Globally, child and adolescent mental health services are a priority. Efforts are being made to highlight the gap in health systems concerning the lack of these services and to provide evidence for their necessity, particularly in disadvantaged areas such as rural communities in low- and middle- income countries. This study aimed to investigate the perceptions of child and adolescent mental health services within primary healthcare facilities and secondary schools in rural communities of the Chris Hani District in the Eastern Cape province, South Africa. The study employed a qualitative research approach with an exploratory design, recruiting 36 participants, including 12 professional nurses and 24 secondary school teachers, through purposive sampling. Data were collected via individual semi-structured interviews (n = 12) with professional nurses and focus group discussions (n = 6) with teachers. Data were analysed using thematic analysis. The findings demonstrated a lack of child and adolescent mental health services in both primary healthcare facilities and secondary schools in rural communities, where children and adolescents could potentially access such services. Specifically, primary healthcare facilities reported having no mental health patients under the age of 18 years. Both healthcare professionals and schoolteachers indicated a lack of expertise in implementing services. Child and adolescent mental health services are lacking in rural communities of the Chris Hani District, Eastern Cape province, South Africa.
Suicide is a leading cause of death amongst children and young people (CYP), and numbers of CYP presenting with suicidality continue to rise. CYP seeking help for suicidal thoughts and behaviours are generally referred to Child and Adolescent Mental Health Services (CAMHS) for assessment and treatment. However, CAMHS across the UK are unable to meet the demand for their services. Little is known about what happens to these children after they have been referred to CAMHS. Grounded in critical realism, and informed by a children's rights approach and feminist perspectives, this qualitative study sought to explore how children and young people presenting with suicidality experience the CAMHS referral process and care journey thereafter. In-depth interviews of between 60-90 minutes duration, were conducted with ten CYP aged between 13-17yrs, living in two different health board areas in Scotland, and having been referred to two different CAMHS (sites A and B). Using Charmaz constructing grounded theory approach, analysis revealed three main themes which are presented: Nothing got resolved: the care experience; "If you had more choice…" about how, when and where they worked with you; The person not the profession who helped, each built upon layers of overlapping subthemes. Further interrogation of the data, and synthesis supported the development of a substantive theory, that conceptualises children and young people presenting with suicidality as "Seen but not Heard". It is argued that CAMHS do not meet these CYP needs even when they are seen. This finding has implications for policy makers and service providers as the CYP in this study express that the support they need and find most helpful is not congruent with CAMHS. Further research is urgently required to develop and design a new service model that better meets the needs of children and young people and prioritises their views.
This study aimed to identify patterns of child abuse and neglect and to examine the associations between these patterns and psychological distress during adolescence. A school-based survey was conducted with 693 high school students in Rio de Janeiro, Brazil, during 2016-2017. Latent class analysis was used to identify child abuse and neglect patterns based on the Childhood Trauma Questionnaire items' combination. Psychological distress was measured using the General Health Questionnaire (GHQ-12). Multiple linear regression models were employed to examine the associations between child abuse and neglect patterns and psychological distress. Three classes of child abuse and neglect were identified for both sexes: (1) mild emotional violence and physical punishment, (2) emotional maltreatment, physical punishment, and neglect, and (3) poly-victimization. Being classified within the poly-victimization was significantly associated with higher psychological distress in both boys and girls. The class characterized by emotional maltreatment, physical punishment, and neglect was significantly associated with increased psychological distress among girls only. Health and educational services should assess child abuse and neglect when working with adolescents presenting psychological distress, as many may experience multiple forms of victimization. The high prevalence of childhood poly-victimization classes and their strong association with psychological distress highlight the urgent need for intersectoral strategies aiming at reducing child abuse and neglect. Este estudo teve como objetivo identificar padrões de abuso e negligência infantil e examinar as associações entre esses padrões e o sofrimento psicológico durante a adolescência. Um inquérito de base escolar foi conduzido com 693 estudantes do Ensino Médio no Rio de Janeiro, Brasil, entre 2016 e 2017. A análise de classes latentes foi utilizada para identificar padrões de abuso e negligência infantil com base na combinação de itens do Questionário sobre Traumas na Infância. O sofrimento psicológico foi aferido por meio do Questionário de Saúde Geral (GHQ-12). Modelos de regressão linear múltipla foram empregados para examinar as associações entre os padrões de abuso e negligência infantil e o sofrimento psicológico. Três classes de abuso e negligência infantil foram identificadas para ambos os sexos: (1) violência emocional leve e punição física; (2) maus-tratos emocionais, punição física e negligência; e (3) polivitimização. Pertencer à classe de polivitimização associou-se significativamente a um maior sofrimento psicológico, tanto em meninos quanto em meninas. A classe caracterizada por maus-tratos emocionais, punição física e negligência associou-se de forma significativa ao aumento do sofrimento psicológico apenas entre as meninas. Os serviços de saúde e de educação devem rastrear o abuso e negligência infantil ao atender adolescentes que apresentam sofrimento psicológico, uma vez que muitos podem vivenciar múltiplas formas de vitimização. A alta prevalência da classe de polivitimização na infância e sua forte associação com o sofrimento psicológico evidenciam a necessidade urgente de estratégias intersetoriais voltadas à mitigação do abuso e negligência infantil. El objetivo de este estudio era identificar patrones de abuso y negligencia infantil y examinar las asociaciones entre estos patrones y el malestar psicológico durante la adolescencia. Se realizó una encuesta escolar a 693 estudiantes de secundaria en Rio de Janeiro, Brasil, durante 2016-2017. Se utilizó el análisis de clases latentes para identificar patrones de abuso y negligencia infantil basados en la combinación de los ítems del Cuestionario de Trauma Infantil. El malestar psicológico se midió utilizando el Cuestionario General de Salud (GHQ-12). Se emplearon modelos de regresión lineal múltiple para examinar las asociaciones entre los patrones de abuso y negligencia infantil y el malestar psicológico. Se identificaron tres clases de abuso y negligencia infantil para ambos sexos: (1) violencia emocional leve y castigo físico, (2) maltrato emocional, castigo físico y negligencia, y (3) polivictimización. La pertenencia a la clase de polivictimización se asoció significativamente con un mayor malestar psicológico tanto en niños como en niñas. La clase caracterizada por maltrato emocional, castigo físico y negligencia se asoció significativamente con un aumento del malestar psicológico solo entre las niñas. Los servicios sanitarios y educativos deberían evaluar el abuso y negligencia infantil cuando trabajen con adolescentes que presenten malestar psicológico, ya que muchos pueden sufrir múltiples formas de victimización. La alta prevalencia de las clases de polivictimización infantil y su fuerte asociación con el malestar psicológico ponen de relieve la urgente necesidad de estrategias intersectoriales destinadas a reducir el abuso y negligencia infantil.
Young people with serious mental illness (SMI) face significant physical health inequalities, including increased risk of obesity, diabetes, and other preventable conditions, contributing to a 15-20-year reduction in life expectancy. Those in CAMHS inpatient care are particularly vulnerable due to high levels of psychological distress, psychotropic medication, obesogenic environments and high levels of adverse health behaviours. However, research in this setting is limited. This study aimed to assess the feasibility of monitoring physical health in CAMHS inpatient services, changes to physical and mental health over 6-months and explore young people's experiences of health care. A longitudinal feasibility study with a separate qualitative component was conducted across three CAMHS inpatient units, assessing physical and mental health at admission, 3-months and 6-months. Feasibility indicators and clinical outcomes including weight, cardiometabolic markers, lifestyle behaviours and wellbeing were collected through self-report, clinical records and physical health checks. A nested qualitative sub-study was conducted to explore participant experiences of physical health care in CAMHS. Twenty-seven participants were recruited across three CAMHS inpatient units, with 93% (n = 25) retained at 6-month follow-up. Completion of assessments was high at baseline but declined post-discharge. At baseline 37% individuals were overweight or obese, which increased to 50% overweight or obese at follow-up. Metabolic conditions were frequently observed across all timepoints. Physical activity remained low, and diet quality was poor. Mental health and functioning appeared to improve, with reductions in HONOSCA scores suggesting improvements to overall health. This study provides the first longitudinal feasibility evidence on monitoring physical health among young people in CAMHS inpatient care, demonstrating high acceptability during admission and identifying substantial challenges with post-discharge monitoring. While descriptive trends indicated a high prevalence of physical health risk factors, the study was not powered to detect meaningful change. These findings highlight the need for integrated, developmentally appropriate models of physical health monitoring across inpatient and community services.
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 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.
Adolescence marks a period of profound neurocognitive maturation, during which cognitive, neural, and biological systems dynamically interact with emerging mental health symptoms. The Adolescent Brain Cognitive Development (ABCD) Study provides a unique opportunity to examine these relationships across late childhood and adolescence using large-scale, longitudinal, multimodal data. This review synthesizes research using the ABCD dataset to investigate links between cognitive processes and mental health across five longitudinal assessment waves (ages 9-14), covering externalizing and internalizing symptoms, depression, anxiety, ADHD, psychotic-like experiences, obsessive-compulsive symptoms, suicidality, substance use, and autism spectrum disorder. We summarize evidence linking core cognitive domains-including executive function, working memory, attention, and processing speed-to mental health symptoms, and highlight studies integrating neuroimaging and genetic data to elucidate underlying mechanisms. Findings revealed common and distinct cognitive impairment patterns across conditions: executive function and working memory impairments were consistently associated with externalizing symptoms, ADHD, and disruptive behavior disorders, while internalizing relationships were more heterogeneous. Psychotic-like experiences had consistent and persistent cognitive associations, with stronger longitudinal coupling between cognitive trajectories and symptom progression, compared to other symptom domains. Data-driven approaches were commonly used, and neuroimaging and genetic findings identified converging mechanisms within some disorders. Effect sizes were predominantly small, as expected in a large community sample, yet consistent replication across analytic approaches suggests these estimates reflect population-level relationships. Collectively, findings from the ABCD Study position cognition as a key component within multimodal developmental models of psychiatric risk, with implications for identifying early cognitive markers that may inform targeted intervention.
Children and adolescents admitted to psychiatric inpatient units may be subjected to restrictive practices. Such practices can have significant psychological and physical consequences for the young inpatients, as well as for their relatives and the staff involved. Despite this, experiences of restrictive practices remain underreported particularly regarding the mechanisms that sustain their continued use, even in the face of international and national regulations aimed at reducing restrictiveness. A deeper understanding of these mechanisms can help nuance clinical decision-making and illuminate the complex relationships between staff, children, and relatives. This integrative review aims to provide such insights through a systematic literature search that includes both peer-reviewed and grey literature across quantitative and qualitative studies. The included papers were assessed using JBI and GRADE-CERQual and findings were analyzed using Systematic Text Condensation showing that restrictive practices persist not only due to acute crises but through intertwined mechanisms: their ethical justification in care, their institutional and legal normalization, and their embeddedness in everyday ward culture. Children and adolescents, relatives, and staff each shape how safety and responsibility are understood, reinforcing restrictive practices in different ways. These findings point to the need for strategies extending beyond regulation toward cultural and relational approaches that promote emotional safety, agency, and recovery-even when restrictive practices remain necessary. The review was preregistered at PROSPERO (CRD420251032437).
Survivors of cancer face increased risks of long-term morbidity compared to people without a cancer history. To quantify the long-term burden of mental health morbidity and to evaluate the healthcare settings in which these events are identified in long-term Scottish cancer survivors diagnosed before 40 years of age. Five-year survivors of cancer diagnosed before 40 years of age in the Lothian region of Scotland between 1980 and 2018 (n = 8862) were matched (1:3) to individuals without cancer history by age, sex, and socioeconomic deprivation (n = 26,586). Mental-health outcomes were identified from psychotropic drug prescribing, hospital admission and general-practice records. Time to first mental health event was analysed using time-stratified Cox proportional-hazards models. During median follow-up of 14.8 years for survivors and 16.7 years for comparators, 2983 survivors (33.7%) and 6774 comparators (25.5%) experienced a first mental health event. Around 90% of first events were identified in general practice or prescribing records, and fewer than 10% in hospital admissions. Survivors had a consistently higher incidence of first mental health events across follow-up intervals when all data sources were considered, with hazard ratios ranging from 1.3 in the first year after study entry (95% CI 1.2-1.4) to 1.5 beyond 15 years (95% CI 1.4-1.6). Integrating data sources provides a more comprehensive assessment of the mental health burden than hospital records alone. Mental health should be a core component of long-term survivorship care, particularly within primary care, and cost-effective strategies are needed to address the sustained excess burden.
Adverse childhood experiences (ACEs) are increasingly recognised as key determinants of self-harm among adolescents, particularly within psychiatric and mental health service settings in Malaysia, where coping resources may shape vulnerability and resilience. A cross-sectional study was conducted among adolescents referred to psychiatry and mental health services in Malaysia. Of 1244 eligible patients aged 10-24 years, 1164 completed a clinician-administered, interviewer-guided questionnaire. Self-harm status was assessed in clinical care and was compared across ACE burden, individual ACE domains and coping-related protective factors through a clinician-led interview. Multivariable logistic regression was used to examine adjusted associations with self-harm. Among 1164 participants, 827 (71.0%) reported lifetime self-harm. In adjusted analyses, a greater burden of ACEs was strongly associated with higher odds of self-harm. Compared with participants with no ACE exposure, the odds increased in a dose-response manner, from an adjusted OR (aOR) of 2.54 (95% CI 1.27 to 5.20) among those with 2-3 ACEs to 6.14 (95% CI 3.13 to 12.40) among those with ≥4 ACEs. Several coping-related factors were associated with lower odds of self-harm, including the ability to cope with stress (aOR 0.32, 95% CI 0.23 to 0.45), a sense of responsibility towards children, loved ones or pets (aOR 0.71, 95% CI 0.51 to 0.98) and perceived social support (aOR 0.63, 95% CI 0.40 to 0.97). In secondary analyses of individual ACE components, violence against household members, emotional abuse, sexual abuse, bullying and witnessing community violence were independently associated with higher odds of self-harm. This study showed high prevalence of self-harm among adolescents attending the psychiatric and mental health services. A greater cumulative burden of ACEs was associated with increased odds of self-harm, whereas protective factors including effective stress coping, a sense of responsibility towards loved ones or pets and social support were associated with reduced odds. These findings emphasised the importance of trauma-informed assessment and interventions that enhance coping capacities and social connectedness among young people presenting to mental health services.
Prisoners have been identified in various international studies as one of the populations most vulnerable to mental health problems, yet the system's response has been notably limited. Enhancing the prison healthcare system to effectively address the challenges involved a complex undertaking compounded by the prevailing constraints and stressors faced by both inmates and prison staff, particularly in low- and middle-income countries such as Cambodia, where research is lacking. This study aimed to examine the perceptions of prison officials and healthcare staff regarding the health system's challenges in addressing prisoners' mental health and well-being and to explore strategies to improve the Cambodian prison healthcare system. Three focus group discussions were conducted in three prisons located in various regions of Cambodia with a total of 15 participants (11 prison health staff and four prison officials). A qualitative content analysis was applied to the collected data. Despite limited resources, the current prison healthcare system managed to provide basic healthcare, refer severe cases, and implement certain preventive measures. However, our study revealed a lack of mental health focus within the system, although certain emotional support was provided by healthcare staff to prisoners with mental health issues. Staff displayed commitment but expressed a sense of resignation due to skills and resource constraints. Participants recommended various strategies, such as increasing awareness and offering vocational training to prisoners and room leaders, intense training for healthcare staff, and enhancing governance and external support to strengthen the prison healthcare system to foster the mental health and well-being of prisoners. Addressing the mental health needs within the prison setting in Cambodia demands an urgent reform of the current prison healthcare system. This entails a comprehensive collaborative effort among governmental institutions, placing emphasis on enhancing the skills and capabilities of inmates, room leaders and prison staff. Moreover, it is also essential to establish stronger partnerships with external organizations to improve health system governance.
Despite growing interest, empirical evidence remains limited for the efficacy of intensive outpatient programmes (IOPs) for eating disorders (EDs), particularly outside the USA. No prior studies have examined the delivery or effectiveness of IOPs for children and young people in the UK. This study addresses this gap by presenting pilot data from a UK-based community IOP embedded within an existing child and adolescent ED service. We conducted a prospective cohort study of young people aged 12-18 years referred to the IOP at the Maudsley Centre for Child and Adolescent Eating Disorders between February 2024 and August 2025. Eligible participants had a diagnosis of an ED according to ICD-11 criteria, or disordered eating requiring acute admission, and completed the IOP treatment. Data were collected on referral pathways, demographic and clinical characteristics, treatment course, and outcomes, including change in weight and self-reported ED/mental health symptoms. During the recruitment period the IOP served a heterogeneous cohort of 68 young people with high rates of psychiatric and neurodevelopmental comorbidity. Treatment delivery included outreach on paediatric wards, intensified outpatient treatment, and consultation with wider care networks. Mean duration of the IOP was 24 days (SD = 10.7). Most participants demonstrated improved weight trajectory (mean weight gain = 4.5% mBMI, SD = 6.8, p < 0.001). ED symptom psychopathology did not significantly improve over the short IOP duration. Findings indicate that a brief IOP intervention is effective for weight restoration in underweight adolescents with EDs, functioning as both an intensification of outpatient treatment and an effective way of keeping young people in the community who are at high risk of an inpatient admission. Future research would benefit from controlled designs, explore long-term outcomes, and examine adaptations for neurodiverse populations. Eating disorders in children and young people are serious mental health conditions that often require intensive treatment. Intensive outpatient programmes (IOPs) provide structured, frequent treatment while allowing young people to remain at home. Although IOPs are increasingly used, there is little research on how effective they are, particularly outside the United States. No previous studies have examined IOPs for young people with eating disorders in the United Kingdom. This study reports early findings from a pilot IOP delivered within a specialist child and adolescent eating disorder service in the UK.We followed a group of young people aged 12–18 who were referred to the programme between February 2024 and August 2025. Participants had a diagnosed eating disorder, or severe disordered eating that might otherwise require hospital admission. We collected information on referral routes, patient characteristics, how the treatment was delivered, and changes in weight and self-reported eating disorder and mental health symptoms.Sixty-eight young people took part. Many had additional mental health or neurodevelopmental conditions. On average, treatment lasted about 24 days. Most participants showed improved weight gain during the programme, but eating disorder thoughts and feelings did not improve significantly over this short period.Overall, the programme helped support weight restoration and may help prevent hospital admission by providing more intensive treatment in the community. Further research should examine long-term outcomes and how programmes can better support neurodiverse young people.
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 1 430 441 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 = 0.014) and regression modelling confirmed that both pandemic phase (p = 0.014) and age (p = 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 = 0.004), whereas emergency and inpatient encounters were strongly influenced by age and sex (p < 0.001), with female adolescents experiencing the highest rates (significant age × sex interaction, p < 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.
Sexual and gender minority youth of color (SGM YOC) face compounded mental health disparities due to oppression experienced at the intersection of racism, cissexism, and heterosexism. Parental responses to youth's sexual orientation and gender identity (SOGI) are critical in shaping youth mental health outcomes, yet prior research has often simplified these responses into a unidimensional acceptance-rejection continuum. Using data from the 2022 LGBTQ National Teen Survey (n = 3187 SGM YOC), this study challenged such an oversimplified conceptualization by exploring heterogeneous patterns of parental responses to children's SOGI among SGM YOC. Further, we also examined the distinct implications of each identified profile for SGM YOC's mental health problems and how the association between intersectional microaggressions and mental health problems might vary across the identified profiles. Three distinct SOGI-specific parental response profiles were found: High Rejection Low Acceptance Response (24.10%), Low Rejection Low Acceptance Response (50.30%), and Low Rejection High Acceptance Response (25.60%). Profile membership varied by race/ethnicity, sex assigned at birth, gender identity, sexual orientation, and caregiver education level. Youth in the High Rejection Low Acceptance Response profile reported significantly higher levels of mental health problems compared with those in the Low Rejection Low Acceptance Response and Low Rejection High Acceptance Response profiles. SOGI-specific parental response profile membership moderated the association between intersectional microaggressions and mental health problems. Intersectional microaggressions were more strongly associated with mental health problems among youth in the Low Rejection Low Acceptance Response profile than among those in the High Rejection Low Acceptance Response profile, with higher overall mental health problems in the latter profile. By identifying diverse patterns of SOGI-specific parental responses and the differential consequences for understanding how SGM YOC's intersectional minority stress relates to mental well-being, our findings underscore the importance of culturally responsive interventions that engage parental figures as active agents of affirmation, support, and socialization, ultimately fostering SGM YOC's positive development amid intersecting systems of oppression.
Anaemia remains a major public health challenge among adolescents in low- and middle-income countries (LMICs). However, longitudinal evidence on its incidence and remission during this critical period is limited. Most existing studies assess anaemia cross-sectionally, providing limited insight into its progression or potential reversibility. We aimed to examine the dynamics of anaemia during adolescence, estimating incidence and remission over one year and identifying sociodemographic, behavioural, nutritional, and dietary predictors of these transitions. We used data from the Africa Research, Implementation Science, and Education Network's multi-site prospective cohort in Nouna (Burkina Faso), Harar (Ethiopia), Dar es Salaam (Tanzania), and Pune (India). Baseline assessments were conducted between November 2021 and December 2023, with follow-up approximately 12 months later. The analytical sample included 3656 adolescents aged 10-19 years. Haemoglobin was measured using HemoCue® analysers and classified according to World Health Organization standards. We used Poisson regression models to estimate risk ratios (RR). Anaemia prevalence was 34.4% at baseline and 32.6% at follow-up. Among 2399 adolescents who were non-anaemic at baseline, 21.2% developed anaemia, whereas 45.6% of 1257 adolescents with anaemia achieved remission. Late adolescence (RR = 0.81; 95% confidence interval (CI) = 0.70-0.95), school attendance (RR = 0.67; 95% CI = 0.57-0.80), and frequent consumption of fruits and vegetables (RR = 0.83; 95% CI = 0.73-0.95) were associated with a lower risk of incident anaemia, whereas stunting (RR = 1.61; 95% CI = 1.33-1.96) increased the risk. Remission from anaemia was more likely among school attendees (RR = 1.49; 95% CI = 1.27-1.76), adolescents living with guardians (RR = 1.19; 95% CI = 1.05-1.35), and those who frequently consumed fruits and vegetables (RR = 1.17; 95% CI = 1.06-1.29), but less likely among adolescents with depressive symptoms (RR = 0.75; 95% CI = 0.61-0.92) and stunting (RR = 0.75; 95% CI = 0.62-0.91). Anaemia among adolescents in LMICs is both prevalent and dynamic. Diet quality, school participation, household stability, and mental and physical health are associated with these trajectories. National nutrition and health strategies should explicitly target adolescents, integrating dietary interventions with educational and clinical platforms to accelerate anaemia reduction.
Maternal folic acid supplementation is a cornerstone of public health for preventing neural tube defects (NTDs), yet its long-term impact on child development remains underexplored. This study evaluates the long-term cognitive and mental health associations of maternal folic acid supplementation by utilising China's 2009 Folic Acid Supplementation Programme for rural women as a quasi-experimental framework. We analysed 1,953 children aged 10-15 years from the 2020 China Family Panel Studies. Using provincial NTD prevalence in 2009 from the Maternal and Child Health Surveillance system as a proxy for intervention intensity, we employed difference-in-differences models to estimate associations, adjusting for demographic and parental covariates. Maternal folic acid supplementation was significantly associated with improved outcomes among girls: higher memory scores (β [95% CI], 0.232 [0.069, 0.394]), enhanced numerical reasoning skills (5.234, [2.188, 8.279]), lower Center for Epidemiological Studies Depression Scale score (-0.523 [-0.933, -0.113]), and reduced likelihood of depressive symptoms (-0.024 [-0.048, -0.001]). No comparable associations were observed in the boys. Although cognitive associations were observed across socioeconomic status (SES) groups among girls, the mental health associations were concentrated among girls from higher-SES families. Results were robust to adjustment for covariates. This study highlights sex-specific, long-term associations of maternal folic acid supplementation but reveals that socioeconomic disparities may constrain mental health gains. Thus, universal nutrition interventions alone may be insufficient to bridge health equity gaps. The findings should be interpreted within the broader nutritional ecology and alongside concurrent macro-social changes that shape child development outcomes. Main findings: Maternal folic acid supplementation was associated with sex-specific, long-term cognitive and mental health outcomes among girls aged 10–15, with mental health associations exclusively concentrated among those from families with higher-socioeconomic status.Added knowledge: Leveraging a national programme as a quasi-experimental framework, this study provided evidence that the associations of folic acid supplementation may extend beyond birth defect prevention while revealing that within a complex nutrition and psychosocial environment, universal biomedical interventions risk inadvertently exacerbating socioeconomic inequalities in adolescent mental health when implemented in isolation.Global health impact for policy and action: Where applicable, policymakers in low- and middle-income countries should consider moving beyond ‘one-size-fits-all’ biomedical approaches by integrating nutrition programmes with targeted psychosocial support, to ensure that the potential benefits of public health investments are shared equitably across socioeconomic groups and in alignment with the Sustainable Development Goals.
Co-design has become a prominent approach in mental health research, policy and service development, aiming to centre lived experience within decision-making processes. Despite its promise, co-design practices often fall short, with reports of tokenism, constrained participation and limited influence. These limitations reflect deeper epistemic and relational inequities within mental health systems. This commentary argues that the challenges of co-design can be understood through the lens of epistemic injustice, where certain forms of knowledge, particularly lived experience, are systematically devalued. Drawing on restorative justice principles, the paper proposes a relational and ethical reframing of participation. Restorative approaches-centred on truth-telling, acknowledgement and repair-offer a means to address the relational harms and power imbalances that undermine meaningful participation. Building on this, the Cycle of Equitable Codesign is introduced as a staged framework comprising: (1) acknowledgement and truth-telling, (2) restoration and relational repair and (3) co-design and collective future-making. The model emphasises the importance of timing, power and relational conditions in shaping equitable participation. Repositioning co-design within a restorative framework highlights the need to move beyond procedural inclusion towards ethically grounded and relationally just practice. Addressing epistemic injustice is essential for co-design to achieve its transformative potential in mental health systems. This commentary is informed by existing literature on co-design and lived experience participation in mental health. It centres and reflects on the reported experiences of people with lived experience of mental health challenges. Although no direct formal patient or public involvement was undertaken in the development of this paper, it was informed following extensive informal communication with those who have a lived experience of mental health challenges and codesign participation over the prior 18 months.
to understand nurses' perception from the Federal District Health Department and Multidisciplinary Program in Child and Adolescent Mental Health residents regarding practices at the Child and Adolescent Psychosocial Care Center, identifying challenges and gaps in their training. semi-structured interviews were conducted and analyzed using thematic analysis, which consists of three phases: pre-analysis, content exploration, and elaboration of results. 55.5% participants have worked at the Child and Adolescent Psychosocial Care Center for four years or more, and 44.4% chose the mental health area. Analysis revealed three thematic axes: "Mental health in the academic context"; "Continuing education in mental health"; "Nursing role deconstruction or construction". it was found that academic training is still insufficient to prepare nurses to work in the biopsychosocial model and expanded clinical practice, generating a feeling of unpreparedness and insecurity. In this scenario, continuing education emerges as an alternative to strengthen professional practice.
Juvenile delinquency, mental health, social determinants of health, and social support are closely intertwined, yet the structural and relational processes linking them remain underexamined. Using a syndemic framework, this study examined whether structural vulnerability and social support were associated with the relationship between juvenile delinquency and depression and anxiety in a nationally representative sample of youth and young adults in the United States. After data-quality exclusions, the full survey sample included 5,311 respondents ages 10 to 34 years, and the present analyses were restricted to the 2,658 respondents assigned to the rotating module that included delinquency items. Survey-weighted descriptive analyses and hierarchical regression models were estimated, followed by exploratory parallel mediation analyses. About one-quarter of respondents reported any juvenile delinquency history. Respondents with delinquency histories showed higher unadjusted depression and anxiety scores, greater adversity, greater social determinants of health burden, and lower social support. In adjusted models, however, the association between delinquency and depression and anxiety was substantially reduced after accounting for structural vulnerability and was further reduced and no longer statistically significant after social support was added. Both indirect associations were statistically significant in exploratory mediation models, and together they accounted for a substantial share of the observed relationship. A small subgroup who reported having been paid for sexual relations showed particularly high adversity and structural burden, although these findings were descriptive only. These findings suggest that the mental health burden observed among youth with delinquency histories is embedded in broader social and structural disadvantage and may be more effectively addressed through interventions that reduce social determinants of health burden, such as material hardship, and strengthen social support.
While family income and neighborhood disadvantage have been associated with adolescent mental health, less is known about their independent associations with distinct, group-based patterns of change. Moreover, little is known about how school environments are associated with such mental health trajectory patterns, and if they serve as independent promotive factors or are protective factors that mitigate risk. Data come from the Adolescent Brain Cognitive Development StudySM(ABCD study®; n = 9769; baseline through year 2; ages 9-13). Internalizing and externalizing behaviors were measured with the Child Behavior Checklist. Growth mixture modeling was utilized to identify subgroups with distinct mental health trajectories, and logistic regression was used to examine the association between family income, neighborhood environment and trajectory group membership, and moderation by baseline school and school district characteristics, controlling for age, sex, race/ethnicity, and parental education. Two trajectory classes were identified for internalizing (91%; low-decreasing, 9%; high-increasing) and externalizing behaviors (92%; low-decreasing, 8%; high-stable). Lower family income was associated with a high-increasing trajectory pattern of internalizing and a high-stable pattern of externalizing behaviors. A more positive school climate predicted belonging to the low-decreasing trajectory group for internalizing and externalizing behaviors, though there was no evidence of moderation. Low family income, but not neighborhood disadvantage, was a risk factor for trajectories of internalizing and externalizing behavior elevated within a clinical range that persisted from age 9 through early adolescence. However, a positive school climate was a promotive, rather than a protective, factor for internalizing and externalizing trajectories. Supporting families with resources and enhancing the school context may improve adolescent mental health.
Child marriage remains a pressing social and public health issue globally, with significant implications for the rights, well-being and development of affected individuals. In Iran, legal frameworks that permit marriage from as young as 9 lunar years for girls-despite countervailing influences such as rising education levels and social reforms-have failed to curb the persistence of early marriage, which continues to be driven by entrenched cultural, socioeconomic and legal factors. Understanding the multifaceted nature of child marriage within this context is crucial for developing effective interventions and policies. Existing research predominantly focuses on quantitative assessments, leaving qualitative insights underexplored. The aim of this protocol is to address the existing gap by undertaking a scoping review and meta-synthesis of qualitative evidence concerning child marriage in Iran. This study seeks to provide an in-depth understanding of the underlying determinants, lived experiences and associated consequences of child marriage with the aim of informing future research endeavours and guiding policy development. This scoping review protocol will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the methodological framework proposed by Arksey and O'Malley, incorporating recent methodological advancements. Selection criteria will be established through the Population, Concept and Context framework, targeting qualitative studies addressing child marriage within Iran. To ensure comprehensive coverage, an inclusive search will be conducted across diverse databases, including PubMed, Scopus, Web of Science, Scientific Information Database (SID), MagIran and the Barakat Knowledge Network System (BKNS), without any restriction on publication date, extending up to the search date. Both Persian and English language sources will be reviewed. Two independent reviewers will undertake the screening of titles, abstracts and full texts, resolving conflicting decisions through consensus or third-party arbitration. The methodological integrity of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Data will be synthesised through content analysis methods. Confidence in the integrated findings will be evaluated employing the GRADE-CERQual approach to enhance the trustworthiness and applicability of the review outcomes. The Research Ethics Committee of Tabriz University of edical Sciences approved this proposed scoping review and meta-synthesis, confrming ethical compliance absent patient involvement. Results from this investigation will be shared through peer-reviewed journal articles and presentations at relevant academic conferences locally and internationally. Furthermore, the synthesised insights into the phenomenon of child marriage in Iran are intended to inform scholars, policymakers and practitioners, supporting evidence-based strategies and policies to mitigate the issue and promote social change.