搜索结果：Child and adolescent psychiatry and mental health

Norwegian Child and Adolescent Mental Health Services (CAMHS) use the World Health Organization's (WHO) multiaxial diagnostic system based on the International Classification of Diseases, Tenth Revision (ICD-10); however, analysis of prescribing patterns among axes I-III is underexplored in electronic health records (EHRs) with intertwined patient, episode of care, and contact information. This study aimed to develop and demonstrate an analytic pipeline for mining and mapping information from EHRs to facilitate understanding of clinical processes and support informed decision-making. This study used the Norwegian CAMHS EHR data to identify common diagnoses, comorbidities, and medication use across axes I-III per individual contact. We extracted records of patients ≤19 years old with a primary mental health diagnosis on axes I-III and one or more medications per individual contact. Diagnoses were categorized according to ICD-10 and medications according to the Anatomical Therapeutic Chemical (ATC) classification system. Descriptive analyses quantified contact counts, diagnosis frequency, comorbidity rates, and medication frequency within each diagnostic category. Next, we mapped the medications used across all the contacts and noncomorbid contacts separately along each axis. Of 7214 prescribing contacts (axis I: n=7179, 99.51%; axis II: n=821, 11.38%; axis III: n=65, 0.90%), comorbidity was present in 12.06% (n=866) contacts in axis I, 96.10% (n=789) contacts in axis II, and 96.92% (n=63) contacts in axis III. Leading diagnoses were behavioral-emotional disorders (ICD-10 codes F90-F98) in axis I, school skills and learning difficulties (ICD-10 code F81) in axis II, and mild mental retardation (ICD-10 code F70) in axis III. Most observed comorbidities were F90-F98 with speech and language development disorder (ICD-10 code F80), ICD-10 code F81, and mixed specific skills development disorder (ICD-10 code F83). Psychostimulants predominated across all diagnosis axes, with methylphenidate being the most common. For other ATC categories, the most commonly prescribed medications were antidepressants (sertraline and fluoxetine), antipsychotics (risperidone and aripiprazole), hypnotics and sedatives (melatonin), antiepileptics (lamotrigine), anxiolytics (diazepam), and nonpsychotropics (laxatives, vitamins, and supplements). Medication profiles varied minimally by axis or comorbidity status. We demonstrated a mining and mapping analytic pipeline for EHRs to analyze diagnoses, comorbidities, and prescribing practices at the individual contact level. In the Norwegian CAMHS, axis I diagnoses are common, often behavioral-emotional disorders. Among the medications, psychostimulants and antidepressants are common. Beyond characterizing diagnoses and medication prescribing patterns, the study presents an approach for mining and mapping EHR data to analyze and provide service-level metrics, as well as clinical practice insights.

Adolescence is a crucial developmental stage characterized by rapid biological, psychological, and social changes, that increase vulnerability to mental health issues. Nearly half of all mental health conditions have their onset during this period and are influenced by individual, family, and environmental factors. Schools play a key role in promoting mental well-being among adolescents due to their accessibility and reach. While school-based mental health prevention interventions have shown positive outcomes in high-income countries, evidence from low- and middle-income countries (LMICs) is limited. This study aimed to assess the feasibility and acceptability of Health Action in Schools for a Thriving Adolescent Generation (HASHTAG), a comprehensive school-based intervention for adolescents aged 13-16 years in Nepal. A feasibility cluster-randomized controlled trial was conducted in four secondary schools in Morang district, Nepal. Adolescents completed surveys at baseline and at a 3-month follow-up to evaluate mental well-being, emotional and behavioral outcomes, social support, school climate, and functioning. The intervention comprised two components: Thriving Environment in Schools (TES), implemented over three months and Thriving Together (TT), delivered through six weekly sessions. Quantitative data were collected electronically and analyzed descriptively. Qualitative data were gathered through focus group discussions and in-depth interviews with adolescents, teachers, and facilitators to explore implementation experiences and were analyzed thematically. Both the TES and TT components were well received, with TT sessions achieving an average attendance rate exceeding 70%, and being delivered as planned by trained facilitators, indicating good acceptability and feasibility. Explanatory analysis suggested a positive trend in anxiety outcomes in the intervention group while, social support showed a modest increase. Other outcomes showed small, non-significant changes. Qualitative findings highlighted perceived benefits such as improvements in school cleanliness, staff-student relationships, bullying and discrimination reduction, and positive social and behavioral changes. Participants found breathing exercises, games, the workbook, and the 'feeling box' particularly helpful. Implementation challenges included limited space, logistical constraints, COVID-19 related disruptions, and session length. HASHTAG demonstrated feasibility and accessibility as a school-based intervention for adolescents in Nepal, with preliminary indications of potential benefits. Addressing identified implementation challenges will be important for optimizing delivery in future studies. A fully powered randomized controlled trial is warranted to evaluate effectiveness.

Despite increasing attention to youth mental health, children and adolescents in Sweden experience fragmented, inequitable care with regional variation. Delays in diagnosis, limited preventive interventions, and poor inter-sectoral collaboration contribute to significant unmet needs. This study investigates system-level challenges and stakeholder perspectives on opportunities to enhance care pathways. We conducted a qualitative study in the Västra Götaland region, Sweden. Fourteen purposively selected participants - including senior executives, healthcare professionals, and parents took part in semi-structured interviews. We used systematic text condensation, according to Malterud, and the four steps involved in this method for analysing the interviews. A central theme across interviews was the requirement for a formal diagnosis before children can access mental health support, particularly in school and primary care settings. Participants described this as a major barrier that delays early intervention and leaves children and young people with complex or atypical presentations without adequate support. Primary care professionals reported increasing mental health caseloads without corresponding increases in staffing or funding, limiting preventive work. Child and adolescent psychiatry (BUP) was described as overwhelmed, with long waiting times and limited continuity of care. A care manager within primary care was proposed as a way to help families navigate fragmented services and improve collaboration, although participants emphasised that such a role would need to be part of broader structural reform. Our findings highlight persistent systemic issues in mental health care for children and young people, including inequitable access, insufficient prevention, and fragmented collaboration across sectors. Strengthening primary prevention, reallocating resources to primary and school-based mental health care and implementing well-defined care coordination roles within broader restructuring may improve continuity and equity in service delivery. Comprehensive policy reform is needed to support person-centred, integrated care pathways for children and young people with mental health needs.

Due to trauma and ongoing adversity, refugee minors are at high risk for mental health issues, including PTSD. This study evaluated the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) and Narrative Exposure Therapy for Children (KIDNET), in reducing PTSD symptoms, behavioural and emotional symptoms and improving quality of life in refugee children and adolescents in the Netherlands, compared to a waitlist control group (WL). A secondary objective was to compare the efficacy of EMDR and KIDNET. A randomized controlled trial was conducted with three arms (N = 96): EMDR (n = 32), KIDNET (n = 32), and WL (n = 32). After 8 weeks, WL participants were re-randomized to EMDR or KIDNET. Follow-ups were conducted at 1- and 3-months post-treatment. Participants were refugee minors aged 8-18 years, accompanied by a caregiver, and meeting criteria for a (partial) PTSD diagnosis. Both treatments included 8 weekly sessions and 1-4 parental guidance sessions. Both EMDR (d = 1.31) and KIDNET (d = 0.94) significantly reduced clinician-rated PTSD symptom severity compared to WL. Similar results were found for child-report, but not for caregiver-report. Regarding secondary outcomes, quality of life and emotional and behavioural symptoms, comparisons of both interventions to the WL revealed small to moderate effect sizes with non-significant effects for KIDNET versus WL, and significant effects for EMDR versus WL. EMDR, compared to KIDNET, showed a significantly greater reduction in clinician-rated PTSD symptom severity (T1-T3) (d=-0.38) with no significant differences on other outcome measures. Results were achieved after an average of 6.61 sessions for EMDR and 9.10 for KIDNET. Dropout rates were 20.8% for EMDR and 10.9% for KIDNET, based on the total sample after the second randomization. These findings suggest that both EMDR and KIDNET are efficacious trauma-focused treatments for refugee children and adolescents. Trial registration The trial was registered in the Overview of Medical Research in the Netherlands on February 2, 2014 (NL-OMON44793), amended on June 16, 2017, and re-registered on June 16, 2021 (NL-OMON22679), where one updated outcome measure and expanded eligibility criteria were documented.

This pilot study primarily aimed to evaluate the feasibility of conducting a cluster randomised controlled trial of the Integrated Network for Student Psychosocial Interventions, Resilience, and Education (INSPIRE) programme, including recruitment, retention, counsellor-led delivery, attendance, and completeness of outcome data. As a secondary aim, the study explored preliminary signals of change in adolescent mental health knowledge and related outcomes to inform the design of a future definitive trial. Two-centre, two-arm cluster randomised controlled pilot trial with pretest and posttest design. Adolescents aged 13-15 years and their parents were recruited from public junior high schools in West Java, Indonesia. Two schools were randomly assigned to intervention or control groups using a computer-generated sequence. The eight-week INSPIRE programme, delivered by a school counsellor, included three joint sessions with parents and two home-based activities. Feasibility outcomes included recruitment, retention, intervention fidelity, attendance, and outcome data completeness. Preliminary signals of change were described at baseline and 2‑month follow-up. Recruitment achieved 74% of eligible adolescent-parent dyads (52/70). Retention was excellent, with 100% of adolescents and 96% of parents completing follow-up assessments, and outcome data were complete. Programme attendance was high (adolescents 91%; parents 79%), and the intervention was delivered as planned by a trained school counsellor, with minor scheduling adjustments for public holidays. Consistent with the primary feasibility objectives, indicators such as recruitment, retention, and delivery were favourable. As secondary findings, adolescents demonstrated preliminary signals of improvement in mental health knowledge and selected literacy domains. In contrast, parents showed gains in mental health knowledge and attitudes, with favourable trends in help-seeking attitudes observed across both groups. INSPIRE demonstrated feasibility and acceptability, with preliminary signals supporting progression to a fully powered trial. The findings support its further evaluation in a fully powered cluster-randomised trial and its integration into school health programmes involving families and counsellors. Trial registration ClinicalTrials.gov (NCT06942637).

Mental health problems in preschool children are rising in Sweden, yet their economic impact on the health sector remains poorly quantified. This study estimated the incremental healthcare utilization and costs associated with early mental health problems to inform resource allocation and early intervention. We analyzed an exact matched sample of 1206 drawn from a cohort of 6957 children aged 3-5 from Uppsala Region, Sweden. Early mental health problems were identified using the Strengths and Difficulties Questionnaire reported by mothers, fathers and teachers. Data were linked to national registers to estimate cumulative healthcare utilization and costs over four years from a health sector perspective. Hurdle models, generalized linear models, and two-part models compared utilization and costs between children with and without early symptoms. Sub-group analyses by sex, symptoms, and raters were performed. Children with early mental health problems consumed three additional units of medication with an incremental cost of US$ 299, one additional specialized outpatient visit with an incremental cost of US$ 622, and five additional primary care visits with an incremental cost of US$ 376 compared to their healthy peers. Healthcare utilization and costs were higher for boys with externalizing and internalizing symptoms. Findings were consistent across all rater groups. Early childhood mental health problems represent a substantial economic impact to the healthcare sector. The findings suggest that early identification and intervention in the preschool years may offer significant opportunities for cost-offsetting and improved long-term system efficiency.

Child and adolescent mental disorders impose substantial individual and societal burdens. This study synthesized randomized evidence on the effects of music therapy on depressive and anxiety symptoms, self-esteem, and health-related quality of life in young people, and explored whether intervention characteristics were associated with variations in effect estimates. Following PRISMA 2020, this review was retrospectively registered with PROSPERO (CRD420261382585). PubMed, Embase, Cochrane CENTRAL, Web of Science, Google Scholar, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform were searched from inception to July 31, 2025, without language limits. Eligible studies were randomized controlled trials enrolling participants aged 6 to 18 years; comparators were no treatment, waitlist, attention control, or usual care; the planned intervention duration was at least four weeks; and outcomes were validated continuous measures at end of treatment. Random-effects models with restricted maximum likelihood generated standardized mean differences (SMD) and 95 percent confidence intervals. Prespecified moderators included age group, session length, session frequency, program duration, and adherence. Nine trials (n = 690) met inclusion criteria. Music therapy reduced depressive symptoms versus controls (SMD - 0.55; 95% CI, - 0.71 to - 0.38) and improved self-esteem (SMD 0.45; 95% CI, 0.26 to 0.64) and quality of life (SMD 0.69; 95% CI, 0.37 to 1.01). Two trials showed reduced anxiety (SMD - 0.42; 95% CI, - 0.75 to - 0.08). Exploratory subgroup analyses suggested larger effect estimates in younger children and in interventions with longer sessions, higher weekly frequency, longer duration, and higher adherence; however, these findings should be interpreted cautiously given the small number of trials. Music therapy may offer meaningful benefits for youth mental health, although evidence for anxiety and quality of life is based on a limited number of studies. Findings related to age and intervention delivery characteristics should be considered exploratory and hypothesis-generating rather than evidence of causality or optimal dosing.

This study examined psychiatric presentations among children and adolescents (C&A) in Alberta, Canada, across pre-pandemic, pandemic and post-pandemic periods, with a focus on age, biological sex and urban/rural status. Utilizing a retrospective cohort design, we analysed health administrative billing data from 1&#x2009;430&#x2009;441 psychiatric encounters among Albertans aged 0-17 between 2017 and 2022. Service utilization rates were compared across pandemic phases, and associations were evaluated using one-way ANOVAs and generalized linear models stratified by healthcare setting. Total psychiatric presentations increased significantly post-pandemic, driven by a 21.3% surge in outpatient settings. One-way ANOVA (p&#x2009;=&#x2009;0.014) and regression modelling confirmed that both pandemic phase (p&#x2009;=&#x2009;0.014) and age (p&#x2009;=&#x2009;0.03) significantly influenced utilization. Adolescents accounted for 64% of encounters and were the most heavily impacted cohort. Outpatient increases were primarily phase-driven (p&#x2009;=&#x2009;0.004), whereas emergency and inpatient encounters were strongly influenced by age and sex (p&#x2009;<&#x2009;0.001), with female adolescents experiencing the highest rates (significant age&#x2009;&#xd7;&#x2009;sex interaction, p&#x2009;<&#x2009;0.001). Conversely, rural presentations declined sharply during the pandemic (-35.2%) and only partially rebounded post-pandemic (+17.4%). The psychological impacts of the pandemic were highly stratified by demographic factors and care settings, with adolescent females showing acute distress in acute care, and rural youth experiencing persistent service gaps. These findings underscore an urgent need for targeted mental health resources, equitable geographic access and tailored interventions across diverse youth cohorts.

Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. However, little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely focused on average differences across a limited number of groups, obscuring non-additive intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression (e.g., relating to gender, socioeconomic position, ethnicity, age, and place), we leveraged recent methodological advances to address this gap. Accordingly, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional positions; and (ii) describe the extent to which inequalities in emotional problems reflect additive and non-additive (intersectional) effects. Data were analysed from 19 590 students aged 11-16 years who participated in the OxWell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by combinations of social positions relating to gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive main effects). Emotional problems (Revised Child Depression and Anxiety Scale; RCADS-11) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. Maltreatment was associated with higher levels of emotional problems, with stratum-specific increases ranging from&#xa0;+3.20 to&#xa0;+6.14 scale points. Socioeconomically disadvantaged females and individuals who selected 'other' or 'prefer not to say' for gender showed the highest levels of emotional problems and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely accounted for by maltreatment exposure and the additive contributions of the included social positions. However, residual non-additive effects were also evident, particularly among individuals exposed to maltreatment, where 5.25% of between-stratum variance remained unaccounted for by additive effects (compared with 3.46% among those not exposed). In this large community sample of adolescents in England, the detrimental effects of maltreatment on emotional problems appear pervasive but not uniform across intersectional social positions. Applying an intersectional MAIHDA framework suggests that inequalities in adolescent emotional problems largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience in adolescence, and support the need for trauma-informed, equity-focused interventions and policy action to reduce unequal exposure to maltreatment and the contexts that amplify its harms.

Children and young people (CYP) with neurodevelopmental diagnoses such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have high child and adolescent mental health service (CAMHS) needs. Mood instability is a common and impairing emotion dysregulation-related symptom linked to increased adult psychiatric service use; however, its role in CAMHS trajectories remains unclear. We aimed to examine whether baseline mood instability was significantly associated with time to discharge and annual CAMHS use in CYP with ASD and/or ADHD. We applied natural language processing (NLP) to extract mentions of mood instability within 3&#x2009;months of ASD or ADHD index diagnosis from electronic health records of 21 906 CYP referred to CAMHS between 2008 and 2022. We used accelerated failure time models and negative binomial regression to assess associations between baseline mood instability and time to discharge and annual CAMHS use, adjusting for clinical and sociodemographic confounders. Mood instability was associated with increased annual CAMHS use across ASD (adjusted incidence rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42), ADHD (aIRR 1.47, 95% CI 1.30 to 1.67) and ASD+ADHD (aIRR 1.27, 95% CI 1.12 to 1.44) groups. While mood instability had no significant effect on discharge timelines in autistic children with or without ADHD, it was linked to reduced time to discharge in the ADHD group (aTR 0.76, 95% CI 0.69 to 0.84). Associations were most pronounced in those not receiving ADHD medication in the ADHD group (aIRR 1.67, 95% CI 1.47 to 1.89; aTR 0.70, 95% CI 0.61 to 0.79). Mood instability was significantly associated with elevated CAMHS use in CYP with neurodevelopmental conditions, with differential effect across diagnostic groups. This may reflect both variations in clinical expression of mood instability and configuration of neurodevelopmental CAMHS provision. These findings suggest the importance of assessing emotion dysregulation in care planning and pathway allocation in neurodevelopmental CAMHS. NLP offers a time- and cost-efficient approach to surface and structure clinical data from electronic CAMHS records for scalable clinical research on complex constructs such as mood instability.

Pakistan has one of the world's largest adolescent populations, yet evidence on the prevalence and correlates of depressive and anxiety symptoms in adolescents remains limited, particularly in rural settings. This study aimed to estimate the prevalence of depressive and anxiety symptoms and examine their associations with household characteristics in a community-based sample of adolescents from the predominantly rural district of Matiari, Pakistan. We examined cross-sectional data from 718 girls (9.0-14.9 years) and 678 boys (10.0-15.9 years) participating in the Nash-wo-Numa Study. Trained psychologists administered the Sindhi versions of the Short Mood and Feelings Questionnaire and the Screen for Child Anxiety Related Emotional Disorders to assess adolescents' depressive and anxiety symptoms. Prevalence estimates and 95% confidence intervals were derived based on validated cut-off scores. Household correlates of depressive and anxiety symptoms were examined in multivariable negative binomial regression models. Approximately 8% of boys and 10% of girls exhibited clinically-significant depressive symptoms. The prevalence of clinically-significant anxiety symptoms ranged from 6% in boys and 8% in girls for generalized anxiety to 24% in boys and 39% in girls for separation anxiety symptoms. Girls experienced more depressive symptoms, panic/somatic and generalized anxiety symptoms than boys at age 12, more separation anxiety symptoms from age 11 onward, and more social anxiety symptoms from age 12 onward. In both sexes, depressive and anxiety symptoms were higher among adolescents exposed to intimate partner violence against their mothers and to moderate&#x2011;to&#x2011;severe food insecurity, and were lower among those with a homemaker mother. Among girls, maternal mental well&#x2011;being attenuated the association between food insecurity and depressive symptoms. Depressive and anxiety symptoms are common among adolescents living in Matiari. Adolescents exposed to intimate partner violence against their mother, moderate-to-severe food insecurity, and poor maternal mental health may be at increased risk of depression and anxiety in predominantly rural Pakistan and may benefit from targeted prevention and intervention strategies.

The psychosocial stress experienced by families with young children during the pandemic raised concerns about developmental risks, particularly for preterm infants, who are highly sensitive to environmental influences. This study examined the association between parent-reported pandemic burden and cognitive, language and motor development of preterm children. Between 2022 and 2023, a total of 69 children (median corrected age: 21.59 months) were assessed, 62.3% of whom were born prematurely. A subset of these preterm children (n&#x2009;=&#x2009;31), restricted to improve age alignment, was compared to a pre-pandemic cohort (n&#x2009;=&#x2009;40; median age: 22.2 months). Development was measured using the Bayley Scales of Infant and Toddler Development (Second and Third Edition). The pandemic burden was quantified using the Corona-Index, which was based on a standardised parental questionnaire. Multiple linear regressions were conducted with the Corona-Index as the main predictor and sex, gestational age, socioeconomic status and parental stress as moderators. Group differences were analysed using Mann-Whitney-U-Tests. Cognitive and motor scores did not differ significantly between cohorts, whereas language scores were significantly lower in the pandemic group (p&#x2009;=&#x2009;0.001). The overall regression models for cognitive and language development did not reach statistical significance, and their sub-analyses should be interpreted with caution. Within the pandemic cohort, a significant interaction between the Corona-Index and sex was found for motor development (p&#x2009;=&#x2009;0.022). Exploratory interaction effects suggested possible sex-related differences. Overall, preterm children assessed during the pandemic showed differences in language scores compared to the pre-pandemic control group, which may theoretically be linked to altered social environments. However, instrument-related variability and residual clinical confounding cannot be excluded. Exploratory analyses highlighted the importance of examining sex-specific patterns in the context of environmental disruptions.

Despite the established association between sleep problems and emotional and behavioral problems in adolescents, there is limited evidence on the relationships of independent, cumulative, and distinct patterns of sleep problems with emotional and behavioral problems. Cross-sectional data were collected from middle school students in Daye City, Hubei Province, China, with 1,381 participants included. Emotional and behavioral problems and sleep problems were assessed using the Strengths and Difficulties Questionnaire and Pittsburgh Sleep Quality Index, respectively. Latent class analysis was used to identify the latent patterns of sleep problems, and linear regression analyses were used to explore the associations between sleep problems (including independent types and cumulative scores) and emotional and behavioral problems. The Bolck-Croon-Hagenaars method was applied to compare emotional and behavioral problems across distinct sleep problem patterns. Additionally, relative importance analysis was conducted to estimate the relative contribution of each sleep problem to the variance in emotional and behavioral problems. Prolonged sleep latency, short sleep duration, inefficient sleep, sleep disturbances, use of sleep medications, and daytime dysfunction were independently correlated with higher levels of emotional and behavioral problems, except for poor subjective sleep quality. Among these sleep problems, daytime dysfunction contributed the most to the variance in emotional (23.5%) and behavioral problems (30.4%). Additionally, the more sleep problems adolescents experienced, the more severe their emotional and behavioral problems were. Three distinct patterns of sleep problems were identified: "global sleep dysfunction", "disturbed and non-restorative sleep", and "mild sleep problems". Adolescents with the "global sleep dysfunction" pattern exhibited the most severe emotional and behavioral problems, whereas those with the "mild sleep problems" pattern exhibited the least severe. The findings highlight the need to consider the types, numbers, and patterns of sleep problems when developing tailored interventions to alleviate emotional and behavioral problems in adolescents.

To examine the effects of social media on future mental health problems (depressive symptoms, anxiety symptoms, poor well-being and self-harm) in adolescents aged 12-18&#x2009;years, overall and stratified by sex and age periods (early, middle and late adolescence). Prospective longitudinal study. Participants were recruited in 2012 through schools in Melbourne, selected using stratified random sampling. In wave 1 (2012), 1239 Grade 3 students participated and have since completed annual surveys. The analysis used data up to wave 11 (2022). Participants with no data on mental health, social media and confounders were excluded, leaving a sample of 1195 (552 [46%] male participants). Exposure was self-reported duration of daily social media use at each wave, from waves 4 to 10 (ages 12-18&#x2009;years). Outcomes (self-reported depressive symptoms, anxiety symptoms, well-being, self-harm) were assessed at the subsequent annual wave, from waves 5 to 11 (ages 13-19&#x2009;years). Across adolescence, >&#x2009;2&#x2009;h versus <&#x2009;1&#x2009;h of daily social media use was associated with a small increase in risk of high depressive symptoms (risk difference [RD] per 100, 6.3 [95% CI, 2.7-9.9]) and poor well-being (RD, 4.9 [95% CI, 1.1-8.6]) at the subsequent annual wave. Estimated risks for all mental health problems were greatest in early adolescence (12-13&#x2009;years), with the largest effects observed for high depressive symptoms in female participants (>&#x2009;2&#x2009;h vs. <&#x2009;1&#x2009;h: RD, 10.8 [95% CI, 2.7-18.9]). Higher levels of social media use were associated with small increases in future risk of high depressive symptoms and poor well-being across adolescence. The largest risks for all mental health problems were observed during early adolescence for both male and female participants, supporting the need to consider policies that mitigate the adverse effects of social media on the mental health of younger adolescents. The Known: Concerns about social media's impact on adolescent mental health have driven policy debate, yet evidence remains limited and largely cross&#x2010;sectional. The New: Using annual data from a longitudinal cohort of Australian adolescents, we estimated future mental health risks from social media use between 12 and 18&#x2009;years of age. More than 2&#x2009;h of daily social media use was associated with an increased risk of high depressive symptoms and poor well&#x2010;being 1&#x2009;year later. Estimated risks were greater in early adolescence (12&#x2013;13&#x2009;years) compared to risks in later ages. The Implications: Early adolescence is a key vulnerability period for social media use, supporting targeted education and policies aimed at limiting use.

This study aimed to investigate the associations of adolescents' self-reported family financial stress, registry-based parental household income and parental education with adolescent anxiety and depression symptoms. Additionally, we adjust these associations for parental anxiety and depression symptoms and examine potential secular changes in these associations. Family linkage study, using two cross-sectional population-based health studies, the Young-HUNT study and the HUNT study. Registry-based data from Statistics Norway (SSB). Northern part of Tr&#xf8;ndelag County, Norway. Adolescent (aged 13-19 years) participating in The Young-HUNT3 Survey (2006-2008, n=8199) and The Young-HUNT4 Survey (2017-2019, n=8066) and their parents participating in The HUNT3 Survey (2006-2008, n=50 800) and the HUNT4 Survey (2017-2019, n=56 042). Adolescent anxiety and depression symptoms were assessed by a short version of the Hopkins Symptom Checklist (HSCL), the five-item HSCL-5. Self-reported family financial stress was measured using a single-item question. Parental anxiety and depression were assessed by the 14-item Hospital Anxiety and Depression Rating Scale (total HADS score). Parental income and parental education were obtained from SSB. We use a multilevel mixed-effects generalised linear model. Adolescents who perceived their family financial stress as worse than others reported a higher SCL-5 total score compared with those with self-perceived average financial stress. The relative differences ranged from 1.16 (95% CI 1.09 to 1.23) in boys to 1.24 (95% CI 1.17 to 1.31) in girls. In contrast, little or no association was found between parental registry-based income or educational level and adolescents' mean SCL-5 total scores. Adjusting for parental HADS scores did not alter the estimates. With a few exceptions for girls, there was no evidence for a secular change in these associations. Self-perceived family financial stress, but not registry-based parental income and education, was associated with elevated anxiety and depression symptom levels in adolescents, and findings were essentially the same in Young-HUNT3 and Young-HUNT4. These findings underscore the importance of incorporating multiple measures of socioeconomic status when investigating socioeconomic inequalities in adolescent mental health.

Adolescent mental health in Sub-Saharan Africa remains critically understudied despite high burden estimates. We assessed the psychometric properties of Western-derived instruments, prevalence of depression and anxiety symptoms, associations with psychosocial and sociodemographic factors, and symptom network structures in a large multi-year sample of Kenyan adolescents. We administered depression (PHQ-8), anxiety (GAD-7), social support, perceived control, and wellbeing measures to 7865 Kenyan secondary school students aged 12-20 across three studies (2021-2023). Both PHQ-8 (&#x3b1;&#x2009;=&#x2009;0.70) and GAD-7 (&#x3b1;&#x2009;=&#x2009;0.78) demonstrated adequate reliability, and confirmatory factor analyses supported unidimensional structures with acceptable fit (PHQ-8: RMSEA&#x2009;=&#x2009;0.052, CFI&#x2009;=&#x2009;0.945; GAD-7: RMSEA&#x2009;=&#x2009;0.056, CFI&#x2009;=&#x2009;0.970). Overall, 30.3% (95% CI 29.3-31.3%) and 25.1% (95% CI 24.2-26.1%) of participants met the &#x2265;&#x2009;10 cut-off for clinically elevated depression and anxiety symptoms, respectively, with descriptive variation across study years (2021: 42.1% [39.6, 44.6%], 37.5% [35.1, 40.0%]; 2022: 25.3% [23.8, 26.8%], 21.7% [20.3, 23.2%]; 2023: 29.7% [28.1, 31.3%], 22.5% [21.1-24.0%]); direct year-on-year comparison is limited by differences in wave composition. Mixed-effects modelling identified social support (B&#x2009;=&#x2009;-&#x2009;0.08) and perceived control (B&#x2009;=&#x2009;-&#x2009;0.29 for depression, B&#x2009;=&#x2009;-&#x2009;0.24 for anxiety) as robust protective factors. Final-year students showed elevated symptoms (B&#x2009;=&#x2009;0.93, B&#x2009;=&#x2009;0.77), as did students in girls' schools relative to mixed schools (B&#x2009;=&#x2009;1.35, B&#x2009;=&#x2009;1.27). Perceived academic ability showed a strong inverse gradient with both outcomes (excellent ability: B&#x2009;=&#x2009;-&#x2009;2.51 for depression, B&#x2009;=&#x2009;-&#x2009;1.76 for anxiety). Network analysis identified worry-related symptoms as most central, with hopelessness and nervousness serving as the primary bridges between depression and anxiety domains. Western-derived measures demonstrated adequate psychometric properties with Kenyan adolescents. Depression and anxiety were highly prevalent and varied by sex, school form, and school type. Social support and perceived control were the strongest protective factors; academic pressure and girls' school attendance were associated with elevated symptoms. Network analyses identify worry, hopelessness, and negative self-evaluation as possible candidate intervention targets warranting empirical evaluation. These findings underscore the urgent need for contextually grounded, school-based mental health provision in Kenya and comparable Sub-Saharan African settings.

The cystic fibrosis transmembrane conductance regulator (CFTR) modulators were shown to improve clinical symptoms in patients with cystic fibrosis (CF). However, the effects of modulator therapy on the mental health of patients with CF remain uncertain. We aimed to investigate the impact of the CFTR modulator therapy on the mental health of children with CF and their parents. This prospective observational study was conducted on children with CF who used modulator therapy (Group 1, n&#x2009;=&#x2009;24) and those who did not (Group 2, n&#x2009;=&#x2009;29) and parents (n, 53). Cystic Fibrosis Quality of Life Questionnaire (CFQ-R), Children's Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED) were applied to patients. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF) were administered to parents. There was no significant difference between the groups in demographics. SCARED scores were higher in patients who did not use modulator therapy (p&#x2009;=&#x2009;0.016). Anxiety and depression scores of BDI and BAI scales applied to parents were found to be statistically significantly higher in parents of patients who did not use modulator therapy (p&#x2009;=&#x2009;0.006, p&#x2009;=&#x2009;0.002, respectively). WHOQOL-BREF scores were higher among parents of patients who used modulator therapy, but the difference was not statistically significant (p&#x2009;=&#x2009;0.060). These findings suggest a possible association between CFTR modulator use and lower anxiety and depression scores in both patients and parents, though causal conclusions cannot be drawn from this observational study. &#x2022; CFTR modulator therapies have been increasingly used in recent years with demonstrated beneficial effects on clinical outcomes. &#x2022; The effects of CFTR modulator therapies on mental health are not yet clearly defined. &#x2022; CFTR modulator use was associated with lower anxiety scores in children with cystic fibrosis and lower anxiety and depression scores among their parents. &#x2022; These findings suggest a potential early psychosocial benefit of CFTR modulator therapy for both patients and caregivers; however, they should be interpreted cautiously because the observational design does not allow causal conclusions.

Suicide attempts (SA) and non-suicidal self-injury (NSSI) are closely related phenomena, both common in adolescent clinical samples. This study examined whether neurobiological markers could enhance the prediction of SA and NSSI over a 2-year period, beyond established clinical predictors and age, in a high-risk sample of female adolescents engaging in NSSI. A total of n&#x2009;=&#x2009;63 (age: M&#x2009;=&#x2009;15.1 years, SD&#x2009;=&#x2009;1.45) female adolescents with NSSI were recruited from our outpatient clinic for risk-taking and self-harming behaviour (AtR!Sk) at the Clinic for Child and Adolescent Psychiatry, University Hospital of Heidelberg, Germany. Machine learning models (linear and logistic regression; elastic net regression; support vector machines with repeated cross-validation) were applied. We tested whether the inclusion of biomarkers (thyroid-stimulating hormone [TSH]; free triiodothyronine [fT3]; adrenocorticotropic hormone [ACTH]; dehydroepiandrosterone sulfate [DHEA-S]; resting heart rate variability [rHRV]; pain threshold) improved prediction of SA and NSSI remission - defined as the absence of any NSSI episodes - over a two years period, beyond clinical variables (past SA; symptoms of borderline personality disorder [BPD]) and age. Models predicting SA that included biomarkers, clinical variables, and age, showed moderate predictive accuracy (AUC: 0.76-0.82), however not higher than when only including clinical variables and age. The strongest predictors were past SA (OR&#x2009;=&#x2009;7.28), followed by fT3 (OR&#x2009;=&#x2009;0.16) and TSH (OR&#x2009;=&#x2009;0.35). The SA prediction models showed high specificity but low sensitivity, indicating strong performance in identifying negative cases but poor detection of positive cases. Models predicting NSSI, including the same variables, did not consistently outperform chance levels and showed low specificity and sensitivity. These findings support the use of machine learning models to predict SA in high-risk adolescents but show that prediction is driven mainly by established clinical features (past SA; BPD) and age, with no added benefit from neurobiological markers. Moreover, all models were more effective at identifying negative than positive cases. Given the small sample size and class imbalance, findings should be interpreted cautiously and require replication in larger and independent samples.

Fear of progression (FoP) represents a significant psychological burden for pediatric cancer patients and their parents. This study investigates FoP levels across acute treatment (AcT) and follow-up care (FuC) and examines trajectories over time, associated sociodemographic factors, and parent-child associations. It also proposes clinically relevant thresholds for psychosocial care. A total of 171 patient-parent dyads participated in a cross-sectional and longitudinal study. Children aged 7-18 and one parent per child completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). Data were collected during AcT (two time points) and FuC. Statistical analyses included nonparametric tests and correlation analyses. FoP levels were significantly lower during FuC compared to AcT for both children and parents, and parental FoP decreased over the 1-year follow-up period. Parents consistently showed higher FoP than their children, and a significant parent-child correlation emerged in FuC. FoP was higher in girls and was positively associated with child age and negatively associated with parent age. Using suggested thresholds, 57.8% of parents showed dysfunctional FoP. Among children, 45.2% reported low, 40% moderate, and 14.8% high FoP. Although levels of FoP are lower in FuC than in AcT, they remain a prevalent burden-particularly for younger parents, older children, and girls. The observed parent-child associations highlight the need for family-oriented psychosocial care. A proposed three-stage cut-off (low, moderate, high FoP) may guide clinical decision-making and support tailored treatment strategies. Routine screening and preventive approaches are recommended to mitigate FoP and its potential intergenerational transmission. The study has been pre-registered at the German Clinical Trials Register (DRKS 00022034, registered 29th of June 2020) and at the Open Science Foundation (https://osf.io/fuahc).