搜索结果：Journal of the American Academy of Child and Adolescent Psychiatry

The negative effects of discrimination on mental health are well established. Few longitudinal studies have investigated protective factors that could mitigate these effects for youth of Mexican origin in the United States. This 3-wave longitudinal study examined individual-, family-, peer-, and neighborhood-level protective factors attenuating the effect of discrimination-related stress on youth depressive and anxiety symptoms. A total of surveyed 344 Mexican-origin youths (ages 12-15) from 2 Midwestern counties were surveyed longitudinally over 3 annual waves. Youths completed self-report measures of depression, anxiety, and discrimination as well as 6 potential protective factors: perceived social position, parent-child relationship, peer relationships, perceived social support, school connectedness, and neighborhood collective efficacy. Multilevel models with time-varying variables were used to analyze the effect of the potential protective factors on the association between discrimination and depressive and anxiety symptoms. Perceived social position, parent-child relationship, peer relationships, and perceived social support significantly attenuated the impact of racial discrimination on depressive symptoms at the between-youth level, but not at the within-youth level. No significant protective factors emerged for racial discrimination and anxiety symptoms at either the between-youth or the within-youth level. No cross-moderation effects were observed. These results highlight the importance of self-perceived social position and support in combating the effects of discrimination on depressive symptoms in Mexican-origin youth. Most protective factors centered on interpersonal relationships with caregivers and peers. Findings indicate the need for a greater understanding of school connectedness and neighborhood collective efficacy as nonsignificant protective factors, taking into consideration that these perhaps continue to be discriminatory rather than supportive contexts. Seguimos Avanzando-Latino Youth Coping With Discrimination; https://clinicaltrials.gov/study/NCT04875208. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

The study aimed to examine the temporal association between psychotic-like experiences (PLEs) and new-onset mental disorders in late adolescents. This longitudinal study used data from the Guangzhou Early Mental Health Screening for University Students (GEMSS), conducted in China from 2020 to 2024. PLEs conditions were defined based on the participants' baseline assessment. Person-year incidence rates of any new-onset mental disorder (MD), psychotic disorder (PD), and non-psychotic disorder (non-PD) were calculated in different PLEs groups. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of different PLEs conditions, and their population attributable fractions (PAFs) for mental disorders were computed. Of the 6,737 included participants (56.2% female; mean [SD] age, 18.84 [0.72] years), 876 (13.0%) were currently experiencing PLEs at baseline (cur-PLEs), 2,815 (41.8%) had previously experienced PLEs (pre-PLEs), and 3,046 (45.2%) had never experienced PLEs before (non-PLEs). Compared to the non-PLEs group, the cur-PLEs group exhibited a significantly higher risk for developing any new-onset MD (HR = 4.83, 95% CI = 3.22, 7.24), PD (HR = 10.59, 95% CI = 1.23, 91.0), and non-PD (HR = 6.22. 95% CI = 3.96, 9.80), whereas the pre-PLEs group exhibited a significantly higher risk for incident MD (HR = 2.11, 95% CI = 1.44, 3.07) and non-PD (HR = 2.25, 95% CI = 1.48, 3.40). The PLEs conditions accounted for 49.1% (95% CI = 0.483, 0.499), 74.4% (95% CI = 0.738, 0.749), and 52.4% (95% CI = 0.515, 0532) of new-onset MD, PD, and non-PD. PLEs in late adolescence are closely associated with the onset of psychotic and non-psychotic disorders. These findings underscore the critical importance of PLEs in screening high-risk populations as a transdiagnostic predictor of mental disorders. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available.ne or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Although it is well-established that maternal depression can be treated successfully with psychological treatments, it is not yet clearwhether successful treatment has a positive effect on the development and mental health of their children. We conducted a random-effects meta-analysis of randomized trials on psychological treatments of depressed pregnant women and mothers, which also reported outcomes on parental functioning /marital distress, the interaction between mother and child, child development, mental health, length and weight. We included 47 randomized trials (51 comparisons between treatment and control groups; 7,745 participants). The interventions had a moderate effect on depression in the mothers (SMD=0.57; 95% CI: 0.43; 0.70). We also found significant effects on parental functioning/marital distress (k=31; g=0.23; 95% CI: 0.07; 0.39), on the interaction between mother and child (k=27; g=0.34; 95% CI: 0.12; 0.56) and on child mental health (k=10; g=0.29; 95% CI: 0.12; 0.45). No significant effect was found for child development, length, and weight, possibly because of low power. Heterogeneity was high in most analyses. Sensitivity analyses resulted in mixed outcomes, with some main results not supported, while others resulted in significant outcomes (child development, child length and weight) that were not significant in the main analyses. Treatment of depressed mothers probably has small but significant effects on parental functioning/marital distress, the interaction between mother and child, and child mental health. This substantially increases the importance of making psychological treatments available to pregnant women and mothers with depression. The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis; https://osf.io/m5xys/overview.

Adolescents' social relationships might partly explain the increased risk of mental health problems in adolescents living in poorer economic circumstances. There are few studies in low- and middle-income countries, where most of the world's adolescents live. This study investigated whether adolescents' relationships with their parents and peers mediated the association between their economic circumstances and emotional symptoms in Ethiopia, India, Peru, and Vietnam. Longitudinal data of 3,529 adolescents from the Young Lives study (1,741 female [49.3%]) were analyzed. Household consumption expenditure and adolescents' subjective assessment of household wealth were measured at age 15. The mediators-adolescents' positive relationships with their parents and peers-were measured at age 19. The outcome-emotional symptoms, characterized by low mood and anxiety-was measured at age 22. Mediation was assessed through counterfactual g-computation formula, adjusting for baseline and intermediate confounders. No evidence was found that adolescents' positive relationships with their parents or peers mediated the association between economic circumstances and emotional symptoms in any country. Living in poorer economic circumstances was typically associated with more severe emotional symptoms. Adolescents' parent and peer relationships might not mediate the effects of poorer economic circumstances on emotional symptoms in these countries, contrasting with previous studies that highlight an important role of relationships in high-income countries. Further research is needed that addresses limitations of this study and to explore other potential mechanisms, including different aspects of social relationships, that might influence mental health outcomes for adolescents living in poverty across different settings. Socio-Economic Inequality in Adolescent Mental Health: Mediating Roles of Adolescents' Relationships With Their Peers and Parents Across Four Countries; https://osf.io/sb67c/overview.

The September 2025 Proclamation, "Restriction on Entry of Certain Nonimmigrant Workers," conditions entry on H-1B visa status on a $100,000 payment attached to new petitions with an effective time of 12:01 a.m. EDT on September 21, 2025. This policy, when considered in the broader context of increasingly restrictive visa-issuing processes including surveillance of social media accounts, introduces substantial uncertainty for non-US international medical graduates (IMGs) whose training and employment routes involve J-1 and H-1B visas.1 The Immigration Act of 1990 created the H-1B visa program to hire highly educated foreign professionals in select occupations, such as technology and medicine, that face a dearth of US workers. While H-1B visa holders can train and practice in the United States, J-1 visa holders must return to the home country for 2 -years following completion of residency or fellowship training unless a J-1 waiver is granted. In addition, IMGs may experience other obstacles in training programs or the healthcare job market in the current climate. However, the national discourse overlooks the voices of the many youths, families, US citizens, healthcare systems, and communities that they serve and the personal stories of IMGs themselves. IMGs make up approximately 25% of the US healthcare workforce; they work largely with underserved families and fill a workforce shortage that is anticipated to exceed 86,000 physicians by 2036.2,3 Furthermore, they have the ability to connect to a growing population of American children of immigrant families and contribute to the innovation and economic engines of our nation.4.

In a retrospective case-controlled study of children of deceased male active duty service members, we examined the prevalence of mental health diagnoses in paternally bereaved children before loss and one and two years after loss compared to non-bereaved children. Prevalence rates of mental health diagnoses in 1,212 bereaved and 1,212 non-bereaved children (matched on child age; child sex; pre-loss military healthcare utilization; parental military rank and deployment history) were calculated based on electronic medical record data in the military healthcare system. Logistic regressions compared prevalence rates between bereaved and non-bereaved children one and two years following paternal loss. Prevalence rates of depressive and adjustment disorders were two- to four-times higher in bereaved compared to non-bereaved youth one and two years after loss. Rates of acute stress disorder/posttraumatic stress disorder (PTSD) were 9.5 times higher in the first year post-loss in bereaved versus non-bereaved youth. Models stratified by sex indicated rates of depressive disorders, adjustment disorders, and acute stress disorder/PTSD were higher in both bereaved male and female youth compared to their non-bereaved counterparts. However, few sex differences were found. An examination of developmental differences indicated that bereaved school-age children had higher rates of acute stress disorder/PTSD compared to adolescents in the first year after death. Paternal bereavement is associated with increased prevalence of depressive disorders, adjustment disorder, and acute stress disorder/PTSD 1- and 2-years post-loss among children in active duty families. Paternally bereaved school-age children may be at heightened risk for trauma-related diagnoses.

BACKGROUND: There is a need to identify effective and safe treatments for depression in children and adolescents. While tricyclic drugs are effective in treating depression in adults, individual studies involving children and adolescents have been equivocal. Prescribing of tricyclic drugs for depression in children and adolescents is now uncommon, but an accurate estimate of their efficacy is helpful as a comparator for other drug treatments for depression in this age group. This is an update of a Cochrane review first published in 2000 and updated in 2002, 2006 and 2010. OBJECTIVES: To assess the effects of tricyclic drugs compared with placebo for depression in children and adolescents and to determine whether there are differential responses to tricyclic drugs between child and adolescent patient populations. SEARCH METHODS: We conducted a search of the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 12 April 2013), which includes relevant randomised controlled trials from the following bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). The bibliographies of previously published reviews and papers describing original research were cross-checked. We contacted authors of relevant abstracts in conference proceedings of the American Academy of Child and Adolescent Psychiatry, and we handsearched the Journal of the American Academy of Child and Adolescent Psychiatry (1978 to 1999). SELECTION CRITERIA: Randomised controlled trials comparing the efficacy of orally administered tricyclic drugs with placebo in depressed people aged 6 to 18 years. DATA COLLECTION AND ANALYSIS: One of two review authors selected the trials, assessed their quality, and extracted trial and outcome data. A second review author assessed quality and checked accuracy of extracted data. Most studies reported multiple outcome measures including depression scales and clinical global impression scales. For each study, we took the best available depression measure as the index measure of depression outcome. We established predetermined criteria to assist in the ranking of measures. Where study authors reported categorical outcomes, we calculated individual and pooled risk ratios for non-improvement in treated compared with control subjects. For continuous outcomes, we calculated pooled effect sizes as the number of standard deviations by which the change in depression scores for the treatment group exceeded those for the control group. MAIN RESULTS: Fourteen trials (590 participants) were included. No overall difference was found for the primary outcome of response to treatment compared with placebo (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.91 to 1.26; 9 trials, N = 454). There was a small reduction in depression symptoms (standardised mean difference (SMD) -0.32, 95% CI -0.59 to -0.04; 13 trials, N = 533), but the evidence was of low quality. Subgroup analyses suggested a small reduction in depression symptoms among adolescents (SMD -0.45, 95% CI -0.83 to -0.007), and negligible change among children (SMD 0.15, 95% CI -0.34 to 0.64). Treatment with a tricyclic antidepressant caused more vertigo (RR 2.76, 95% CI 1.73 to 4.43; 5 trials, N = 324), orthostatic hypotension (RR 4.86, 95% CI 1.69 to 13.97; 5 trials, N = 324), tremor (RR 5.43, 95% CI 1.64 to 17.98; 4 trials, N = 308) and dry mouth (RR 3.35, 95% CI 1.98 to 5.64; 5 trials, N = 324) than did placebo, but no differences were found for other possible adverse effects. Wide CIs and the probability of selective reporting mean that there was very low-quality evidence for adverse events.There was heterogeneity across the studies in the age of participants, treatment setting, tricyclic drug administered and outcome measures. Statistical heterogeneity was identified for reduction in depressive symptoms, but not for rates of remission or response. As such, the findings from analyses of pooled data should be interpreted with caution.We judged none of these trials to be at low risk of bias, with limited information about many aspects of risk of bias, high dropout rates, and issues regarding measurement instruments and the clinical usefulness of outcomes, which were often variously defined across trials. AUTHORS' CONCLUSIONS: Data suggest tricyclic drugs are not useful in treating depression in children. There is marginal evidence to support the use of tricyclic drugs in the treatment of depression in adolescents.

Refugee and internally displaced children and adolescents experience high rates of post-traumatic stress symptoms (PTSS). Yet there is a lack of evidence of the effectiveness of psychological interventions in this population. This systematic review and meta-analysis investigates the effects of psychological interventions on PTSS among refugee and internally displaced children and adolescents (PROSPERO CRD[masked]). A comprehensive literature search up to December 19th, 2025, was conducted in PubMed, PsycINFO, PSYNDEX, Web of Science, Epistemonikos, PTSDpubs and ClinicalTrials.gov. Controlled trials were eligible if they studied psychological interventions aiming to reduce PTSS in refugee and internally displaced children and adolescents. Study quality was assessed using Cochrane's RoB-2 tool. Outcomes were analyzed using a random-effects-model meta-analysis. Eight studies met the inclusion criteria, providing data on nine active treatment conditions and 448 participants. Analyses showed a small effect of psychological interventions on PTSS reduction, g = -0.35, 95%-CI [-0.61, -0.09], and no significant effects on depression, g = -0.34, 95%-CI [-0.76, 0.09], and dropout, OR = 1.71, 95%-CI [0.35, 8.32]. No significant moderators of PTSS reduction could be identified, but pretest-PTSS, b = -0.30, suggesting potential greater effects for those with higher initial symptoms. The findings support the effectiveness of psychological interventions in treating PTSS in refugee and internally displaced children and adolescents. However, further research is needed to understand, whether and why treatment effects appear smaller than in the general population, and whether this relates to migration-factors or factors associated with service-provision and -use or the need for intervention adaptations. Psychological interventions for post-traumatic stress disorder in internally displaced and refugee children and adolescents - A systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024614752.

To investigate the utilization of specialist child and adolescent mental health services (CAMHS) among refugee and asylum-seeking children (<18 years old) globally compared with nonrefugee peers, specifically looking at differences in diagnostic and therapeutic profiles, service use referral pathways and barriers to access, and hospitalization. A systematic search of MEDLINE, Embase, PsycINFO, and CINAHL was conducted from inception until August 8, 2025. Observational studies with quantitative outcomes comparing CAMHS use between refugee/asylum-seeking and nonrefugee/non-asylum-seeking children were included. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale, and data were presented in a narrative synthesis due to heterogeneity. This review included 25 studies, mainly from high-income settings and of high quality. Refugee/asylum-seeking youth exhibited higher rates of posttraumatic stress disorder, anxiety, and depression, but lower outpatient CAMHS utilization, compared with nonrefugee/non-asylum-seeking peers. Refugees/asylum-seekers received fewer guideline-concordant treatments, particularly for attention-deficit/hyperactivity disorder and mood disorders. Compared with nonrefugees, refugees were more likely to be referred by nonmedical agencies. Barriers included language, stigma, fragmented primary care registration, and crisis-driven entry into services through emergency departments or social services rather than primary care. Findings on inpatient admissions yielded a mixed picture, with unaccompanied minors overrepresented in involuntary care. Results imply inequity in CAMHS contact among refugee youth, in the context of high need and despite lack of economic barriers. More timely and culturally sensitive access is needed, as well as effective training for nonmedical agencies and responsive public policies that reduce structural barriers to psychiatric care and address the complex circumstances and needs of displaced youth. Systematic Review: Child and Adolescent Refugees and Asylum-Seekers' Contact With Specialist Mental Health Services; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022310239.

Alarmingly, during 2019 to 2020, the prevalence of adolescent fatalities due to drug overdose more than doubled in the United States, despite relatively stable rates of adolescent overdose mortality in the preceding years.1 As nonfatal overdoses often precede fatal overdoses,2 it is critical to understand trends in prevalence and patterns of nonfatal overdoses in the period preceding the observed rise in overdose fatalities. Adolescence is a developmentally sensitive time associated with emergence of several risk factors for overdose, including depressive disorders, risk-taking behaviors, and experimentation with substances.3 Medicaid recipients have historically higher rates of these predisposing risk factors and thus represent an appropriate population to study overdose patterns.4 Until now, few studies using Medicaid claims data have examined time trends of nonfatal overdoses. In this issue of the Journal, Bushnell et al.5 leveraged Medicaid claims data from 2016 to 2020 to estimate trends in the prevalence of nonfatal overdoses among adolescents in acute-care settings (inpatient or emergency department [ED]), documented intent of overdose, and substances involved.

Most youth in routine mental health care do not receive evidence-based treatments, and when implemented in real-world settings, their effects are typically smaller than those observed in controlled efficacy trials. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one of the most efficacious and widely implemented evidence-based treatments for traumatized youth worldwide, yet little is known about how it is delivered and adapted in routine practice. We examined 25,000 treatment sessions to understand 1) how TF-CBT is implemented in routine care, 2) what delivery adaptations are made based on child age and the presence of complex posttraumatic stress disorder (CPTSD) symptoms, and 3) whether adaptations are associated with outcomes. Data came from an observational study of TF-CBT implementation (2018-24) across Norwegian child and adolescent mental health services. Youth (6-18 years) with clinically significant posttraumatic stress symptoms (N=1,373) received treatment from 357 therapists across 74 outpatient clinics representing 82% of such services in Norway. Overall, 66% completed treatment and 59% showed reliable improvement. Clinicians applied TF-CBT flexibly as prescribed by the model. Patients with CPTSD received more trauma processing but had less caregiver involvement than those without CPTSD. Children received more stabilization and caregiver involvement than adolescents. More trauma experiences predicted higher dropout, while more caregiver sessions predicted lower dropout. CPTSD was associated with reliable improvement. Number of potentially traumatic event types were more strongly associated with dropout for children than adolescents, and caregiver sessions more strongly predicted improvement in CPTSD cases. This study provides the first large scale systematic documentation of TF-CBT delivery in routine care, showing that TF-CBT can be scaled-up in community clinics, with high improvement rates comparable to recent meta-analyses. A majority of the therapists received supervision, and future studies need to dismantle the importance of case consultation when scaling up evidence-based treatments.

Predominant psychopathology classification systems (Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases) exhibit multiple limitations. Alternative, empirically based dimensional approaches (eg, the Hierarchical Taxonomy of Psychopathology [HiTOP]) have been examined mostly with adults, with less structural research in youth, and even less incorporating youth personality dysfunction alongside "common" symptoms. Exploratory, descriptive work among youth is needed to organize an empirically based, comprehensive structure of psychopathology that is also generalizable across time, informant, gender, and development. Exploratory factor analyses were conducted using data from a general community sample of 588 youth (baseline, mean age = 13.58 years, range = 9.3-17.5 years; 55.5% female) and parent informants on youth psychopathology symptoms. Additional exploratory analyses evaluated hierarchical structure models across time (18 months apart), informant (youth- and parent-report), gender, and pubertal status. Hierarchical factor analyses revealed a structure unfolding from one general psychopathology factor down to 9 interpretable narrowband symptom factors. Intermediate factors replicated 3 broadband spectra found in prior research on child psychopathology structure (internalizing, disinhibited externalizing, and personality dysregulation). This structure was largely consistent at the broadband spectra level across informants. Narrowband symptom structure exhibited some consistencies and nuanced differences across gender and pubertal status for both informants and across time for youth-reports. Parent-report structure was more consistent than child-report across time, gender, and pubertal status. Results yield new insights on the empirically based organization of youth mental health symptoms. We discuss (dis)continuities across informants, youth gender, and developmental stage. Findings highlight the importance of considering developmental considerations when planning and evaluating alternative diagnostic models of mental health. Testing a Hierarchical Structural Model of Youth Psychopathology Symptoms Over Time and Across Informants, Gender, and Pubertal Status; https://osf.io/9agvs/.

Advances in genetics, neuroscience, clinical trials, and implementation science promise to improve outcomes for youth with mental health, substance use, or neurodevelopmental conditions. These innovations are much needed, given the youth mental health crisis.1 Child and adolescent psychiatrists (CAPs) are ideally poised to discover, test, and implement novel treatments with our intersecting medical training, understanding of psychological health, and developmental understanding of the brain. Unfortunately, a critical shortage of CAP physician-scientists exists,2 which we made a top priority for the Research Committee of the American Association of Directors of Child and Adolescent Psychiatry (AADCAP), comprising 7 of this Commentary's authors. Here, we describe a key approach to addressing this problem: CAP training programs that combine robust clinical and research training to foster the development of CAP physician-scientists with sustained and impactful research programs.

The term second-generation antipsychotics (SGA) is applied to a rather heterogeneous group of medications that share pharmacological activity on the dopaminergic neurotransmitter system and demonstrated efficacy in reducing psychotic symptoms in schizophrenia. They are commonly also prescribed to children and adolescents for the treatment of other conditions, either with regulatory approval (bipolar disorder, irritability in autism, Tourette disorder) or off-label (aggressive, disruptive, and impulsive behaviors). In fact, most pediatric use is for treating non-psychotic conditions.1 A more correct designation than SGA, based on the specific neurotransmitter activity of these medications, has been introduced.2 Evidence of the efficacy of SGA in reducing symptoms comes from randomized controlled trials, but little information is available on their effects on "hard" or "real-world" outcomes such as hospitalization, self-harm, violent crime, or accidental injury. To this end, randomized trials are of questionable feasibility because of the large sample sizes and extended duration of observation that would be required. Therefore, alternative methods are needed.

Irritability, conceptualized as elevated proneness to anger, is a transdiagnostic feature and robust predictor of multiple psychological disorders. Identifying neurophenotypes of irritability in early childhood is critical to inform timely intervention, as irritability persisting into school age is associated with increased psychopathology and impairment. The present study aims to examine the neural substrates of irritability in early childhood in relation to reward processing, which is implicated in multiple disorders. Data from 185 children (Mage = 6.16 years, SD = 0.50) were included. A child-friendly version of the Monetary Incentive Delay task during functional MRI acquisition assessed neural activity during reward anticipation (i.e., reward vs. no-reward) and feedback (i.e., hit vs. miss the target with a reward expected vs. not). The Multidimensional Assessment Profiles - Temper Loss Scale assessed irritability. Whole-brain multilevel analysis on neural activation and functional connectivity examined associations between irritability and reward processing. Greater irritability was associated with greater differences in response to reward vs. no-reward, reflected in left putamen activation. It was also associated with alterations in amygdala and striatal connectivity with multiple frontotemporal and parietal regions. The directionality of the effects varied depending on task-specific conditions (e.g., hitting a target with reward expected, missing a target with no reward expected). Our findings provide insights into the reward-related neural pathways of irritability in early childhood, a critical yet understudied developmental stage, which has the potential to facilitate timely and mechanistically informed interventions in young children.

Attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood is associated with adverse socioeconomic outcomes, but questions remain about causality. Prior work is limited by single-timepoint assessments, narrow socioeconomic measurement, and inadequate control for genetic and environmental confounds. We used data from the Minnesota Twin Family Study, a multi-decade longitudinal study of 2,764 twins, to examine associations between ADHD and socioeconomic status (SES) across development. Childhood ADHD was defined as meeting diagnostic criteria at baseline (n = 131). SES was measured with parental education and occupation, household income, and neighborhood disadvantage in childhood, and participants' own education, occupation, and income in adulthood. Co-twin control analyses accounted for genetic and shared environmental confounding. We examined apparent adult-onset ADHD (n = 32) as an exploratory comparison. Childhood ADHD was associated with both rearing family SES and adult education. In twin pairs discordant for childhood ADHD, the affected twin showed lower levels of education, indicating that the association is not entirely attributable to the intergenerational transmission of SES and consistent with a causal effect of ADHD. Within-pair differences in adult occupational status and income were not significant, suggesting that these associations reflect shared familial factors. Adult-onset ADHD showed weaker associations overall, with no significant within-pair effects. Lower SES in childhood was associated with childhood ADHD, which predicted lower adult SES, particularly for education. Co-twin analyses suggest the childhood ADHD-educational attainment association is not entirely attributable to genetic or familial confounds, whereas adult-onset ADHD showed weaker and less consistent patterns. ADHD and Socioeconomic Status: Approaching Causal Inference in a Longitudinal Study of Twins; https://osf.io/4kufm.

Second-generation antipsychotic (SGA) treatment has increased in youth globally. However, the effects of these agents on real-world outcomes are largely unknown, especially for non-approved indications. This study included a national cohort of incident SGA recipients 7 to 17 years of age in Sweden from 2007 to 2020. Youth were followed from 1 year before SGA initiation through up to 1 year afterward, and in recurrent treatment analyses, up to 13 years after initiation. Within-individual comparisons were used to examine the risk of psychiatric hospitalization, self-harm, accidental injury, and violent crime before and after treatment. The study included 21,306 SGA initiators (53.1% male; median age 14.8 years at baseline). Indications included psychosis-related disorders (1,966 [9.2%]), autism spectrum disorders (5,140 [24.1%]), depression/other mood disorders (3,669 [17.2%]), intellectual disability (987 [4.6%]), and attention-deficit/hyperactivity disorder (2,992 [14.0%]). Within a year of initiation, 5,604 (26.3%) experienced psychiatric hospitalization, 1,749 (8.2%) self-harm, 954 (13.6% of those &#x2265;16 years of age) violent crime, and 3,134 (14.7%) accidental injury. Risks were generally elevated immediately before SGA initiation and decreased across subsequent treatment without fully returning to baseline, although there was variation across indications. For example, psychiatric hospitalization and self-harm displayed larger pre-initiation elevations and subsequent decreases for youth with psychosis-related disorders (eg, psychiatric hospitalization: pre-initiation odds ratio [ORpre] = 11.30 [95% CI, 9.84-12.97]; ORpost = 2.59 [95% CI = 2.21-3.02]). Conversely, youth with neurodevelopmental disorders demonstrated greater decreases in violent crime (eg, attention-deficit/hyperactivity disorder: ORpre = 1.66 [95% CI, 1.23-2.26]; ORpost = 1.26 [95% CI, 0.94-1.70]). Accidental injury risk did not statistically significantly differ (eg, ASD: ORpost = 0.90 [95% CI, 0.77-1.07]). After having escalated before initiation, risk of psychiatric hospitalization, self-harm, and violent crime decreased during SGA treatment without fully returning to baseline. There was little evidence of associations with accidental injury.

Adolescent depression remains one of the leading causes of disability worldwide, contributing substantially to the global burden of disease.1 Despite growing interest in early identification and prevention of depression, a persistent challenge is to deliver the right support to the right young people, at the right time. Lessons from other fields in medicine illustrate how risk-informed prevention-guided by composite prediction models-can make preventive efforts both proportionate and effective. Depression, in particular, demands a multifaceted, individualized approach to early detection-especially during adolescence, when incidence peaks and prevention opportunities are greatest. Psychiatry, however, has traditionally emphasized discrete factors, thereby constraining our capacity to model the complex interplay of risk and protective factors that underlie vulnerability. Current approaches also often rely on subthreshold depressive symptoms, limiting the ability to identify adolescents most at risk before symptoms emerge. Furthermore, although early predictive models show promise, their performance often fails to generalize beyond development samples.

Do psychiatrists need to talk more? We are taught to listen more than we speak, to invite the patient's narrative, and to observe its unspoken undertones. But are we vocal enough in sharing our formulations with patients and explaining our thought processes as we plan and prescribe treatment? Despite the evidence that providing psychoeducation to patients and families improves mental health outcomes, many providers forgo the opportunity to engage in it, perhaps because of time constraints, lack of reimbursement, or inadequate training and skills development in the practice.1 We need to talk more, and yet, when we do offer psychoeducation, might we be talking too much? Explaining symptom constellations and relaying the evidence for proposed interventions can easily veer toward a one-sided lecture, bypassing the opportunity for dialogue and collaborative connection with patients.