2020, negative binomial regression models were fitted to predict monthly incidence rates after the pandemic began in March, 2020. Percentage differences between observed and expected incidence were calculated to indicate changes since the onset of the pandemic, with stratification by sex, age, and deprivation quintile.

FINDINGS

The primary care health records of 9 184 712 patients aged 10-24 years (4 836 226 [52·7%] female patients and 4 348 486 [47·3%] male patients; n=1881 general practices) were included for analysis. The incidence rates of eating disorders and self-harm among girls were higher than expected between March 1, 2020, and March 31, 2022. The observed incidence of eating disorders was 42·4% (95% CI 25·7-61·3) higher than expected for girls aged 13-16 years, and 32·0% (13·3-53·8) higher than expected for girls aged 17-19 years, whereas other age groups showed little difference between observed and expected incidence. Similarly, the increase in self-harm incidence was driven by girls aged 13-16 years, for whom the observed incidence was 38·4% (20·7-58·5) higher than expected. By contrast, among boys in all age groups, the incidence rates of eating disorders and self-harm were lower than, or close to, the expected rates. Among boys, the observed incidence of eating disorders was 22·8% (9·2-34·4) lower than expected, and the observed incidence of self-harm was 11·5% (3·6-18·7) lower than expected. The estimated increases in eating disorder and self-harm incidence among girls aged 13-16 years were largely attributable to increases within less deprived communities.

INTERPRETATION

Although causes are uncertain, increased incidence of eating disorder diagnoses and self-harm among teenage girls in the UK during the first 2 years of the COVID-19 pandemic highlight an urgent need for intervention. Early identification of mental health difficulties by primary care clinicians is necessary. Timely access to treatments and sufficient support from general practitioners and mental health services needs to be available to manage presenting problems and to prevent exacerbations of conditions.

FUNDING

National Institute for Health and Care Research.

Risk of type 2 diabetes mellitus between adolescents with antidepressant-resistant and antidepressant-responsive depression: A cohort study of 15,651 adolescents

BACKGROUND

Whether response to antidepressants is related to the risk of developing type 2 diabetes mellitus (T2DM) in adolescents with depression remains unknown.

METHODS

This study used the Taiwan National Health Insurance Research Database to enroll 1739 adolescents with antidepressant-resistant depression, 6956 with antidepressant-responsive depression, and 6956 controls between 2001 and 2010, with an end-of-2011 follow-up. Physician-diagnosed T2DM was identified at follow-up. T2DM-related risk factors, namely hypertension, dyslipidemia, and obesity, were assessed and controlled for as confounding factors.

RESULTS

Adolescents with antidepressant-resistant depression (hazard ratio [HR], 95 % confidence interval [CI]: 4.62, 2.75-7.75) and those with antidepressant-responsive depression (HR, 95 % CI: 3.06, 1.98-4.72) had a higher risk of developing T2DM at follow-up than did the control group. Those with antidepressant-resistant depression were more likely to receive a diagnosis of T2DM (HR, 95 % CI: 1.51, 1.04-2.19) later in life than were those with antidepressant-responsive depression.

DISCUSSION

Clinicians should closely monitor factors related to T2DM, such as fasting blood sugar, in high-risk populations, especially in adolescents with antidepressant-resistant depression.

Incidence and associations of hospital delirium diagnoses in 85,979 people with severe mental illness: A data linkage study

INTRODUCTION

Delirium is an acute neuro-psychiatric disturbance precipitated by a range of physical stressors, with high morbidity and mortality. Little is known about its relationship with severe mental illness (SMI).

METHODS

We conducted a retrospective cohort study using linked data analyses of the UK Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. We ascertained yearly hospital delirium incidence from 2000 to 2017 and used logistic regression to identify associations with delirium diagnosis in a population with SMI.

RESULTS

The cohort included 249,047 people with SMI with median follow-up time in CPRD of 6.4 years. A total of 85,979 patients were eligible for linkage to HES. Delirium incidence increased from 0.04 (95% CI 0.02-0.07) delirium associated admissions per 100 person-years in 2000 to 1.05 (95% CI 0.93-1.17) per 100 person-years in 2017, increasing most notably from 2010 onwards. Delirium was associated with older age at study entry (OR 1.05 per year, 95% CI 1.05-1.06), SMI diagnosis of bipolar affective disorder (OR 1.66, 95% CI 1.44-1.93) or other psychosis (OR 1.56, 95% CI 1.35-1.80) relative to schizophrenia, and more physical comorbidities (OR 1.08 per additional comorbidity of the Charlson Comorbidity Index, 95% CI 1.02-1.14). Patients with delirium received more antipsychotic medication during follow-up (1-2 antipsychotics OR 1.65, 95% CI 1.44-1.90; >2 antipsychotics OR 2.49, 95% CI 2.12-2.92).

CONCLUSIONS

The incidence of recorded delirium diagnoses in people with SMI has increased in recent years. Older people prescribed more antipsychotics and with more comorbidities have a higher incidence. Linked electronic health records are feasible for exploring hospital diagnoses such as delirium in SMI.

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

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