The rapid rise in internet access and smartphone use has significantly changed how children and adolescents engage in screen-based activities. To date, no systematic review has examined long-term trends in screen time use among children and adolescents that cover periods before and after the onset of the COVID-19 pandemic. This systematic review examined repeated cross-sectional studies to determine whether screen time use among children and adolescents changed over time. This systematic review was registered with PROSPERO (ID: CRD42021243869). The Web of Science, PubMed, Embase, and PsycINFO databases were searched to identify peer-reviewed studies that had been published in English, included data from at least two time points, and focused on children and adolescents between 0 and 19 years of age. The search was conducted without any restrictions on publication year. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis was conducted following the Synthesis Without Meta-analysis guidelines. This review identified 60 studies covering the period 1991-2022. The findings indicate that traditional TV watching declined while the use of computers and video games grew. Screen time increased significantly over the years, especially after the COVID-19 pandemic started. The studies reviewed varied in how they defined and measured screen time. The review underscores the importance of continued research and evidence-based policies to guide responsible technology use in the lives of young people. The rapid spread of internet access and smartphones has changed how children and adolescents use digital technologies in their everyday lives. This systematic review looked at 60 studies from around the world to understand how screen time has changed over time from 1991 to 2022, including during the COVID-19 pandemic. Before the pandemic, screen use was increasing gradually, with traditional TV watching decreasing while computer use, video gaming, and mobile phone use grew. The COVID-19 pandemic caused a sharper rise in screen time as children and teenagers relied on screens for school, social interactions, and entertainment during lockdowns. Studies showed that both boys and girls spent more time on screens, though boys tended to spend more time gaming. Younger children generally spent less time on screens than older children, and children from higher-income families often spent slightly less time on screens, although the pandemic increased their screen use too. The review also highlighted that studies measure screen time in different ways, making it hard to compare results. Most studies focused on how long children spent on screens, but few looked at what they were actually doing online. While technology provides benefits like learning, social connection, and creativity, excessive screen time can be linked to problems such as poor sleep, lower physical activity, weight gain, mental health challenges, and exposure to harmful online content. The review concludes that screen time among children and teenagers has generally increased over the past decades, especially after the pandemic started. It recommends that parents, schools, and communities guide young people to use technology in a balanced and safe way, combining digital skills with physical activity, sleep, and offline experiences. Future research should explore not just how much time children spend on screens, but also the type and quality of screen activities.
Oppositional Defiant Disorder (ODD) often occurs with or without Conduct Disorder (CD) symptoms, yet it is unclear whether these presentations differ meaningfully in parenting, parent mental health, or co-occurring child difficulties. Using parent-report data from a cross-sectional, nationally representative sample of 1,000 children aged 5-12 years, this study compared those who screened positive for both ODD and CD, ODD only, or neither condition across measures of child and parent psychopathology and parenting practices and knowledge. Children with both ODD and CD showed broad elevations in anxiety, depression, and attention problems, along with higher rates of parent anxiety and depression. Their parents also reported poorer supervision, less positive parenting, and more inconsistent and harsh discipline. In contrast, children with ODD alone displayed moderate elevations in symptoms but largely normative parenting knowledge and discipline practices, differing little from those without disruptive behaviors. Findings highlight distinct symptom patterns associated with ODD with and without CD and underscore the importance of assessing these disorders separately. Clinicians should evaluate both child and parent mental health when ODD is present and tailor interventions accordingly. Moving beyond a "one-size-fits-all" approach may improve outcomes by aligning treatment strategies with each family's unique constellation of symptoms and functioning. Children who often argue, refuse to follow rules, or show anger toward adults may have Oppositional Defiant Disorder (ODD). Some children with ODD also show more serious behaviors, such as aggression or rule-breaking, which are symptoms of Conduct Disorder (CD). It is not well understood whether children with ODD alone differ from those who have both ODD and CD, especially in terms of parenting and family mental health. In this study, parents of 1,000 children aged 5 to 12 across the United States reported on their child’s behavior, their own mental health, and their parenting practices. We compared three groups of families: those whose children screened positive for ODD only, ODD with CD, or neither condition. Children with both ODD and CD had much higher levels of anxiety, depression, and attention problems, and their parents also reported higher levels of anxiety and depression. These parents described more challenges with parenting, such as less supervision and more inconsistent or harsh discipline. In contrast, children with ODD alone showed only modest emotional and behavioral difficulties, and their parents reported largely healthy parenting. Children with both ODD and CD may need more intensive, combined support for both parent and child mental health, while children with ODD alone may benefit from more targeted, focused interventions.
BackgroundEmotional and behavioral problems (EBPs) in children significantly influence developmental domains, including interpersonal relationships, academic performance, and life skills.MethodsA cross-sectional study was adopted with purposive sampling. The study includes 120 children aged 6-14 years from West Bengal, equally divided into groups with and without EBPs. Standardized tools such as the Pediatric Symptom Checklist (PSC), Child Interpersonal Relationships and Attitudes Assessment (CIRAA), Academic Performance Scale (APS), and Life Skills Assessment Scale (LSAS) were used.ResultsChildren with EBPs significantly scored lower in interpersonal relationships (p = .015) and life skills (p < .001) compared to peers without EBPs. However, they seem to scored slightly better in academic performance (p = .026). Correlation analyses showed a weak but significant relationship between EBPs and interpersonal relationships (r = 0.198, p = .030), a negative correlation with academic performance (r = -0.217, p = .017), and a moderately strong positive correlation with life skills (r = 0.457, p < .001).ConclusionThese EBPs obstruct the development of interpersonal and life skills, while their impact on academics varies with contextual factors. Thus, the study stresses that interventions should provide academic support, social-emotional learning and life skills training in schools and communities. Our recent study examined how emotional and behavioral problems in children affect their daily lives and development. We have collected the data from 120 children between 6 and 14 years old in India. We wanted to understand how these challenges impact three important areas of children’s lives: their relationships with others, their performance in school, and their ability to handle everyday tasks and situations. Using several assessment tools designed for children, we measured how well the kids were doing in each of these areas. We found that children dealing with emotional and behavioral problems had noticeably more difficulty forming and maintaining relationships with friends, family, and teachers compared to children without these issues. They also struggled significantly more with everyday life skills things like managing their time, solving problems, making decisions, and coping with stress. We found that emotional and behavioral problems had a moderate to strong relationship with life skills difficulties, meaning children with more emotional challenges typically struggled more with handling daily situations. The connection with relationships and academic performance was weaker but still noticeable. Our study’s key message is clear: emotional and behavioral problems in children create real obstacles in developing social connections and practical life skills, even though their effect on schoolwork may vary. This means that schools and communities need to provide comprehensive support not just helping children keep up academically, but also teaching them how to manage emotions, build healthy relationships, and develop the skills they need to navigate life successfully.
Little is known about the psychological impact of community crime in older victims, whether signposting to their general practitioner is helpful, or the barriers and facilitators to help-seeking. Previous pilot work suggested that a 'cognitive-behavioural therapy'-informed Victim Improvement Package showed promise for treating psychological distress in older victims, but further evaluation was needed. The study was undertaken between June 2017 and June 2023 in selected areas of a United Kingdom city using Safer Neighbourhood Teams. Safer Neighbourhood Teams consist of a group of police personnel, working across several local authority areas, who are dedicated to managing victims in the community. Within 2 months of the crime, police Safer Neighbourhood Teams screened 3192 victims, aged 65 or over who had reported a crime, for psychological distress using the Generalised Anxiety Disorder-2 and Patient Health Questionnaire-2 items. Those identified as distressed were advised (signposted) by the police to seek help from their general practitioner. The impact of signposting was evaluated using qualitative and quantitative methods. At 3 months post crime, 877 older victims were reassessed by our researchers and, if still distressed, invited to participate in a randomised controlled trial. This compared the addition of our Victim Improvement Package to treatment as usual against treatment as usual alone. The Victim Improvement Package used a manual to guide our talking therapy (cognitive-behavioural therapy), delivered individually and weekly, for up to an hour by a mental health charity. Up to 10 sessions were offered. The Beck Depression Inventory, version 2, and the Beck Anxiety Inventory, combined in a composite score, were used to evaluate clinical effectiveness. Measures were collected at baseline (3 months post crime), post intervention (primary end point) and follow-up; 6 and 9 months post crime, respectively. Cost-effectiveness was evaluated using the EuroQol-5 Dimensions and a modified Client Service Receipt Inventory. The police screened 24% of older victims (n = 17,611) in our selected areas. A third of the police-screened victims were significantly distressed, and for those we rescreened at 3 months post crime, almost half remained distressed. Few distressed older victims (13%) approached their general practitioner (barriers included wait times and personal beliefs they should cope), and only a third of those who did so received help. One hundred and thirty-one participants were randomised (65 = Victim Improvement Package; 66 = treatment as usual) at 3 months post crime. The primary outcome was completed in 87 (66.4%). The Victim Improvement Package was acceptable to participants, although it was not possible to recruit our target sample of 226, because of a number of hurdles, which included changes in police leadership, the coronavirus disease discovered in 2019 pandemic and possible reduced confidence in the police. We report on these, the lessons learnt, and make recommendations for further research. No treatment effect was found for the Victim Improvement Package. Mean Victim Improvement Package -0.41 (standard deviation 0.89) versus mean treatment as usual -0.19 (standard deviation 1.11); adjusted difference in means -0.039, 95% confidence interval (-0.39 to 0.31) and the Victim Improvement Package was not cost-effective. Recruitment was challenging, with insufficient numbers recruited to meet the sample size calculation. While appearing representative of the population, only 0.7% (131/17,611) of older victims reporting a crime participated in the trial. Assessing the quality of delivery of cognitive-behavioural therapy was challenging. Crime significantly psychologically impacts older victims, with chronicity of symptoms. Distress can be identified by incorporating screening into routine police visits. While Victim Improvement Package remains acceptable and promising, more research is needed, including the feasibility of using typical clinical services to assess clinical effectiveness. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 13/164/32. Many older people are adversely psychologically affected by a community crime but do not seek formal help. Our review of existing research suggested a talking therapy called cognitive-behavioural therapy may be promising for treating distress, but it is unclear whether it specifically helps older crime victims. The police identified and screened older victims of crime for distress within 2 months of a crime through face-to-face visits or over the telephone using two questions about mood and worry, respectively. Distressed victims were advised to see their general practitioner for help. We then reassessed older victims 3 months after the crime to see who had acted on our advice and whether they remained upset. Those still distressed were offered the opportunity to participate in a trial comparing 2 interventions: usual care alone or usual care plus up to 10 cognitive–behavioural therapy sessions, adapted for crime victims and delivered by a mental health charity. The treatment intervention was decided at random by a computer. The responses to the interventions were determined using two questionnaires measuring low mood and anxiety, respectively. Two-fifths of older victims were distressed within 2 months of a crime, and only 15% of these had taken up the advice to see their general practitioner. Half of distressed victims reassessed were still distressed at 3 months. Because of service demands on the police caused by public events, the COVID-19 pandemic, changes in the priorities of police leads and possibly decreased public confidence in the police, we could not recruit enough people to determine whether cognitive–behavioural therapy was effective, and we found the quality of therapy needed improving. Community crime impacts older people, distress is sustained, but help is rarely sought. In addition to the police, further research may consider working with a range of other agencies, such as the charities, to enhance recruitment and retention of older victims. Conflicting service demands make needed research in this population challenging.
Cystic fibrosis (CF) is a genetic disorder with significant physical and psychological impacts. CFTR modulators (CFTRm) have transformed CF care. Although CFTRm have transformed CF care, genetic eligibility creates distinct patient experiences. This study evaluates the psychological impact of genetic CFTRm eligibility status on children with CF and their caregivers. This cross-sectional study included 118 children with CF and their primary caregivers. Psychological assessments were performed by the child psychiatry team. Children completed the Child Attitude Toward Illness Scale (CATIS), Brief Illness Perception Questionnaire (BIPQ-Patient), and Children's Hope Scale (CHS). Caregivers completed the Beck Hopelessness Scale (BHS), Strengths and Difficulties Questionnaire (SDQ), and BIPQ-Caregiver. Clinical and demographic data were collected, and analyses were stratified according to CFTRm genetic eligibility and the presence of bronchiectasis. Among participants, 53.39% (n = 63) were genetically eligible for CFTRm, while only 35.59% (n = 42) were actively receiving treatment. Genetically eligible children demonstrated higher levels of hope and a more positive perception of their illness compared with genetically ineligible children. Among patients without bronchiectasis, psychological outcomes did not differ between eligibility groups. In contrast, among those with bronchiectasis, modulator-eligible children reported greater hope and more positive attitudes toward their disease, and their mothers also reported higher levels of hope.  Genetic eligibility for CFTRm is associated with meaningful differences in psychological well-being among children with CF, particularly in those with more advanced lung disease. These findings suggest that eligibility status itself may function as a psychosocial determinant and should be considered when delivering patient-centered care for children with CF and their families. • CF is associated with increased psychological burden in both children and their caregivers. • Although CFTR modulators have transformed cystic fibrosis care, access remains limited, and real-world use may be affected by factors such as genetic eligibility, treatment adherence, and potential adverse effects. • Children with CF who are genetically eligible for CFTR modulator therapy-particularly those with advanced lung disease-report higher levels of hope, more positive attitudes toward their illness, and lower perceived illness threat than ineligible peers.
Amid growing global concern about child and adolescent mental health problems and their long-term consequences, research in this area is increasingly critical. Population-representative datasets are valuable resources for addressing these challenges. The Mental Health of Children and Young People (MHCYP) 2017 survey was designed to meet this need in England. The 2017 survey included 9117 children and young people aged 2 to 19 years. Information was collected from parents or carers (hereafter referred to as 'parents'), and for those aged 11 years or over, directly from the young people themselves, as well as from teachers. The baseline assessment used the standardised Development and Wellbeing Assessment (DAWBA), based on ICD-10 and DSM-5 diagnostic criteria. The subsequent waves in 2020, 2021, 2022 and 2023, measured mental health difficulties using the Strengths and Difficulties Questionnaire (SDQ). The MHCYP 2017 survey and its follow-up waves provide population-representative data on children and adolescents in England, encompassing a range of mental health disorders and difficulties-from eating disorders and attention and hyperactivity disorder to depression and anxiety, with longitudinal data on mental health, social situation and activities during the Covid-19 pandemic. It builds on earlier UK representative surveys conducted in 1999 and 2004. Togetherwith the 1999 and 2004 surveys, this dataset offers a unique opportunity to investigate trends in mental health disorders among young people, assess associated difficulties and comorbidities, and explore links with socio-economic factors. The MHCYP 2017 survey and follow-ups offer valuable cross-sectional data for understanding child and adolescent mental health trends in the UK, with longitudinal data from four subsequent surveys conducted between 2020 and 2023.
IntroductionLimited research has examined the circumstances surrounding childhood suicidal thoughts and behaviors. The interpersonal psychological theory of suicide proposes that suicidal desire arises from perceived burdensomeness and thwarted belongingness, and that suicide attempts result from an acquired capability for suicide. No published study, of which we are aware, has tested whether this theory applies to children's suicidal thoughts or behaviors. The present study examined whether components of the interpersonal psychological theory of suicide would be present in the narratives of children who presented for clinical care with suicide ideation or attempts.MethodsThirty-nine children, ages 7-12 years, recruited from two public hospitals and one outpatient clinic, completed semi-structured interviews assessing the circumstances surrounding their recent suicide ideation or attempts. Interviews were analyzed thematically using a hybrid inductive-deductive approach.ResultsFindings indicated that thwarted belongingness stemmed from loneliness, perceived rejection, and a lack of reciprocal care. Themes reflecting perceived burdensomeness included internalized criticism, low self-esteem, and perceived liability. Children described experiences, such as physical punishment, that may contribute to acquired capability for suicide.DiscussionThese findings support the relevance of the interpersonal psychological theory of suicide in childhood and underscore the critical role caregivers play in protecting children from suicide-related risk. There is very little research that has tried to understand what leads children to think about and attempt suicide. Our study tried to fill this gap in the literature. We interviewed children who went to a hospital after having suicidal thoughts or behaviors to better understand whether how they described what led them to think about or attempt suicide was consistent with one of the most prominent theories of suicide -- the Interpersonal Theory of Suicide. This theory was developed with and has been studied primarily with adults, and to a lesser degree, with adolescents. However, its relevance to children is unknown. By analyzing children’s descriptions of their recent suicidal crises, we found that children described what led to their suicidal thoughts or attempts in ways consistent with this theory. Specifically, themes that arose in their descriptions reflected feeling like a burden to others, lack of belonging, hopelessness about the future, and experiences that reflected being capable of suicide. For example, children who seemed to see themselves as a burden to others described feeling that others would be better off without them, seemed to internalize others’ criticisms of them, and experienced low self-esteem. Children who described lack of belonging did so in ways that suggested they were lonely, felt rejected by others, and saw themselves as caring more about others than others cared about them. Our results suggested that the Interpersonal Theory of Suicide can be used to understand children’s suicidal thoughts and behavior, although with some differences from older age groups.
IntroductionResilience in adolescence has been widely studied, yet most instruments used to assess it were created in Anglo-Saxon contexts and often lack cultural resonance in Latin America. This study examined the factor structure and psychometric properties of the VOLANTÍN Resilience Capabilities Scale, a Chilean instrument designed to capture culturally meaningful expressions of resilience in school settings.MethodA total of 3,934 students aged 10-18 from public schools in Chile completed the scale and an established mental health screening measure. The sample was randomly divided to conduct exploratory and confirmatory analyses using methods appropriate for ordinal data and systematic criteria for refining items.ResultsThe analyses supported a coherent 19-item structure with four dimensions (Self-esteem, Prosocial Behavior, Perseverance, and Emotional Regulation) explaining 51.7% of the variance. Items with unstable patterns were removed. The confirmatory analysis showed strong overall fit (CFI = .953; TLI = .946; RMSEA = .058; SRMR = .055) and supported a hierarchical model with an overarching resilience factor.DiscussionThe VOLANTÍN Scale emerges as a culturally grounded, concise, and psychometrically robust measure of adolescent resilience in Chile. Its properties make it suitable for school-based screening, applied research, and interventions that require contextually sensitive assessments. Resilience refers to the ability of young people to cope with difficulties, recover from stressful experiences, and continue developing in a healthy way. During adolescence, this capacity is especially important, as young people face emotional, social, and academic challenges that can affect their mental health and well-being. However, many existing tools used to measure resilience were developed in specific cultural contexts and may not fully capture how resilience is expressed in everyday life across diverse settings. This study presents the development and evaluation of a brief, practice-based tool designed to assess key resilience capacities in adolescents. The scale focuses on four core areas that are commonly observed and strengthened in clinical and psychosocial practice: self-esteem, prosocial behavior, perseverance, and emotional regulation. These areas reflect how adolescents relate to themselves, to others, and to challenging situations. The tool was tested with a large group of adolescents aged 10 to 18. Advanced statistical analyses were used to examine whether the items worked together in a clear and consistent way. The results showed that the scale has a solid structure, good reliability, and performs similarly across different age groups and between girls and boys. Higher resilience scores were also linked to fewer emotional and behavioral difficulties, supporting the usefulness of the measure. Overall, this assessment tool offers a concise and reliable way to capture important resilience capacities in adolescents. Its clear language and practical focus make it suitable for use in research, clinical settings, and applied programs that aim to understand and support adolescent mental health and positive development.
BackgroundEarly-onset depression contributes significantly to long-term disability and suicide, making high-quality healthcare for young people with depression a critical concern. Medical record review (MRR) is widely used to assess healthcare quality. However, its application to depression care for children and adolescents appears underexplored, with no consensus on conceptualising or measuring quality. This systematic review aimed to evaluate how quality was operationalised in primary studies using MRR in this context.MethodsA structured search in PubMed, CINAHL, and PsycInfo following PRISMA guidelines identified 1,690 unique articles. Studies using MRR to evaluate outpatient depression healthcare quality for patients ≤17 years were included. Thematic synthesis was applied, focusing on methods, indicator themes, and quality framework alignment.ResultsSix studies published in 2005-2022 were included. These used 3-32 indicators covering risk assessments, diagnostic assessment, treatment, and monitoring, but indicators and operationalisation methods varied widely. Two studies reported using consensus methods. None incorporated the Institute of Medicine or World Health Organization quality frameworks. Binary opportunity indicator assessments were standard, but methods for deriving composite measures differed.ConclusionsDespite shared themes, heterogeneity and lack of framework alignment limit comparability. Robust operationalisation methods ensuring indicator reliability and validity would strengthen future measurement of depression healthcare quality. Why This Study Was DoneDepression in young people is a major cause of long-term health problems and suicide, making access to high-quality care especially important. Researchers often use medical records to understand how well care is delivered, but this approach appears to be rarely used to assess the quality of depression care for children and adolescents. There is also no clear agreement on how to define or measure quality in this context.What Was DoneResearchers searched three major databases (PubMed, CINAHL, and PsycInfo) for studies that used medical records to assess the quality of outpatient depression care for young people aged 17 and under. After screening 1,690 articles, six studies published between 2005 and 2022 met the inclusion criteria. The researchers examined how each study defined and measured quality, which areas of care they evaluated, and whether established quality frameworks were used to guide the assessments.What Was FoundThe six included studies used 3–32 indicators each to assess areas such as risk evaluation, diagnosis, treatment, and monitoring. However, the indicators themselves and how they were defined varied widely. Only two studies described using consensus-based methods to develop their indicators, and none used quality frameworks from the Institute of Medicine or the World Health Organization. All studies used simple yes/no checklists to determine whether specific actions had been documented, but the ways they grouped or summarised indicators differed.What This MeansAlthough the studies addressed similar areas of care, the lack of standardisation in how quality was defined and measured makes the findings difficult to compare. To support better care for young people with depression, future research would benefit from clearer and more reliable ways to define and measure healthcare quality.
IntroductionTrauma-informed care (TIC) has been promoted as a way for services to be aware and respond to the potential impact of trauma. Although professionals are encouraged to adopt it in routine practice, understanding of TIC is often unclear. A TIC training provider sought advice how to improve training for professionals working with children and adolescents.MethodThis qualitative study explored participants' understanding of TIC after being trained, experiences of barriers and facilitators to implementing TIC, and recommendations to improve training. Nine professionals from health, social and education services completed semi-structured interviews. Participants varied in age and experience but lacked ethnic and gender diversity.ResultsA model of behavior change (COM-B: capabilities, opportunities, motivation, behavior) guided analysis. Participants described an understanding of TIC consistent with current guidelines, with some divergence regarding responsibility for using TIC and the conceptualization of trauma. Facilitators and barriers to TIC implementation were shaped by these perceptions. Some barriers could be addressed through training, while others require more systemic change, (e.g. shared TIC language; increased resources). Suggested training improvements included clarifying definitions and roles, increasing hands-on practice, and training of supervisors.DiscussionFindings offer theory-driven contributions to the evidence-base of TIC understanding, facilitators and training improvement. Traumatic events, such as abuse, can negatively affect mental and physical health. Individuals who have experienced trauma are vulnerable to distress or re-traumatization as a result of healthcare experiences. Understanding this, led to the development of trauma-informed care, which encourages service providers to respond to clients’ needs by being “aware, sensitive, and responsive to the potential impact of trauma.” Trauma-informed care is intended for use by all professionals, from administrators to therapists and teachers, across mental health services, hospitals and schools. In the UK, services are advised to adopt trauma-informed care and train staff accordingly. However, staff often remain confused about what trauma-informed care actually means, how to put it into practice, and how trainings can be improved. A service providing trauma-informed care training for professionals working with children and young people sought advice on how to improve their trainings. The study explored professionals’ understanding of trauma-informed care after training, what helps and hinders their use of trauma-informed care in practice, and recommendations to improve training. Interviews were completed with 9 professionals across young people’s health, social and education services. A psychological model of behavior change guided the analyses of these interviews. Participants generally understood trauma-informed care, with minor differences on who is responsible for using it and what trauma means. Depending on how they understood trauma-informed care, they described different things that helped or stood in the way of using it. Based on this learning, this paper makes recommendations on how to improve trauma-informed care trainings.
The concepts of Clinical High Risk of psychotic transition (CHRp) and emerging psychosis are rapidly evolving. Their development and assessment have been mainly driven by adult psychiatry. However, adolescents present developmental and psychological characteristics that the CAARMS does not fully explore. In CHRp adolescents, the specificity of the psychotic transition -i.e. the ability to distinguish early psychotic symptoms from other developmental or psychiatric phenomena- is low.The aim of this study is to illustrate the particularities of our Clinical High Risk of psychotic transition (CHRp) diagnostic outpatient clinic: Specialized Clinic for CHRp. The clinic is designed to improve the accuracy of identifying adolescents truly at risk of psychotic transition.We present the case of a 14-year-old girl referred to our outpatient clinic with suspected CHRp. This clinical case describes the different phases of her evaluation: the CAARMS assessment, the neurodevelopmental and attachment history, the collaborative interview and the summary.Combining adult psychiatry's expertise in emerging psychosis with the child and adolescent psychiatrist's specific knowledge of differential diagnoses and neurodevelopment at this age may enhance the accuracy of psychotic transition in CHRp adolescents. Adolescence is a period when changes in thoughts and emotions can sometimes look like early signs of psychosis, but most of these experiences are not the beginning of a psychotic disorder. This report presents the case of a 14-year-old girl evaluated for a possible risk of psychosis. Using both adult assessment tools and child psychiatry expertise, we highlight how understanding developmental history, attachment, and anxiety can help clinicians make more accurate evaluations. Our goal is to improve the accuracy of detecting true risk of psychosis in young people, while avoiding overdiagnosis.
Adverse events across the lifespan have been linked to poorer health outcomes, but the biological mechanisms remain unclear. The aim of this study was to quantify the independent and joint associations of adversity experienced in childhood and/or adulthood with molecular, clinical and functional markers of biological ageing. We analysed data from up to 153,557 middle-aged and older adults in the UK Biobank. Adversity was assessed through questionnaires capturing five types of childhood and adulthood adverse events. Biological ageing markers included metabolomic age (MileAge) delta, a metabolomic mortality profile, the frailty index, telomere length and grip strength. Regression models were adjusted for age, sex, education, income, ethnicity and neighbourhood deprivation. Across childhood and adulthood exposures, adversity and its severity were most consistently associated with higher frailty index values. The strongest associations were observed in individuals exposed to multiple types of adverse events. Individuals who experienced adversity in both childhood and adulthood also had a metabolite-predicted age exceeding their chronological age and lower grip strength. Abuse was more consistently associated with biological ageing markers than neglect. Cumulative exposure to adversity across childhood and adulthood is associated with older biological ageing profiles across multiple domains. These findings highlight biological ageing as a potential pathway linking adversity to poor health outcomes and premature mortality.
BackgroundResearch on adolescent emotional regulation and resilience has largely developed in separate domains, with little integration to provide a holistic perspective. Most prior studies have focused on clinical populations or specific emotional difficulties, leaving the school context underexplored. In addition, limited attention has been given to background variables and the use of culturally appropriate instruments and strategies.MethodThis study was conducted among 9th-grade students in the SS Kulum block to assess emotional regulation and resilience. A cluster-randomized method was used, with two schools chosen randomly through a lottery approach. Students with prior exposure to resilience training, emotional skill development, personality development, or life skills programs, as well as those with psychiatric or chronic illnesses, were excluded. Ethical approval was obtained from KMCH and SRIHER Ethical Committees, with formal consent from the school principal. Informed written consent and student assent were secured, and confidentiality was strictly maintained.ResultsThe mean emotional regulation score was 20.30, while the average resilience score was 65.63. These findings suggest that students demonstrated low resilience and challenges in emotional regulation.ConclusionThe study highlights the need for integrated, targeted school-based interventions to strengthen emotional regulation and resilience, thereby enhancing adolescents' psychological well-being and adaptive functioning. This study explores how secondary school students manage their emotions and recover from difficult situations in their daily lives. These abilities are important because they help young people handle stress, perform better in school, and maintain good mental health. The research was carried out among 9th-grade students from selected schools in Coimbatore. A total of 150 students participated after obtaining consent from schools, parents, and students. Standard questionnaires were used to measure how well students regulate their emotions and how resilient they are when facing challenges. The findings showed that most students had only moderate skills in managing their emotions, and many had low to moderate levels of resilience. Only a small number of students showed strong emotional control and high resilience. Differences were observed based on factors such as gender, family income, parental education, and family background. For example, girls generally showed better emotional control and resilience than boys. Students from families with higher income and more educated parents tended to cope better with stress and challenges. Overall, the results indicate that many students need support in developing stronger emotional skills and resilience. Schools can play a key role by introducing programs that teach students how to understand their feelings, manage stress, and adapt positively to difficulties. Strengthening these skills during adolescence can improve students’ well-being, confidence, and academic success, helping them grow into emotionally healthy and capable adults.
BackgroundTraditional bullying and cyberbullying have many negative physical and psychological consequences on adolescents.AimIn this study, the effects of a school-based bullying prevention program on adolescents' traditional bullying and cyberbullying victimization, tendencies and future expectations were examined.MethodThis research is a randomized controlled experimental study with a pretest-posttest design. The data of the study were collected adolescents studying a school in the Southeastern Anatolia Region of Turkey between September and October 2024. The study was completed with a total of 169 adolescents. The adolescents in the intervention group were included in the school-based bullying prevention program.ResultsAdolescents who were included in the school-based bullying prevention program had statistically significantly lower mean scores of physical victimization and bullying, verbal victimization and bullying, and relational victimization and bullying, and higher mean scores of future expectations total scale than adolescents who were not included in the program in the measurements made one month after the program.ConclusionsSchool-based bullying prevention program is effective in reducing traditional bullying and victimization of adolescents and increasing their future expectations. It is thought that school-based interventions to improve adolescents' future expectations will contribute to reducing bullying and victimization rates of adolescents. Traditional bullying and cyberbullying have many negative physical and psychological consequences on adolescents. In this study, the effects of a school-based bullying prevention program on adolescents’ traditional bullying and cyberbullying victimization, tendencies and future expectations were examined. This research is a randomized controlled experimental study with a pretest-posttest design. The data of the study were collected adolescents studying a school in the Southeastern Anatolia Region of Turkey between September and October 2024. The study was completed with a total of 169 adolescents. The adolescents in the intervention group were included in the school-based bullying prevention program. Adolescents who were included in the school-based bullying prevention program had statistically significantly lower mean scores of physical victimization and bullying, verbal victimization and bullying, and relational victimization and bullying, and higher mean scores of future expectations total scale than adolescents who were not included in the program in the measurements made one month after the program.School-based bullying prevention program is effective in reducing traditional bullying and victimization of adolescents and increasing their future expectations. It is thought that school-based interventions to improve adolescents’ future expectations will contribute to reducing bullying and victimization rates of adolescents.
ObjectiveThis study aimed to evaluate the performance of large language models-ChatGPT-4o and Gemini 1.5 Pro-in assessing suicide risk and guiding treatment in adolescents presenting to the emergency department with suicidal ideation and/or attempts.Materials and MethodsA retrospective review was conducted on child psychiatry consultation notes from 36 adolescents evaluated between February and March 2024. Structured clinical data were entered into ChatGPT and Gemini, and the resulting decisions were compared to those made by clinicians regarding hospitalization, sedation need, medication initiation, follow-up timing, and notification of social services or law enforcement.ResultsChatGPT showed higher concordance with clinicians than Gemini, especially in hospitalization (41.6% agreement) and sedation decisions (100% agreement). ChatGPT recommended hospitalization in 58.3% of cases, compared to 33.3% by clinicians and 36.1% by Gemini. For outpatient cases, ChatGPT demonstrated partial alignment with clinical decisions on medication and follow-up, while Gemini's responses were often uncertain or incomplete.ConclusionLarge language models show promise as decision-support tools in adolescent psychiatric emergencies. ChatGPT was more consistent with clinical judgments than Gemini. However, limitations remain, and further studies involving broader populations are needed before routine clinical integration. Suicide attempts in adolescents are serious and complex situations that require careful evaluation by clinicians. In this study, we compared how two artificial intelligence (AI) systems, ChatGPT and Gemini, perform in supporting clinical decisions for adolescents presenting to the emergency department after a suicide attempt. We used real clinical cases and asked both AI systems to make decisions about hospitalization, need for sedation, medication use, and follow-up timing. We then compared these decisions with those made by experienced clinicians. Our findings showed that ChatGPT generally performed closer to clinicians, especially in decisions such as sedation and follow-up planning. However, it also tended to recommend hospitalization more often, suggesting a more cautious approach. Gemini, on the other hand, showed more uncertainty and lower agreement with clinicians. Although AI systems showed some strengths in structured decision-making, they were not consistent across all areas and relied entirely on the information provided by clinicians. This means that they cannot replace human judgment. Overall, AI tools may be helpful as support systems, but final decisions should always be made by trained healthcare professionals, especially in sensitive situations such as adolescent mental health emergencies.
BackgroundSelf-guided Digital Mental Health Interventions (DMHIs) are increasingly used amongst young people as they are scalable and may improve access to support.ObjectiveTo assess the acceptability, feasibility, utility, and immediate effects of Project ABC-UK, a Single-Session Behavioural Activation DMHI for UK youth.MethodsA single group pre-post design was used. Participants (aged 13-18) completed demographics, as well as measures of hope, self-agency, hopelessness, and perceived control before and after the online intervention. It was completed anonymously, and participants gave feedback. T- and chi-square tests compared completers and non-completers; pre-post effects were assessed using paired t-tests with effect sizes (Cohen's d). Thematic analysis explored feedback.ResultsOf 799 participants, 401 (50.1%) completed the intervention, of whom 356 (88%) completed at least one post-intervention measure. Completers were more likely to be younger, have higher pre-intervention hope and self-agency, and to identify as sexual minorities. Significant improvements were found in hope and self-agency (d = -0.41), hopelessness (d = 0.52), and perceived control (d = 0.45). Most found the intervention enjoyable and useful.ConclusionFindings support the feasibility and acceptability of Project ABC-UK, with promising immediate effects on all outcomes. Future studies should assess effects on depression and anxiety at follow-up and compared to other interventions. Online mental health support can be useful for adolescents who find it difficult to access support from clinic based mental health services. Online mental health support can be made widely available on demand, meaning it could help adolescents when they need it, without waiting. It can also be made available anonymously, meaning they do not have to talk to adults to access it. We wanted to find out what UK adolescents (aged 13–18) thought about Project ABC, a self-help mental health support activity completed online, in one sitting. We asked adolescents to provide some demographic information about themselves, and to rate how hopeful/hopeless and in control of their life they felt before and after completing the Project ABC activity. They also provided some feedback on how they had found out about the activity, what they liked, and what could be improved or changed. In total, 799 adolescents agreed to take part in the activity, 401 completed the activity and 356 of them answered at least one question about feelings of hope/hopelessness and being in control of life after the activity. Younger adolescents (e.g., aged 13–15), adolescents who reported they had higher hope and control over their life before completing the activity, and sexual minority adolescents were more likely to complete the Project ABC activity. The activity also appeared to increase feelings of hope, and decrease feelings of hopelessness, and increase sense of control over life; adolescents also found it enjoyable and useful. To find out more about how the Project ABC activity compares to other options, future studies should compare it to other online mental health support activities, and also find out more about longer-term effects by including longer term follow up questionnaires.
BackgroundRecent data highlight problematic rates of mental health symptoms (MHS) among adolescents and young adults following the COVID-19 pandemic, with implications for early identification and clinical service provision. This study estimated the prevalence of MHS and its sociodemographic correlates among Canadian youths.MethodsWe conducted a cross-sectional analysis of 896 iundividuals aged 18-24 years using data from Statistics Canada's Survey on COVID-19 and Mental Health. Symptoms of anxiety, psychological distress, depression, and post-traumatic stress disorder (PTSD) were assessed using validated self-report instruments. Analyses included descriptive statistics, Pearson's chi-square tests, two-way analysis of covariance (ANCOVA), and multivariate linear regression.ResultsParticipants' mean (SD) age was 21.2 (2.0) years; 53% identified as women, and 81% lived in urban areas. Prevalence was highest for psychological distress (57.0%), followed by depression (31.6%), anxiety (23.7%), and PTSD symptoms (12.6%). Women reported higher anxiety and distress than men (p < 0.05). In multivariable analyses, female gender, non-essential worker status, poorer self-rated mental health, weaker community belonging, lower household income, lower life satisfaction, and pre-existing mental health disorder were associated with greater symptom severity (p < 0.05).ConclusionThe rising prevalence of mental health symptoms reflects gendered, socioeconomic, and psychosocial vulnerabilities, requiring trauma-informed clinical screening and equity-focused public health interventions for Canadian youth. Before the COVID-19 pandemic, approximately one in five Canadian youth experienced mental health symptoms annually, with limited access to appropriate care; only 20% received the help they needed. Hospitalization rates for mental health conditions were also increasing, signaling a growing public health concern. This cross-sectional study examines the prevalence and sociodemographic correlates of mental health symptoms among Canadian youth aged 18 to 24 during the COVID-19 pandemic. Using national survey data, we found that about 60% of respondents met the screening criteria for at least one mental health disorder, indicating a significant rise compared with pre-pandemic levels. Psychological distress was the most common condition, followed by symptoms of anxiety and depression. The findings revealed that women and youth experiencing socioeconomic or psychosocial disadvantages were disproportionately affected, reflecting intersecting vulnerabilities that compound mental health risks. In contrast, essential workers reported lower psychological distress levels, possibly due to heightened health awareness, stronger coping mechanisms, and a sense of social purpose linked to their occupational roles. These results underscore the urgent need for targeted mental health interventions, particularly for socioeconomically disadvantaged groups and young women. Strengthening accessibility, affordability, and inclusiveness of mental health services could mitigate long-term adverse outcomes. Moreover, identifying the youth demography at most risk may guide the development of community-based preventive and support strategies to enhance youth mental well-being during future public health crises.
Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.
Sleep problems in early childhood are common and may be shaped by maternal psychological factors. This study, performed in Turkey, explored the association between mothers' early maladaptive schemas (EMS) and sleep difficulties in children aged 12-36 months. Mothers' early maladaptive schemas were assessed using the Young Schema Questionnaire-Short Form 3 (YSQ-S3), and sleep difficulties in children were defined according to BISQ-derived clinical criteria. The sample consisted of 58.8% boys and 41.2% girls. Among 153 mothers, those whose children had sleep problems exhibited lower levels of "enmeshment/dependence" and "punitiveness" schemas. In contrast, higher maternal "failure to achieve" scores were associated with an increased likelihood of child sleep problems, while elevated "enmeshment/dependence" scores and receiving occasional support from a partner or family served as protective factors. Notably, maternal age over 30 emerged as a strong risk factor, whereas children aged 25-36 months demonstrated fewer sleep problems compared to younger counterparts. These findings point to possible associations between maternal schematic tendencies and child sleep characteristics across developmental contexts. These preliminary observations may highlight areas for further research on caregiver-child processes relevant to early childhood sleep.
Parent training (PT) interventions constitute a gold standard for preventing a variety of mental health symptomatology in children and youth. Yet, there is a need to understand the best ways to deliver specific core PT components to caregivers who have experienced adverse backgrounds as children and contextual stressors that impact their parenting practices. In this review paper for clinicians and prevention interventionists, we reflect on lessons learned in a 15-year program of parenting prevention research with low-income Latine immigrants in the United States who have experienced significant adversity. Specifically, we examine the relevance of two core PT components of GenerationPMTO, an evidence-based parenting intervention. The components, positive involvement and skill encouragement, have been documented in empirical research as key precursors of positive child and youth development. Thus, we describe in this paper a process of clinical change that integrates GenerationPMTO theory, cultural adaptation and advocacy principles, as well as key tenets of experiential and contextual family therapy theories. We document the use of this process of clinical change as implemented across three prevention initiatives with low-income Latine immigrant populations. Lastly, we address implications for family therapy practice. Specifically, we elaborate on alternatives for providers to implement evidence-based programs and potentially enhance their effectiveness through the integration of experiential and contextual family therapy strategies. By focusing on Latine immigrant families as a case study, we hope that this manuscript can support the efforts of family therapists engaged in the delivery of parenting interventions for underserved caregivers exposed to backgrounds of adversity.