The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
The association between a parent's mental illness and the risk of mental disorders in the offspring is multifactorial. The aim of this study was to explore the characteristics of mentally ill parents and their minor children and to provide information on family influences among families who consented to participate in a cross-sectional study. Specifically, this study explores the sociodemographic data, diagnoses of mentally ill parents and their minor children, and the perceived quality of life of the children, assessed by both parents and children themselves. Participants were 65 families with 100 children aged under 18, where one or both parents had a formal diagnosis of a mental disorder. We obtained a variety of sociodemographic and clinical data from the families/parents and their children and identified certain risk and protective characteristics. We analyzed the relationships between the observed measures (responses in questionnaires) and selected demographic and risk factors using a multivariable linear regression model. Normality of residuals was verified by the Shapiro-Wilk test. P-values < 0.05 were considered statistically significant. We found that a total of 31 children from 28 families already had an ICD-10 mental disorder diagnosis. Half of the parents lived with the child's other parent. Just over one half of the parents had been hospitalized in the past. Just under one quarter of the parents had experienced their own parents' mental illness. Over one half of the parents had informed their offspring about their psychiatric diagnosis. The greater the number of risk factors the family faced, the worse the children perceived their quality of life. The higher the net family income was, the better both children and parents perceived the children's physical well-being. Our findings highlight the need for targeted prevention for parents with mental illness and their children. Identification of adult patients who are parents is the starting point for reaching out to other family members, especially the most vulnerable, that is, the children. Targeted prevention can address multifactorial links, alleviate the impact of parental disorder on children and mitigate the risk of psychopathology in the offspring. ClinicalTrials.gov Identifier: NCT05554458. Registered on 16 September 2022. Retrospectively registered.
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.
: It is advised that children up to two years of age avoid any screen time (i.e., using digital screens), that those between the ages of two and five years should not exceed one hour per day, and that children aged five to 12 years should only have access to two hours of screen time per day. However, in the digital age, parents find it difficult to control the time their children spend on screens. : This article aimed to systematically synthesise the evidence on the associations between screen time and mental health outcomes in children aged 0 to 12 years. : A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was defined according to the Population, Exposure, Comparator, and Outcomes (PECO) strategy, using the descriptors 'children', 'screen time' and 'mental health' when searching the databases PubMed, Scopus, and PsycINFO. Articles were included if they directly evaluated the associations between screen time and mental health, measured the results using validated instruments, included children aged 0 to 12 years, and were published since 2013. The Newcastle-Ottawa scale was used to check the methodological quality of the studies. The results were described by presenting the characteristics of the studies, the quality assessment, and the associations between screen time and mental health in longitudinal and cross-sectional studies. : This review assessed the quality of evidence and the frequency with which different mental health problems have been investigated in relation to screen time in children. Fifty-two studies were included, with most addressing attention deficit-hyperactivity disorder (n = 19), conduct problems (n = 13), externalising symptoms (n = 9), depression (n = 11), and anxiety (n = 9). Symptoms of attention deficit-hyperactivity disorder, oppositional defiant disorder, mood symptoms, emotional and social difficulties, conduct problems, low self-esteem, and sleep disturbances were positively associated with screen time, presenting evidence considered to be of high quality. : Although this review concluded that screen time significantly affects children's mental health, some limitations should be noted. The lack of longitudinal data made it difficult to establish a clear causal relationship in most studies, and screen time measures may have introduced a potentia memory bias, as well as relying on parental recall. : Screen time warrants careful consideration in relation to children's mental health. Promoting off-screen activities may be crucial to reducing the risk of unfavourable mental health outcomes associated with exposure to the digital environment. Future research should focus on longitudinal studies to understand the causal relationships between children's psychosocial responses to the different purposes of screen use and the type of content to which they are exposed.
To examine trends in the frequency and costs of emergency hospital admissions in acute wards for mental health conditions among children and young people in England between 2012 and 2022 and to assess socioeconomic and geographic disparities in these costs. Retrospective observational cohort study using routinely collected administrative data. Secondary care acute wards; analysis includes all National Health Service (NHS) hospital admissions in England. All emergency hospital admissions in acute wards for individuals aged 5-18 years with a primary or secondary mental health diagnosis recorded between 2012 and 2022. Exclusion criteria included admissions without a mental health diagnosis or outside the defined age range. Primary outcomes were the annual number and total cost of mental health-related emergency admissions. Secondary outcomes included length of stay, diagnostic categories contributing to cost, and variation by socioeconomic deprivation and geographic location. Between 2012 and 2022, the total cost of emergency admissions for mental health among children and young people rose markedly, driven by increases in both admission rates and length of stay. Children from the most socioeconomically deprived areas experienced higher admission rates and greater associated costs. Substantial regional variation in the financial burden was also observed. Eating disorders and self-harm were the main diagnostic categories contributing to the rise in costs. Following the COVID-19 pandemic, total admission numbers declined, but overall costs remained high due to a shift in diagnostic mix towards conditions associated with longer hospital stays and higher per-admission costs. The increasing financial burden of paediatric mental health crises highlights the urgency of addressing upstream drivers of poor mental health. Policies should prioritise early intervention, reduce regional and socioeconomic disparities, and ensure equitable allocation of mental health resources. Further research should explore the effectiveness of community-based alternatives to hospital care.
Norwegian Child and Adolescent Mental Health Services (CAMHS) use the World Health Organization's (WHO) multiaxial diagnostic system based on the International Classification of Diseases, Tenth Revision (ICD-10); however, analysis of prescribing patterns among axes I-III is underexplored in electronic health records (EHRs) with intertwined patient, episode of care, and contact information. This study aimed to develop and demonstrate an analytic pipeline for mining and mapping information from EHRs to facilitate understanding of clinical processes and support informed decision-making. This study used the Norwegian CAMHS EHR data to identify common diagnoses, comorbidities, and medication use across axes I-III per individual contact. We extracted records of patients ≤19 years old with a primary mental health diagnosis on axes I-III and one or more medications per individual contact. Diagnoses were categorized according to ICD-10 and medications according to the Anatomical Therapeutic Chemical (ATC) classification system. Descriptive analyses quantified contact counts, diagnosis frequency, comorbidity rates, and medication frequency within each diagnostic category. Next, we mapped the medications used across all the contacts and noncomorbid contacts separately along each axis. Of 7214 prescribing contacts (axis I: n=7179, 99.51%; axis II: n=821, 11.38%; axis III: n=65, 0.90%), comorbidity was present in 12.06% (n=866) contacts in axis I, 96.10% (n=789) contacts in axis II, and 96.92% (n=63) contacts in axis III. Leading diagnoses were behavioral-emotional disorders (ICD-10 codes F90-F98) in axis I, school skills and learning difficulties (ICD-10 code F81) in axis II, and mild mental retardation (ICD-10 code F70) in axis III. Most observed comorbidities were F90-F98 with speech and language development disorder (ICD-10 code F80), ICD-10 code F81, and mixed specific skills development disorder (ICD-10 code F83). Psychostimulants predominated across all diagnosis axes, with methylphenidate being the most common. For other ATC categories, the most commonly prescribed medications were antidepressants (sertraline and fluoxetine), antipsychotics (risperidone and aripiprazole), hypnotics and sedatives (melatonin), antiepileptics (lamotrigine), anxiolytics (diazepam), and nonpsychotropics (laxatives, vitamins, and supplements). Medication profiles varied minimally by axis or comorbidity status. We demonstrated a mining and mapping analytic pipeline for EHRs to analyze diagnoses, comorbidities, and prescribing practices at the individual contact level. In the Norwegian CAMHS, axis I diagnoses are common, often behavioral-emotional disorders. Among the medications, psychostimulants and antidepressants are common. Beyond characterizing diagnoses and medication prescribing patterns, the study presents an approach for mining and mapping EHR data to analyze and provide service-level metrics, as well as clinical practice insights.
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.
BACKGROUND: WHO recommend that children and adolescents attend scheduled well-care visits for health promotion, prevention, early detection, identification and management of disability and disease. Children born to adolescent mothers experience a disproportionate burden of poor health outcomes, but their well-care attendance is under-researched. METHODS: Cross-sectional data were used from a cohort of adolescent and young mothers (10–24 years; n = 1040) and their children (n = 1145) recruited through purposive, convenience-based sampling across healthcare facilities and community-based settings in Eastern Cape, South Africa (2017–2019). Quantitative data on visit attendance up to 18 months were analysed using descriptive statistics for children of adolescent mothers (10–19 years) aged ≥ 19 months at data collection, to allow complete observation of visits. In 2022, semi-structured interviews (n = 16) were conducted until saturation, to explore factors influencing attendance. Themes were developed and matched to the capability, opportunity and motivation model of behaviour (COM-B) and Theoretical Domains Framework using a realist thematic template analysis approach. RESULTS: Records were available for 415/482 eligible children. Attendance declined from 85.1% (95%CI: 81.3–88.4) at 6 weeks to 49.7% (95%CI: 46.6–56.5%) at 18 months, with higher attendance during visits coinciding with the childhood immunisation schedule. Attendance and qualitative findings were similar by maternal HIV status. Themes were matched to the COM-B. Capability: mothers’ organisational and financial acumen facilitated their child’s attendance; mothers persisted in attending despite harsh attitudes from healthcare workers. Opportunity: financial and kinship support and information in the child health booklet facilitated visit attendance; lack of childcare support, poor weather, cost and distance to clinic interfered with attendance. Motivation: mothers were motivated to attend visits to gain knowledge and fulfil their parental role. CONCLUSION: This study identified missed opportunities for promoting life-course health and well-being among children and their adolescent mothers, and theory-informed opportunities to support well-care visit attendance. Findings challenge deficit-based narratives highlighting mothers’ motivations and strategies for ensuring attendance. Enhancing the quality of nurse-adolescent mother interactions may increase the perceived and actual value of visits and support attendance. Further research is needed on interventions to promote consistent attendance, address barriers to access and identify opportunities to strengthen integration of well-care and HIV-related 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.
This study aimed to identify adverse childhood experiences (ACEs) clusters and investigate the longitudinal relationships between ACEs clusters and their effects on health and health-related quality of life (HRQoL) in Australian children and adolescents. This study used data from the kindergarten cohort of the Longitudinal Study of Australian Children. Latent class analysis was employed to identify ACEs clusters. Generalized estimating equation (GEE) models were used to examine longitudinal associations between ACEs clusters and multiple health outcomes, including general health, mental health, obesity, and HRQoL domains. The study included 3,089 participants contributing 18,534 observations. Three ACEs clusters were identified: low adversity (65.8%), moderate adversity (25.5%), and high adversity (8.7%). Children in the high-adversity cluster had a higher risk of poorer mental health (IRR = 1.89, 95% CI 1.85-1.92) and suboptimal general health (OR = 1.19, 95% CI 1.17-1.22) compared with those in the low-adversity cluster. Moderate adversity was also associated with elevated risks, although of smaller magnitude. HRQoL scores across social, school, psychosocial, physical, and emotional domains were consistently lower among children exposed to higher adversity. Distinct ACEs clusters were associated with differences in health and HRQoL among Australian children and adolescents. Identifying ACEs patterns provides valuable insights for developing targeted prevention and intervention strategies aimed at mitigating the long-term health and psychosocial consequences of childhood adversity.
Child maltreatment is a significant risk factor for mental and metabolic health, with negative effects that can persist into adulthood. Using data from a U.S.-nationwide study, the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examined the associations between child maltreatment, specifically childhood threat (i.e., harm or threat of harm) and deprivation (i.e., absence of expected environmental inputs), and young adult mental (i.e., depressive symptoms) and metabolic health (i.e., metabolic risk). The moderating effect of social support was also examined, focusing on both quality of different types of support (i.e., from teachers, friends, and other adults) and variety of support sources. Results showed that young adults who experienced more threat during childhood exhibited higher levels of depressive symptoms in young adulthood, and those exposed to more deprivation reported elevated levels of metabolic risk. This study also highlighted the protective-stabilizing role of quality of teacher support in buffering the impact of deprivation on depressive symptoms, and the protective-stabilizing role of high-quality other adult support in the link between childhood deprivation and metabolic risk, such that the benefits of social support remained stable across increasing levels of deprivation. Additionally, the variety of social support showed a protective-reactive pattern in moderating the link between deprivation and metabolic risk, wherein the benefits of variety of social support were released under low deprivation but not high deprivation conditions for metabolic risk. These findings underscore the importance of eliminating child maltreatment experiences and highlight potential interventions, such as enhancing teacher-student relationships and broadening adolescents' access to diverse support networks, to buffer the long-term mental and metabolic health consequences associated with early experiences of threat and deprivation.
ABSTRACTBackground: Mental disorders often emerge in childhood, affecting individual development and family functioning. Parents are often responsible for seeking mental health care for their child and thereby encounter structural, emotional, and knowledge-related barriers. For parents of children exposed to traumatic events, additional challenges may arise.Objective: This study aims to investigate parental perceptions of barriers to psychotherapy for their child and to compare perceptions between parents of children with and without traumatic experiences.Methods: Perceived barriers were measured with a self-developed 10-item scale. Online survey was conducted with N = 271 parents who had at some point been seeking or receiving psychotherapy for their child. Non-parametric Mann-Whitney-U-tests were performed for several group comparisons: search only (n = 63) vs. treatment (n = 208); child with (n = 71) vs. without traumatic experience (n = 200); trauma- (n = 54) vs. non-trauma-related reasons for treatment (n = 154).Results: Parents reported a moderate level of barriers. The highest agreements were found for waiting time and time investment (Md = 4.00; IQR = 2.00). Parents of children who had only sought but not received psychotherapy reported greater difficulties in finding adequate treatment (p < .05, r = -0.18). Both if children had experienced a traumatic event and if the reason for therapy was trauma-related, parents reported a significantly higher degree of time investment (p < .05, r = -0.16), the concern that their child might be too burdened (p < .01, r = -0.20) and lack of confidence in professional competence (p < .01, r = -0.19).Conclusions: Structural barriers were reported as most prominent. Trauma exposure of the child may further increase perceived barriers. These findings highlight the need for parental support and trauma-informed guidance. Parents encounter multiple barriers when seeking or engaging in psychotherapy for their child, with structural barriers being most prominent.Children’s exposure to traumatic events may further increase the perception of barriers.Trauma-informed training and guidance for parents, improved access to support, improved trauma-focused training for professionals and transparent communication between professionals and parents are needed. Antecedentes: Los trastornos mentales con frecuencia emergen en la niñez, afectando el desarrollo individual y el funcionamiento familiar. Los padres son con frecuencia los responsables de la búsqueda de atención en salud mental para sus niños y por lo tanto se enfrentan a barreras estructurales, emocionales y de conocimiento. Para los padres de niños expuestos a eventos traumáticos, pueden aparecer otros desafíos. Objetivo: Este estudio tiene como objetivo investigar las percepciones parentales de las barreras a la psicoterapia para sus hijos y comparar las percepciones entre los padres de niños con y sin experiencias traumáticas. Métodos: Las barreras percibidas se midieron con una escala de 10 ítems desarrollada para este estudio. Se realizó una encuesta en línea a N = 271 padres que en algún momento habían buscado o recibido psicoterapia para sus hijos. Se realizaron pruebas U de Mann–Whitney no paramétricas para varias comparaciones de grupos: solo búsqueda (n = 63) vs. Tratamiento (n = 208); niños con experiencias traumáticas (n = 71) vs sin experiencias traumáticas (n = 200): razones para el tratamiento relacionada con el trauma (n = 54) vs no relacionas con trauma (n = 154). Resultados: Los padres reportaron un nivel moderado de barreras. Los mayores acuerdos se encontraron en el tiempo de espera y la inversión de tiempo (Md = 4.00; IQR = 2.00). Los padres de niños que solo buscaron psicoterapia, pero no la recibieron reportaron mayores dificultades en encontrar un tratamiento adecuado (p < .05, r = −0.18). Tanto si los niños tuvieron experiencias traumáticas como si el motivo de la terapia estaba relacionado con el trauma, los padres reportaron un grado significativamente mayor de inversión de tiempo, (p < .05, r = −0.16), la preocupación que su hijo pudiera estar demasiado sobrecargado (p < .01, r = −0.20) y la falta de confianza en la competencia profesional (p < .01, r = −0.19). Conclusiones: Se reportaron las barreras estructurales como más prominentes. La exposición a trauma del niño podría incrementar aun mas las barreras percibidas. Estos hallazgos destacan la necesidad del apoyo parental y orientación especializada en trauma.
Adverse Childhood Experiences (ACEs) are associated with poor adult mental health, particularly in low-and middle-income countries where ACE exposure is high. This study used latent class analysis (LCA) to characterise patterns of ACEs in a longitudinal sample of South African adolescents and explored associations between ACE classes and adult mental health, including anxiety, depression, post-traumatic stress disorder, psychosis, and suicidality. Fourteen ACEs were assessed in 1648 adolescents (54.92% girls) from Mpumalanga using data collected across three waves (2010/2011, 2011/2012, and 2022/2023). Each ACE was dichotomised (exposed vs. not exposed), with exposure defined as meeting threshold criteria at either childhood wave. A four-class solution was identified: Low ACEs, High Parental AIDS-Affectedness and High Parental Sickness, High Parental AIDS-Affectedness and High Parental Death, and High multi-type ACEs. Compared to the low ACEs class, other classes had significantly higher poverty levels with further differences in gender, age and location. Adults in the highest multi-ACEs class reported significantly worse symptoms across all five mental health outcomes. Contextually sensitive ACEs (such as parental AIDS-affectedness) played an important role in differentiating ACE classes. Adults who experience multiple ACEs may be particularly at risk for poor mental health. In the two classes with, on average, the worst mental health outcomes, classes were primarily characterised by expanded ACEs, suggesting these broader adversities may confer unique risks in low-resource settings. Findings highlight the value of person-centred approaches like LCA to understand the complexity and multiplicative effects of ACEs and their long-term mental health impacts.
Psychological comorbidities are common in adolescents with SLE. Incorporating structured mental-health screening into adolescent SLE care may facilitate improved disease control and holistic well-being. We aimed to evaluate evidence describing changes in mental health including psychological comorbidities and associations with disease states in adolescents with SLE. A prospective cohort study was conducted in adolescents aged 12-18 years diagnosed with SLE and completed paired assessments at two visits 6-12 months apart. Mental-health measures included the Patient Health Questionnaire-Adolescents (PHQ-A) (depressive symptoms), Generalised Anxiety Disorder (GAD-7) (anxiety), PedsQL Multidimensional Fatigue Scale (PedsQL-MFS) (fatigue), Pittsburgh Sleep Quality Index (PSQI) (sleep quality), Brief Illness Perception Questionnaire (B-IPQ) (illness perception) and visual analogue scale for pain (VAS-P) (pain). Disease states comprised SLE Disease Activity Index 2000 (SLEDAI-2K) (disease activity) and attainment of childhood lupus low disease activity state (cLLDAS) or childhood-onset SLE (cSLE) remission. Group comparisons, paired analyses and correlation analyses were performed. 120 participants were enrolled, of which 117 had complete paired assessments. Most participants were females (90.5%), with a mean age of 15.1±0.2 years. Significant improvement in mental health measures was observed including PHQ-A (3 (1, 6) vs 2 (1, 5), p=0.013), GAD-7 (2 (1, 5) vs 2 (0, 4), p=0.004) and PSQI (4.6±2.8 vs 3.9±2.4, p=0.015) scores, whereas PedsQL-MFS, B-IPQ and VAS-P scores remained unchanged. SLEDAI-2K scores were low (2 (0, 4) vs 2 (0, 3)). The proportions of achieving cLLDAS (64.1% vs 72.6%, p=0.122) and cSLE remission (27.4% vs 35.9%, p=0.021) increased. The relationship between the psychological measures and SLEDAI-2K was not observed; however, active disease (SLEDAI-2K ≥5) was associated with greater fatigue (p=0.015) at the second visit. No associations were identified between the psychological measures and cLLDAS or cSLE remission, consistently in both visits. Mental health monitoring over 6-12 months apart revealed changes in depressive symptoms, anxiety and sleep quality during routine paediatric SLE care. The absence of associations with cLLDAS or remission underscores the importance of integrating mental health outcomes into the treat-to-target strategies.
Tuberous sclerosis complex (TSC) is a rare genetic disorder caused by pathogenic variants in the TSC1 or TSC2 genes. Apart from multisystem physical manifestations, most individuals with TSC experience TSC-associated neuropsychiatric disorders (TAND). Little is known about how TAND severity changes over time and what factors may predict these changes. Preliminary data suggest the presence of differential TAND severity trajectories. Caregiver well-being may act as a mediator of TAND severity, and a well-being intervention designed for caregivers of children with developmental disabilities may improve caregiver well-being. The study aims are to (1) examine longitudinal trajectories of TAND severity in a large sample of individuals with TSC and to examine potential predictors of differential trajectories, (2) evaluate the association between caregiver well-being characteristics, TAND severity, and severity trajectories, and (3) adapt and evaluate the feasibility, acceptability, and potential efficacy of a brief, online group-based well-being intervention for family caregivers. For the first 2 aims, 500 individuals with TSC or their caregivers will be recruited in an accelerated longitudinal design to document TAND severity at 5 time points over 12 months via a web-based app. At each time point, participants will complete demographic, TSC characteristics, intervention, and well-being questionnaires. Data will be analyzed using latent class mixed and multinomial regression modeling (aim 1) and structural equation and mediation modeling (aim 2). Participatory methods will be used to adapt an existing caregiver well-being intervention for the TSC community (aim 3). Thirty caregivers will be invited to participate in the adapted group-based online well-being intervention. This study was funded from July 2024 (HT94252410790 and HT94252410791), and ethics approvals were obtained from the University of Cape Town (July 2024), Vrije Universiteit Brussel (November 2024), and the Department of Defense Office of Human Research Oversight (December 2024). The TAND Toolkit app was adapted for longitudinal data collection (aims 1 and 2). Recruitment started in December 2025 and will continue until 500 participants are enrolled (anticipated December 2026). Primary outputs are expected by July 2028. For aim 3, experiential and adaptation workshops were completed in June 2025, the pilot intervention was delivered in November 2025, and data collection will continue till May 2026. Outputs are expected by December 2026. Identification of differential longitudinal TAND trajectories and their correlates will stimulate research in TSC and generate evidence for the self-report quantified TAND checklist as a clinical outcome measure. Understanding the association between caregiver well-being and TAND severity will provide support for targeted well-being interventions. A successful pilot trial will provide preliminary data for larger-scale clinical trials, with the potential to support caregivers and improve TAND outcomes. Together, the findings from the study will help close the gap in interventions for TAND. ClinicalTrials.gov NCT06879665; https://clinicaltrials.gov/study/NCT06879665. DERR1-10.2196/91726.
Although the COVID-19 pandemic's negative impact on mental health has been well established, more research is needed to better understand the vulnerability of certain populations. This study compared the perceived negative impact of COVID-19 on mental health between United States of America (USA) adolescents with and without a past-year major depressive episode (MDE). Additionally, we examined factors associated with higher perceived negative impact among those with a past-year MDE. The sample included adolescents aged 12 to 17 years from the 2021-2023 National Surveon Drug Use and Health (N = 31 861). Based on self-reported past-year MDE, participants were grouped as either with (n = 6 186) or without past-year MDE (n = 25 675). The prevalence of the perceived negative impact of COVID-19 on mental health was assessed between groups. Adjusted logistic regression was then conducted to examine factors associated with higher perceived negative impact among adolescents with past-year MDE. USA adolescents with past-year MDE were significantly more likely to report higher perceived negative impact than those without an MDE (41% vs. 10.3%). Among adolescents with past-year MDE, females, older adolescents, and individuals from higher household income levels were more likely to report higher perceived negative impact than their respective counterparts. Additionally, financial worries due to COVID-19 were a significant predictor, showing a positive association with higher perceived negative impact. It is crucial to implement targeted interventions for high-risk subgroups of adolescents with a mental health condition to address their unique needs and mitigate the pandemic's lasting effects on mental health.
To examine trends in mental health service use across four provider types (family doctors, psychiatrists, psychologists, and social workers) and identify sociodemographic predictors of provider-specific access in Canada. This study analyzes seven cycles (2007-2020) of the Canadian Community Health Survey, a nationally representative cross-sectional survey. Trends over time were examined using weighted proportions and counts of service users. Weighted multivariable logistic regression models were applied to the 2019-2020 cycle to assess associations between sociodemographic factors and provider-specific service use. Family doctors were consistently the most accessed providers for mental health concerns, followed by psychologists and social workers, with psychiatrists being least accessed. Psychologist and social worker use increased between 2017 and 2019. In the adjusted regression models (2019-2020), women had higher odds of using family doctors (AOR = 1.21, 95% CI: 1.05-1.39) and social workers (1.19, 1.02-1.40) and lower odds of psychiatrists (AOR = 0.66, 95% CI:0.55-0.79) than men. Adults 65 + had greater odds of family-doctor use (AOR = 4.82, 95% CI: 3.59-6.47) and lower odds of psychologist (AOR = 0.33, 95% CI: 0.24-0.45) and social-worker use (AOR = 0.21, 95% CI:0.16-0.29) than ages 12-17. Post-secondary education (vs less than secondary school) was associated with higher psychologist use (AOR = 1.83, 95% CI 1.12-2.98). Higher income (≥$80,000 vs < $20,000) was associated with lower psychiatrist use (AOR = 0.66, 95% CI 0.50-0.86). Non-Indigenous respondents more often used psychologists (AOR = 1.58, 95% CI: 1.13-2.23), and respondents who are not a visible minority more often used family doctors (AOR = 1.37, 95% CI:1.06-1.77). This study reveals a stratified mental health care system in Canada, where sociodemographic factors shape who accesses which providers. While primary care dominates, growth in psychologist and social worker use suggests shifting patterns of engagement. Findings underscore the need for policies that address financial and structural barriers, promote equitable access, and expand coverage for community-based mental health providers.
The cystic fibrosis transmembrane conductance regulator (CFTR) modulators were shown to improve clinical symptoms in patients with cystic fibrosis (CF). However, the effects of modulator therapy on the mental health of patients with CF remain uncertain. We aimed to investigate the impact of the CFTR modulator therapy on the mental health of children with CF and their parents. This prospective observational study was conducted on children with CF who used modulator therapy (Group 1, n = 24) and those who did not (Group 2, n = 29) and parents (n, 53). Cystic Fibrosis Quality of Life Questionnaire (CFQ-R), Children's Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED) were applied to patients. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF) were administered to parents. There was no significant difference between the groups in demographics. SCARED scores were higher in patients who did not use modulator therapy (p = 0.016). Anxiety and depression scores of BDI and BAI scales applied to parents were found to be statistically significantly higher in parents of patients who did not use modulator therapy (p = 0.006, p = 0.002, respectively). WHOQOL-BREF scores were higher among parents of patients who used modulator therapy, but the difference was not statistically significant (p = 0.060). These findings suggest a possible association between CFTR modulator use and lower anxiety and depression scores in both patients and parents, though causal conclusions cannot be drawn from this observational study. • CFTR modulator therapies have been increasingly used in recent years with demonstrated beneficial effects on clinical outcomes. • The effects of CFTR modulator therapies on mental health are not yet clearly defined. • CFTR modulator use was associated with lower anxiety scores in children with cystic fibrosis and lower anxiety and depression scores among their parents. • These findings suggest a potential early psychosocial benefit of CFTR modulator therapy for both patients and caregivers; however, they should be interpreted cautiously because the observational design does not allow causal conclusions.
Childhood chronic illness affects not only medical outcomes but also psychosocial wellbeing, requiring coordinated support from families, schools, and healthcare systems. While patient satisfaction and attitudes toward chronic illness have been studied separately, less is known about how these perspectives interact across key reference groups. A cross-sectional quantitative study was conducted among children aged 10-18 years with chronic illnesses and their reference persons in a university paediatric clinic. The sample included 107 children and their parents, along with teachers and healthcare professionals. Patient and parental satisfaction with care were assessed using a structured satisfaction questionnaire, while attitudes toward chronic illness among parents, teachers, and healthcare workers were measured across educational, social/community, and future-oriented dimensions. Factor analysis, cluster analysis, correlation analyses, and regression models were applied to explore satisfaction patterns, attitudinal differences, and interrelationships. Three distinct parental satisfaction profiles were identified: parents satisfied with all aspects of care, parents dissatisfied with disease-specific information, and parents dissatisfied with examinations and information. Higher parental satisfaction was associated with better child psychosocial outcomes, including lower illness burden and higher health-related quality of life. Attitude profiles differed across reference groups: parents showed the strongest educational attitudes but more negative perceptions of community inclusion and future prospects, whereas teachers and healthcare professionals demonstrated more positive community-focused and future-oriented attitudes. Intergroup analyses revealed meaningful associations, particularly in future-oriented attitudes, which were positively related to parental satisfaction. The findings suggest potentially complementary roles of parents, teachers, and healthcare professionals in supporting children with chronic illness. Strengthening cross-sectoral collaboration and aligning attitudes across family, educational, and healthcare contexts may enhance patient satisfaction and promote psychosocial wellbeing.
Childhood depressive disorders represent a growing mental health concern, yet region-specific evidence in Asia remains limited. Asia hosts more than half of the global child population and has experienced rapid social and environmental changes that may heighten psychosocial stress. This study assessed the burden, temporal trends, geographic variation, and determinants of childhood depressive disorders across Asia from 1990 to 2023. Data for children aged 0-14 years were obtained from the Global Burden of Disease (GBD) 2023 study. Incidence and disability-adjusted life years (DALYs) were analyzed by age, sex, region, and country. Joinpoint regression quantified annual and long-term temporal trends. Bullying victimization was evaluated as a behavioral risk factor. Extreme Gradient Boosting (XGBoost) models with Shapley Additive Explanations (SHAP), which show how each variable influences model predictions, were used to identify the major predictors of incidence and DALYs. In 2023, South Asia showed the highest incidence rate (1099 per 100,000) and DALYs rate (119 per 100,000). Across all regions, children aged 10-14 years and girls had the greatest incidence and DALYs rates. India, China, and Pakistan contributed the largest absolute numbers of cases and DALYs, while Mauritius, Bangladesh, and Pakistan recorded the highest rates. Pakistan demonstrated the steepest long-term increases in both incidence and DALYs. Bullying-attributable DALYs increased across all regions, with the largest growth in South and Southeast Asia. SHAP analyses identified age, sex, calendar year, and population size as the strongest predictors, with older children and girls showing markedly higher predicted burdens. Childhood depressive disorders have increased steadily across Asia over the past three decades, with clear demographic and geographic disparities. These findings highlight the urgency of early detection, school-based mental health programs, antibullying interventions, and gender-responsive services. Strengthening child mental health systems in Asia is critical for improving developmental outcomes.