Adverse childhood experiences (ACEs) are increasingly recognised as key determinants of self-harm among adolescents, particularly within psychiatric and mental health service settings in Malaysia, where coping resources may shape vulnerability and resilience. A cross-sectional study was conducted among adolescents referred to psychiatry and mental health services in Malaysia. Of 1244 eligible patients aged 10-24 years, 1164 completed a clinician-administered, interviewer-guided questionnaire. Self-harm status was assessed in clinical care and was compared across ACE burden, individual ACE domains and coping-related protective factors through a clinician-led interview. Multivariable logistic regression was used to examine adjusted associations with self-harm. Among 1164 participants, 827 (71.0%) reported lifetime self-harm. In adjusted analyses, a greater burden of ACEs was strongly associated with higher odds of self-harm. Compared with participants with no ACE exposure, the odds increased in a dose-response manner, from an adjusted OR (aOR) of 2.54 (95% CI 1.27 to 5.20) among those with 2-3 ACEs to 6.14 (95% CI 3.13 to 12.40) among those with ≥4 ACEs. Several coping-related factors were associated with lower odds of self-harm, including the ability to cope with stress (aOR 0.32, 95% CI 0.23 to 0.45), a sense of responsibility towards children, loved ones or pets (aOR 0.71, 95% CI 0.51 to 0.98) and perceived social support (aOR 0.63, 95% CI 0.40 to 0.97). In secondary analyses of individual ACE components, violence against household members, emotional abuse, sexual abuse, bullying and witnessing community violence were independently associated with higher odds of self-harm. This study showed high prevalence of self-harm among adolescents attending the psychiatric and mental health services. A greater cumulative burden of ACEs was associated with increased odds of self-harm, whereas protective factors including effective stress coping, a sense of responsibility towards loved ones or pets and social support were associated with reduced odds. These findings emphasised the importance of trauma-informed assessment and interventions that enhance coping capacities and social connectedness among young people presenting to mental health services.
Background: The full invasion of Ukraine by Russia in 2022 has created a situation of sustained stress for the Ukrainian population. Initial surveys indicate that Ukrainians have experienced elevated rates of anxiety, depression, and posttraumatic stress disorder (PTSD) since the onset of the war. Most research has focused on adults and there is relatively less study on children and adolescent mental health. Research that has been conducted is limited by (a) predominant reliance on parent reports of children's mental health, (b) biased sampling, (c) lack of integrated child and caregiver reports, and (d) cross-sectional designs.Method: The Ukrainian Families Navigating Insecurity, Trauma, and Yielding Strength (UNITY) initiative is a nationally-representative longitudinal cohort study of mental health in Ukrainian children aged 8-16 years. Children (N = 3,000) will be recruited via schools from 22 oblasts across Ukraine. Sampling will be stratified from regions with high, medium, and low exposure to Russian attacks during the war. Recruitment will be stratified according to 8-12 and 13-16 years of age (on a 1:1 basis), gender of children (1:1), and urban vs. rural region (1:1). One caregiver of the child participant will also be assessed. Children will be assessed for anxiety, depression, PTSD, prolonged grief, externalizing problems, suicidality, positive affect, social and family support, posttraumatic cognitions, somatic symptoms, functioning, and posttraumatic growth. Caregivers will be assessed for family exposure to traumatic events, psychological distress, prolonged grief, psychological wellbeing, parenting practices, hope, and positive affect. The UNITY study will initially be conducted over three waves, with the expectation of ongoing collection following the war. The protocol was pre-registered at https://archive.org/details/osf-registrations-n62gy-v1.Discussion: The UNITY study will provide much-needed evidence regarding the mental health needs of young Ukrainians and their families, and the factors that moderate psychological adjustment during and after the war. The war in Ukraine has placed enormous psychological strain on young Ukrainians.The UNITY study is a longitudinal survey of mental health in children and their caregivers.This study will yield longitudinal evaluations of children’s and caregivers over multiple waves. Antecedentes: La invasión a gran escala de Ucrania por parte de Rusia en 2022 ha generado una situación de estrés sostenido para la población ucraniana. Los estudios iniciales indican que los ucranianos han experimentado tasas elevadas de ansiedad, depresión y trastorno de estrés postraumático (TEPT) desde el inicio de la guerra. La mayoría de las investigaciones se han centrado en adultos, y existen relativamente menos estudios sobre la salud mental de niños y adolescentes. Las investigaciones realizadas presentan limitaciones debido a (a) la dependencia predominante de los reportes de los padres sobre la salud mental de sus hijos; (b) el sesgo en el muestreo; (c) la falta de reportes integrados de niños y cuidadores; y (d) el uso de diseños transversales. Método: La iniciativa Ukrainian Families Navigating Insecurity, Trauma, and Yielding Strength (UNITY) es un estudio de cohorte longitudinal representativo a nivel nacional sobre la salud mental de niños ucranianos de entre 8 y 16 años. Los niños (N = 3.000) serán reclutados a través de escuelas de 22 provincias de Ucrania. El muestreo se estratificará según regiones con alta, media y baja exposición a los ataques rusos durante la guerra. El reclutamiento se estratificará según grupo etario (8–12 y 13–16 años, en una proporción de 1:1), el género de los niños (1:1) y la región de procedencia urbana o rural (1:1). También se evaluará a un cuidador de cada niño participante. Los niños serán evaluados en cuanto a ansiedad, depresión, TEPT, duelo prolongado, problemas de externalización, suicidalidad, afecto positivo, apoyo social y familiar, cogniciones postraumáticas, síntomas somáticos, funcionamiento y crecimiento postraumático. Los cuidadores serán evaluados respecto de exposición familiar a eventos traumáticos, malestar psicológico, duelo prolongado, bienestar psicológico, prácticas de crianza, esperanza y afecto positivo. El estudio UNITY se llevará a cabo inicialmente en tres fases, con la expectativa de continuar la recolección de datos tras la guerra. Discusión: El estudio UNITY proporcionará evidencia muy necesaria sobre las necesidades de salud mental de los jóvenes ucranianos y sus familias, y sobre los factores que influyen en la adaptación psicológica durante y después de la guerra.
Childhood trauma is a public health challenge, and low-threshold interventions are important to prevent long-term problems. A stepped care approach is recommended so the intensity of care can be adjusted according to the child's needs. This approach requires coordination and collaboration between service levels. However, interagency collaboration can be challenging. The aim of the NorStep Collaborate study is to develop and evaluate a model for collaboration between the primary and secondary mental healthcare levels in Norway. NorStep Collaborate is part of an ongoing randomised controlled trial investigating the effectiveness of a low-threshold, parent-led trauma treatment provided in the primary care level services. Children in need of more therapist-intensive treatment will be stepped up to the secondary care level. NorStep Collaborate is based on principles of participatory action research, and the collaboration model will be developed together with stakeholders from six primary level services and four secondary level services. In phase I, the model will be developed. Stakeholders will participate in focus group interviews and full-day dialogue conferences to suggest and discuss routines for collaboration and a suggested collaboration model will be refined through feedback meetings. In phases II and III, the co-created model will be implemented and tested for 1 year, and therapists, leaders, children and parents will be interviewed about their experiences with the collaboration and transfer between the primary and secondary care level. Interviews will be analysed with thematic analyses. In phase IV, results of the evaluation will be shared, and final adjustments made if necessary. The study has been evaluated by the Norwegian Agency for Shared Services in Education and Research (SIKT, reference number 161459) and is approved by the data protection officer at Norwegian Centre for Violence and Traumatic Stress Studies, Norway. Participants will be provided with written information about the study, and participation is voluntary, based on verbal consent and assent. The findings will be presented to the Norwegian Ministry of Health and Care, all participating services and the professional public via conferences, and in international and Norwegian peer-reviewed publications.
Digital media literacy (DML) may help adolescents to handle online risks, misinformation, digital violence, and problematic media use more reflectively. However, structured interventions for adolescents in child and adolescent psychiatry (CAP), particularly in inpatient and day-treatment settings, remain scarce. This study evaluated the feasibility, acceptability, and perceived usefulness of a manualized DML group for adolescents in CAP and explored preliminary changes in digital self-efficacy and critical media literacy (CML). A prospective single-arm feasibility study with an embedded pretest-posttest and session-level process evaluation was conducted across 3 CAP clinics in Germany. The intervention comprised 6 weekly 60-minute, manualized modules covering data protection, social media use, and digital violence. Sessions were delivered in an open-group format by trained clinical staff. Recruitment was embedded in routine care, and clinical group participation was independent of study evaluation. Adolescents and facilitators completed paper-and-pencil questionnaires at baseline (T1), after each session, and post intervention or discharge (T2). Analyses were primarily descriptive; exploratory pre-post analyses used paired t tests. The analytic feasibility sample comprised 121 adolescents who attended at least 1 module. T1 data were available for n=60 and T2 data for n=38. Overall, adolescents attended a median of 2 modules (IQR 1-3; mean 2.46, SD 1.65, range 1-6), and 45 attended at least 3 modules. Session-level ratings indicated moderate to high acceptability. Facilitator-rated manual fidelity was moderate to high. Retrospective T2 ratings indicated moderate to high helpfulness (n=38; mean 3.55, SD 1.18; median 4.0, IQR 3.0-4.0) and satisfaction (n=38; mean 3.79, SD 1.07; median 4.0, IQR 3.0-5.0), with no significant differences between completers and noncompleters for helpfulness (U=125.00; P=.60) or satisfaction (U=122.00; P=.53). Among completers (≥3 modules and T2 data; n=28), didactic method acceptability was moderate (mean 2.85, SD 0.60), and perceived learning was moderate to high (mean 3.33, SD 0.95). Exploratory pre-post analyses indicated an increase in perceived self-efficacy for recognizing misinformation (n=21; T1 mean 2.94, SD 0.59; T2 mean 3.38, SD 0.63; t20=2.58; Hedges g=0.56, 95% CI 0.09-1.02; P=.02). Overall CML increased descriptively (P=.07), whereas digital media self-efficacy did not change significantly (P=.27). Our manualized DML group was feasible and acceptable in routine CAP. Open-group delivery and variable treatment stays limited intervention exposure and data completeness. Findings suggest that brief DML groups may address safety- and knowledge-oriented competencies, but controlled mixed methods studies with systematic recruitment and missing-data documentation are needed.
Early childhood is a sensitive developmental period for the acquisition of cognitive and socio-emotional skills that are strongly associated with later mental health, academic achievement, and social functioning. Children growing up in socioeconomically disadvantaged contexts are at increased risk for early emotional and behavioral difficulties, highlighting the need for accessible, scalable, and developmentally appropriate preventive interventions. Japi 2.0 is a tablet-based gaming platform designed to stimulate six interrelated cognitive and socio-emotional skills-working memory, inhibitory control, emotion recognition, social competence, empathy, and cognitive planning-through structured play in preschool settings. We conducted a pilot cluster randomized controlled trial in low-income preschools in Santiago, Chile. Schools were randomized to either the Japi 2.0 intervention or treatment as usual. The intervention consisted of 24 individual sessions delivered over 12 weeks during regular class hours. Primary outcomes were acceptability (perceived by children, early years educators, and parents) and feasibility (recruitment, retention, attendance, intervention delivery, and data completeness). Secondary outcomes explored preliminary changes in cognitive, socio-emotional, and behavioral functioning using standardized assessments and parent- and teacher-reported measures. Exploratory analyses were conducted using multilevel models adjusted for baseline scores and clustering, based on available outcome data from randomized participants. Japi 2.0 showed high acceptability across stakeholders. Educators and parents reported that the game and the accompanying web-based dashboard were engaging, age-appropriate, easy to use, and pedagogically relevant. Children reported high levels of enjoyment and positive emotional experiences during gameplay. Feasibility indicators were satisfactory: most planned sessions were delivered as scheduled, attendance was high, and outcome data completeness was adequate. Exploratory analyses indicated improvements over time in both groups across most outcomes. Preliminary exploratory signals favoring the intervention were observed for empathy and parent-reported emotional and behavioral difficulties; however, these findings should be interpreted cautiously given the small number of clusters and exploratory nature of the analyses. This pilot trial demonstrates that Japi 2.0 is a feasible and highly acceptable digital intervention for preschool children in low-income educational settings. Although efficacy findings are preliminary, results support progression to a fully powered randomized controlled trial to evaluate effectiveness and longer-term impacts on cognitive, socio-emotional, and behavioral development. Trial registration Clinical Trials NCT06420544, May 20th, 2024. https://www. gov/study/ NCT06420544.
Over the last two decades, increases in adolescent mental health difficulties have been recorded alongside a rapid expansion in social media use. In response to these trends, on 10 December 2025, the Australian government implemented Social Media Minimum Age legislation prohibiting Australians under the age of 16 years from having social media accounts. The introduction of this legislation allows for a unique quasi-experimental investigation of the impact of social media use on adolescent mental health and the mechanisms through which social media may impact young Australian adolescents' mental health, well-being and cognition. To assess the relationship between social media use and young adolescents' mental health, well-being and cognition, a longitudinal mixed-methods approach will be taken. 422 young people (aged 10-15 years) and parent/carer dyads were recruited and invited to complete a baseline assessment before the implementation of the Social Media Minimum Age legislation (October-December 2025). Three follow-up assessments will then be completed after 6 (April-May 2026), 12 (October-November 2026) and 18 months (April-May 2027). Data from parent/carer and adolescent surveys, ecological momentary assessments (EMAs), cognitive tasks and smartphone-recorded screenshots of social media and messaging app use across each of these timepoints will be analysed. Linear regression analyses will be used to assess correlational relationships between social media experiences and responses and mental health outcomes as well as how individual factors moderate these relationships. To assess these relationships over time and between momentary experiences and responses (EMA data) and more stable trait-based (individual) and environmental (parenting and government restrictions) factors, we will use linear mixed-effects models and mixed-effects segmented regression. This study has been approved by the UNSW Human Research Ethics Committee (iRECS 9197). Findings from this study will help identify potential opportunities for interventions at individual, micro (parental) and macro (governmental) levels to mitigate any negative impacts of social media for younger adolescents. Results will be disseminated through peer-reviewed publications, conference presentations, public engagement opportunities and researcher-associated websites. After each assessment timepoint, core findings will also be distilled into engaging formats such as infographics and videos, which will be shared with young people and their parent/carer.
Background: Early identification of posttraumatic symptoms in children and adolescents is essential for timely intervention. The Child and Adolescent Trauma Screen-2 (CATS-2) is a brief, freely accessible instrument that simultaneously assesses DSM-5 PTSD, ICD-11 PTSD, and ICD-11 complex PTSD (CPTSD) symptoms across child and caregiver report forms. Cross-cultural validation of the CATS-2 in underrepresented settings remains limited. This study examined the psychometric properties of the Turkish CATS-2 in a clinical sample.Method: Participants were 196 children and adolescents referred to a child and adolescent psychiatry outpatient clinic. ICD-11 PTSD and CPTSD diagnoses were established through clinician-administered assessments. Internal consistency, test-retest reliability, convergent and discriminant validity, child-caregiver agreement, confirmatory factor analysis (CFA), known-groups validity, and diagnostic accuracy were examined.Results: The CATS-2C showed good to excellent internal consistency (α=.81-.94) and test-retest reliability (ICC = .86-.90). CFA supported a two-factor correlated model of ICD-11 PTSD and disturbances in self-organization (DSO), and the DSM-5 four-factor model, for both forms. The CATS-2C showed strong convergent validity (r = .79-.89) and negligible associations with externalizing symptoms (r = .08-.12, ns). Known-groups validity was excellent for the CATS-2C (η² = .48-.58) but limited for the CATS-2P (η² = .076-.119). Diagnostic accuracy was good to excellent for the CATS-2C (AUC = .868-.947) and poor to acceptable for the CATS-2P (AUC = .606-.735), all subscales significant. Optimal CATS-2C cut-offs against clinician ICD-11 diagnoses were ≥7 for ICD-11 PTSD (sensitivity = 84%, specificity = 78%), ≥17 for ICD-11 CPTSD (93%, 85%), and ≥30 for DSM-5 PTSD (85%, 89%). Child-caregiver agreement was poor (ICC = .259-.344).Conclusions: The Turkish CATS-2C demonstrated sound psychometric properties, supporting its use as a reliable screening tool in child and adolescent mental health settings. The CATS-2P showed acceptable structural validity and internal consistency but more limited diagnostic discrimination, underscoring the importance of directly assessing symptoms from the child. These findings contribute preliminary evidence regarding ICD-11 PTSD and CPTSD constructs in an underrepresented, middle-income clinical setting.Trial registration: ClinicalTrials.gov identifier: NCT06975852. CATS-2 child report showed strong psychometrics across ICD-11 and DSM-5.CATS-2 caregiver report showed valid structure, weaker discrimination.ICD-11 PTSD/CPTSD cut-offs were derived against clinician diagnosis.Findings support ICD-11 PTSD/CPTSD use in a middle-income setting.
Background: Childhood maltreatment (CM) is a major risk factor for different mental disorders and transdiagnostic mechanisms, including emotion dysregulation. Progress in the field has been constrained by substantial variability in the measurement of CM across studies.Objective: We aimed to examine the associations among three common retrospective measures of CM and their relationship with emotion dysregulation in a transdiagnostic adult sample, with a focus on exploring the significance of sensitive developmental periods.Method: In our cross-sectional study, we collected data from N = 462 participants with and without different mental disorders. We assessed facets of CM using two questionnaires and one in-person interview, specifically the Childhood Trauma Questionnaire - Short Form (CTQ-SF), the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and the brief German interview version of the Maltreatment and Abuse Chronology of Exposure scale (MACE), the KERF-40+. We measured emotion dysregulation in a subsample of n = 244 participants using the Difficulties in Emotion Regulation Scale (DERS). We analysed data applying correlational analyses and machine-learning-based conditional random forest regression.Results: In our transdiagnostic sample, global scores (including sum, multiplicity, and duration scores) and subscale scores of the CTQ-SF, CECA.Q, and KERF-40+ were highly intercorrelated. Both global scores of the CTQ-SF and KERF-40+, and emotional CM scores of the CTQ-SF, CECA.Q, and KERF-40+ showed significant associations with the DERS total score. Regarding sensitive developmental periods, exposure to parental emotional abuse, emotional neglect, and emotional and physical abuse by peers - particularly during the ages 12-17 - was significantly associated with the DERS total score.Conclusions: Despite substantial differences in the facets of CM assessed, the CTQ-SF, CECA.Q, and KERF-40+ demonstrate high convergent validity. While CTQ-SF and CECA.Q allow for a more efficient assessment of CM experiences, the KERF-40+ offers added value for developmentally sensitive analyses of adult emotion dysregulation. Strong convergence across widely used retrospective childhood maltreatment measures (i.e. CTQ-SF, CECA.Q, KERF-40+) in a transdiagnostic adult sample.Self-reported emotional maltreatment by parents and peers, especially during early to mid-adolescence, is associated with self-reported adult emotion dysregulation.CTQ-SF and CECA.Q offer efficient childhood maltreatment assessments, while KERF-40+ adds clear value for a developmentally sensitive understanding of adult emotion dysregulation. Antecedentes: El maltrato infantil (MI) es un importante factor de riesgo para diversos trastornos mentales y mecanismos transdiagnósticos, incluida la desregulación emocional. El avance en este campo se ha visto limitado por la considerable variabilidad en la medición del MI entre estudios. Objetivo: Nuestro objetivo fue examinar las asociaciones entre tres medidas retrospectivas comunes del MI y su relación con la desregulación emocional en una muestra transdiagnóstica de adultos, con especial atención a la exploración de la importancia de los periodos sensibles del desarrollo. Método: En nuestro estudio transversal, recopilamos datos de N = 462 participantes con y sin distintos trastornos mentales. Evaluamos facetas del MI mediante dos cuestionarios y una entrevista presencial, concretamente la Escala de Acontecimientos Traumáticos en la Infancia (Childhood Trauma Questionnaire – Short Form [CTQ-SF]), el Cuestionario de Experiencias Infantiles de Cuidado y Abuso (CECA.Q por sus siglas en ingles) y la versión breve alemana en formato de entrevista de la Escala de Cronología de la Exposición al Maltrato y Abuso (MACE por sus siglas en ingles), la KERF-40+. Medimos la desregulación emocional en una submuestra de n = 244 participantes utilizando la Escala de Dificultades en la Regulación Emocional (DERS). Analizamos los datos mediante análisis correlacionales y regresión de bosques aleatorios condicionales basada en aprendizaje automático. Resultados: En nuestra muestra transdiagnóstica, las puntuaciones globales – incluidas las puntuaciones de suma, multiplicidad y duración – y las puntuaciones de las subescalas del CTQ-SF, el CECA.Q y la KERF-40+ estuvieron altamente intercorrelacionadas. Tanto las puntuaciones globales del CTQ-SF y la KERF-40+ como las puntuaciones de MI emocional del CTQ-SF, el CECA.Q y la KERF-40+ mostraron asociaciones significativas con la puntuación total de la DERS. En cuanto a los periodos sensibles del desarrollo, la exposición al abuso emocional parental, la negligencia emocional y el abuso emocional y físico por parte de iguales – especialmente entre los 12 y los 17 años – se asoció significativamente con la puntuación total de la DERS. Conclusiones: A pesar de las diferencias sustanciales en las facetas del MI evaluadas, el CTQ-SF, el CECA.Q y la KERF-40+ muestran una elevada validez convergente. Aunque el CTQ-SF y el CECA.Q permiten una evaluación más eficiente de las experiencias de MI, la KERF-40+ aporta un valor añadido para los análisis de la desregulación emocional en adultos que tienen en cuenta el desarrollo.
The burden of mental health problems remains largely unexplored among vulnerable young people, especially those seeking peer support. Accessing peer support is often a first form of help-seeking, allowing early identification of signs of distress. The lost (mental) health and expenses of these young people upon presenting for peer support can be revealed through monitoring of health-related quality of life (HRQoL) and costs of mental healthcare and productivity loss, examined in this study among young people visiting the @ease peer-to-peer walk-in centres in the Netherlands. From @ease's inception in January 2018 to mid-2024, a total of 940 answered questionnaires gathered through consecutive sampling contained minimally one required item. This bottom-up prevalence-based study focused on youth aged 12-30 who sought peer counselling at @ease. Burden of disease was estimated by: (1) HRQoL (EQ-5D-5L), and (2) Cost-of-illness through school absenteeism and mental healthcare use. Multiple imputation was used before conducting regression analyses, followed by non-parametric bootstrapping. This study expands upon an earlier publication that analysed data up to May 2019. HRQoL was impaired (M = 0.64, SD = 0.24) and significantly lower if living alone or having parents with mental health problems, and higher if having a higher level of social and occupational functioning. In the three months before presenting, 35.2% of young people had been absent from school (3 days on average, costing €358 per individual) and 33.4% had visited mental healthcare (2 visits on average, costing €234 per individual). Total cost-of-illness was €1,501,743 annually, and €2,318 per individual. Mental healthcare costs were higher for those born in the Netherlands and without occupation, and school absenteeism costs were higher outside the COVID-19 pandemic and if not born in the Netherlands. Found impairments and costs underscore the importance of investing in early-stage low-threshold services where substantial burden is already detectable, and of strengthening their capacity and links to stepped-care pathways to ensure timely support. Initiatives that help improve functioning and aid with challenging contexts may be advantageous in lowering the burden. Prospective (cost-)effectiveness studies are needed.
Children and adolescents admitted to psychiatric inpatient units may be subjected to restrictive practices. Such practices can have significant psychological and physical consequences for the young inpatients, as well as for their relatives and the staff involved. Despite this, experiences of restrictive practices remain underreported particularly regarding the mechanisms that sustain their continued use, even in the face of international and national regulations aimed at reducing restrictiveness. A deeper understanding of these mechanisms can help nuance clinical decision-making and illuminate the complex relationships between staff, children, and relatives. This integrative review aims to provide such insights through a systematic literature search that includes both peer-reviewed and grey literature across quantitative and qualitative studies. The included papers were assessed using JBI and GRADE-CERQual and findings were analyzed using Systematic Text Condensation showing that restrictive practices persist not only due to acute crises but through intertwined mechanisms: their ethical justification in care, their institutional and legal normalization, and their embeddedness in everyday ward culture. Children and adolescents, relatives, and staff each shape how safety and responsibility are understood, reinforcing restrictive practices in different ways. These findings point to the need for strategies extending beyond regulation toward cultural and relational approaches that promote emotional safety, agency, and recovery-even when restrictive practices remain necessary. The review was preregistered at PROSPERO (CRD420251032437).
Bullying poses a major risk for poor mental health. While findings from the general population highlight harmful effects of bullying, data from clinical samples with diverse diagnoses and evidence-based diagnostic methods is rare. This study aimed at exploring the association between psychopathology and active bullying involvement in child and adolescent psychotherapy outpatients. The preregistered study ( https://aspredicted.org/VYW_9TT ) included data from N = 719 outpatients aged 6-20 years from a German child and adolescent psychotherapy centre. Current experiences as a victim, bully-victim, or bully and distressing bullying-specific intrusions were assessed with a screening instrument. Gold-standard diagnostic assessment of psychopathology provided categorial ICD-10 diagnoses. The Strength and Difficulties Questionnaire depicted a dimensional proxy measure of psychopathology. Analyses included examining the frequencies of the bullying roles (victim, bully-victim, bully) and the occurrence of distressing bullying-specific intrusions, Pearson's chi-square tests for gender-specific differences, binary logistic regression analyses testing the bullying roles as predictors of ICD-10 diagnoses, and multiple one-way ANOVAs examining group differences on the Strength and Difficulties Questionnaire scores between the bullying roles. 29% of all outpatients reported to be actively involved in bullying (22% victims, 5% bully-victims, 2% bullies), with 32% frequently experiencing distressing bullying-specific intrusions. While victims were more likely to have mood disorders (ICD-10 F3 disorders), bully-victims were less likely to have internalising and more likely to have externalising disorders and behavioural and emotional disorders with onset usually occurring in childhood and adolescence (ICD-10 F9 disorders). Bullies were more likely to have multiple disorders but less likely to have internalising disorders. Independent from specific diagnoses, victims, bully-victims, and bullies overall reported greater emotional and behavioural difficulties than outpatients without bullying experiences. Among outpatients in child and adolescent psychotherapy, bullying is linked to specific related psychological burden and role-specific psychopathology. Bullying and related psychological burden should be addressed and routinely assessed in mental health care settings. The link between bullying and psychopathology as well as specific intervention methods may be explored further in future research.
Child marriage remains a pressing social and public health issue globally, with significant implications for the rights, well-being and development of affected individuals. In Iran, legal frameworks that permit marriage from as young as 9 lunar years for girls-despite countervailing influences such as rising education levels and social reforms-have failed to curb the persistence of early marriage, which continues to be driven by entrenched cultural, socioeconomic and legal factors. Understanding the multifaceted nature of child marriage within this context is crucial for developing effective interventions and policies. Existing research predominantly focuses on quantitative assessments, leaving qualitative insights underexplored. The aim of this protocol is to address the existing gap by undertaking a scoping review and meta-synthesis of qualitative evidence concerning child marriage in Iran. This study seeks to provide an in-depth understanding of the underlying determinants, lived experiences and associated consequences of child marriage with the aim of informing future research endeavours and guiding policy development. This scoping review protocol will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the methodological framework proposed by Arksey and O'Malley, incorporating recent methodological advancements. Selection criteria will be established through the Population, Concept and Context framework, targeting qualitative studies addressing child marriage within Iran. To ensure comprehensive coverage, an inclusive search will be conducted across diverse databases, including PubMed, Scopus, Web of Science, Scientific Information Database (SID), MagIran and the Barakat Knowledge Network System (BKNS), without any restriction on publication date, extending up to the search date. Both Persian and English language sources will be reviewed. Two independent reviewers will undertake the screening of titles, abstracts and full texts, resolving conflicting decisions through consensus or third-party arbitration. The methodological integrity of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Data will be synthesised through content analysis methods. Confidence in the integrated findings will be evaluated employing the GRADE-CERQual approach to enhance the trustworthiness and applicability of the review outcomes. The Research Ethics Committee of Tabriz University of edical Sciences approved this proposed scoping review and meta-synthesis, confrming ethical compliance absent patient involvement. Results from this investigation will be shared through peer-reviewed journal articles and presentations at relevant academic conferences locally and internationally. Furthermore, the synthesised insights into the phenomenon of child marriage in Iran are intended to inform scholars, policymakers and practitioners, supporting evidence-based strategies and policies to mitigate the issue and promote social change.
To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.
The Far East is highly vulnerable to natural disasters and mass trauma, underscoring the critical need for child and adolescent psychiatrists (CAPs) equipped to deliver disaster mental health care. To understand regional capacity and preparedness, we conducted the third wave of a 12-year longitudinal survey tracking CAP postgraduate training systems and workforce trends in the Far East. In 2024, representatives from 16 of 17 countries and functionally self-governing areas completed a standardized online questionnaire. Data regarding CAP training structures, specialty recognition, and workforce size were descriptively compared with previous survey waves (2012 and 2017). The CAP workforce has steadily increased, with new specialists emerging in Cambodia, Mongolia, and Myanmar. By 2024, 75% (12/16) of regions offered postgraduate CAP training-up from 59% in 2017-and recognition of CAP as a distinct specialty increased to 75%. Curricula have diversified, frequently integrating school consultation (83%) and forensic psychiatry (58%). However, national guidelines, board certification (44%), and institutional support remain highly uneven across the region. While CAP training in the Far East has significantly expanded, persistent workforce disparities limit the region's ability to deploy skilled specialists during humanitarian emergencies. Strengthening CAP training systems is an essential public health measure to fortify regional resilience and address child and family disaster psychiatry needs.
While personal recovery is a well-established concept for people with mental illness, its application to carers, who share a similarly demanding journey, remains underexplored. This cross-sectional study firstly applied the CHIME framework (Connectedness, Hope and optimism, Identity, Meaning in life, and Empowerment) to 333 carers of children and young people with mental illness in China, via an online survey from September 2024 and February 2025, and aimed to provide baseline data on personal recovery and its correlates in this population. Carers completed questionnaires on demographic, caregiving and illness-related information, five indicators of personal recovery, and three indicators of psychological wellbeing. Latent profile analysis, descriptive analysis, bivariate analysis, and ordinal logistic regression were conducted using SPSS 26.0 and Mplus 8.3. Three profiles of personal recovery were identified: struggling group (13.2%), progressing group (62.4%), and recovering group (24.3%). Bivariate analyses showed that care recipients' sex, carers' employment, illness duration, and SDQ prosocial, externalising, and internalising domains differed significantly across profiles. Ordinal logistic regression (adjusting for all factors) revealed that carers' sex, care recipients' sex, and SDQ prosocial and internalising domains were independently associated with profile membership. Carers in the struggling group had the poorest psychological wellbeing, followed by the progressing and recovering groups. These findings may help identify carers with poor recovery and inform interventions tailored to profile membership. CHIME-based approaches targeting stigma reduction and enhancement of hope and mastery may be related to better personal recovery and psychological wellbeing in this population.
Juvenile delinquency is closely linked to complex psychosocial and value-based developmental trajectories. This study compares life-course narratives (childhood and school experiences, daily life structure), value orientation, self-concept, and standardized self-reports of emotions among adolescents with delinquent behavior, adolescents with psychiatric disorders, and healthy peers. Using a mixed-methods design, narrative interviews were conducted with all three groups (N = 48). Participants were asked to describe their feelings in relation to these domains in order to assess emotional processing, measured by the Positive and Negative Affect Schedule (PANAS). Compared with their healthy peers, narratives from adolescents with delinquent behavior were characterized by greater strain across their developmental course. These descriptions were marked by housing and caregiving instability, insecure bonding experiences with primary caregivers, difficulties in forming coherent and socially oriented value systems, and a tendency toward self-concepts marked by overcompensation. Regarding emotional experience, PANAS results indicate that both the delinquent and psychiatric groups reported higher levels of negative affect than healthy adolescents. Although adolescents with psychiatric disorders also reported adversity, their narratives tended to reflect greater variability in protective factors and more opportunities to benefit from therapeutic and relational support. The findings suggest that delinquent behavior may arise from the cumulative interplay of early adversity, environmental instability, disrupted relational experiences, and challenges in developing individualized values and stable, non-compensatory self-concepts. These results highlight the importance of interventions that address potential moral injury, strengthen reliable relational contexts, and promote socially integrated value orientations. Qualitative approaches provide important insights into these mechanisms and should complement quantitative assessments when working with high-risk youth.
In recent years, the field of digital health has grown exponentially, leading to notable benefits, such as easier access to health-related information, but also to content saturation and misinformation. Thus, it is crucial to identify digital health tools that provide meaningful value and assess them in real-world settings. This preregistered study aims to quantitatively assess the Lernstörungen Online-Diagnostik und Intervention (LONDI) platform, a German platform designed for different user groups supporting children with learning disorders. This assessment focused on user groups of mental health professionals (ie, learning therapists and school psychologists) and was grounded in 4 of the 5 reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework dimensions: reach, adoption, implementation, and maintenance. Data were collected over a 10-month period between May 1, 2024, and March 1, 2025. The reach dimension was measured via a pop-up questionnaire (n=1324) collecting demographic and professional experience data. The adoption dimension was measured via a second pop-up questionnaire (n=160) measuring user experience (UX) and reuse intention for the platform's help system. The implementation dimension was measured via web analytics (N=37,133) measuring reading time for pages intended for mental health professionals. Moreover, this dimension was also assessed by comparing chatbot engagement rates with industry benchmarks, in the absence of established benchmarks for digital health chatbots. The maintenance dimension was measured via web analytics as well, comparing the use in the previous (n=20,496) and current platform versions (N=37,133) in terms of number and location of users, time spent on the platform, number of actions per visit, and used devices and software. A total of 21.90% (291/1324) and 10.64% (141/1324) of the users who filled out the first pop-up questionnaire stated that they were learning therapists or school psychologists, respectively, exceeding their percentage in the German population (<0.01%). The second pop-up questionnaire revealed an overall mean UX score of 1.54 (SD 1.14), surpassing the benchmark average, and UX ratings predicted intention to reuse. Time spent on the pages intended for mental health professionals was below the time needed to read them. The 0.18% rate of chatbot engagement was very low compared with industry benchmarks of 35% to 40%. Use changed in the 2 time periods compared, and most strikingly, there was an 81.2% (n=16,637) increase in the number of users. The study provides evidence of the LONDI platform's positive contribution to public health in terms of the reach, adoption, and maintenance dimensions of the RE-AIM framework. Further research and endeavors are needed to better understand and improve the platform's contribution in terms of the implementation dimension.
Child maltreatment is a major global public health concern with well-documented psychological consequences, but its associations with long-term physical health conditions remain less well understood. To examine the associations between childhood maltreatment and adult multimorbidity using electronic health records in Hong Kong. This population-based cohort study used electronic health record data from Hong Kong, comprising 7473 individuals with a first recorded episode of maltreatment between ages 0 and 19 years from 2001 to 2010 and 26 834 matched individuals without documented maltreatment. Individuals who reached adulthood (ie, after age 19 years) by December 31, 2024, were included. History of childhood maltreatment vs none. The primary outcome was the occurrence of multimorbidity during adulthood as documented in participants' diagnostic records through December 31, 2024. Cox proportional hazards models were used to estimate the risks of 16 disease categories and multimorbidity patterns diagnosed after age 19 years, both overall and stratified by preexisting physical, mental, or neurodevelopmental conditions in childhood. After exclusions, the final cohort comprised 32 674 individuals (16 986 female [52%]), including 7137 who were exposed to childhood maltreatment and 25 537 unexposed individuals. Their median (IQR) age was 9.0 (6.0-13.0) years at inclusion and 28.1 (24.2-31.6) years at the end of follow-up. The median (IQR) follow-up duration was 19.0 (16.6-21.3) years. Childhood maltreatment was associated with increased risks across 13 adult diagnostic categories. The highest risks were observed with mental and behavioral disorders (hazard ratio [HR], 2.78; 95% CI, 2.49-3.09), ear diseases (HR, 1.88; 95% CI, 1.27-2.78), injuries (HR, 1.81; 95% CI, 1.65-1.98), and blood diseases (HR, 1.67; 95% CI, 1.41-1.97). Maltreatment was also associated with a higher risk and earlier onset of complex multimorbidity (HR, 1.96; 95% CI, 1.68-2.27). The associations between childhood maltreatment and adult diagnoses were attenuated among individuals with mental health or neurodevelopmental conditions diagnosed in childhood. In this 19-year cohort study of 32 674 individuals, childhood maltreatment was associated with elevated risks for multiple health conditions in adulthood. These findings underscore the need for early prevention and sustained, trauma-informed health care support to reduce the risk of lifelong multimorbidity among children who have experienced maltreatment.
Adverse childhood experiences (ACEs) and neurodevelopmental disorders (NDDs) are frequent yet the relationship between cumulative ACEs and multiple NDDs remains poorly understood. Using data from 120,629 children aged 3-17 years in the 2021-2023 US National Survey of Children's Health, we examined associations between ACEs and multiple NDDs, defined as the presence of ≥ 2 NDDs. Logistic regression, adjusted for sociodemographic and health covariates, estimated associations for ACEs treated as a continuous variable and as categorical groups (0, 1, 2, and ≥ 3 ACEs). We also assessed associations for common NDD combinations and individual ACE. The prevalence of multiple NDDs increased with the number of ACEs: 4.5% (95% confidence interval [CI]: 4.2-4.8) for 0 ACE, 8.4% (95% CI: 7.7-9.1) for 1 ACE, 11.9% (95% CI: 10.7-13.2) for 2 ACEs, and 17.8% (95% CI: 16.5-19.2) for ≥ 3 ACEs. Each additional ACE was associated with 13% higher odds of multiple NDDs (adjusted odds ratio [aOR] = 1.13, 95% CI: 1.09-1.17). Compared with no ACE, the odds of multiple NDDs were higher for 1 ACE (aOR = 1.48, 95% CI: 1.30-1.68), 2 ACEs (aOR = 1.78, 95% CI: 1.52-2.09), and ≥ 3 ACEs (aOR = 1.91, 95% CI: 1.62-2.26). Associations were consistent across three NDD combinations. Individually, health- or disability-related mistreatment, household mental illness, and economic hardship showed significant associations. Cumulative ACEs are associated with a greater likelihood of multiple NDDs, suggesting future research, health policy, system and service planning require coordinated responses that account for the diverse adversities experienced by many families and children.
Adolescent mental health problems are rising globally, with problematic digital media use identified as an important risk factor. Universal school-based interventions that integrate Social and Emotional Learning (SEL) with digital balance strategies may promote resilience and reduce risk. This study evaluated On the Inside, a classroom-based SEL and digital balance program. A total of 750 students aged 13-15 years from eight schools (two control schools) participated. Surveys were completed at baseline (T1), post-intervention (T2), and, for a subsample, one year later (T3). The program comprised five video-based sessions delivered by teachers. Outcomes included psychological distress (PHQ-4), problematic social media use (GSMQ-9), and adaptive behaviors. Data were analyzed using multilevel mixed models to account for clustering by school. Relative to controls (n = 193), students in the intervention group (n = 557) reported reductions in psychological distress, problematic social media use, multitasking, and avoidance, alongside increased use of adaptive strategies such as distancing phones during study and challenging negative thoughts. Several effects, including reduced distress and avoidance, and sustained strategy use, remained at one-year follow-up. No significant effects were observed for sleep, help-seeking, or breathing strategies. This universal, teacher-delivered program integrating SEL and digital balance was feasible and produced small but clinically meaningful improvements in adolescent distress and related behaviors, with some effects sustained after one year. These findings support the potential of school-based interventions to address digital media-related risks and promote mental health at a population level. Further research should refine program components, particularly for sleep and screen time, and examine cost-effectiveness to inform broader implementation.