Pharmacovigilance findings have marked clozapine use. Prescribers and package inserts worldwide focus on clozapine-induced neutropenia. The literature on clozapine adverse drug reactions (ADRs) for those under age 18 and their associated fatal outcomes is limited. Reports to the World Health Organization's global pharmacovigilance database (VigiBase) were analyzed among patients under 18 years of age extending from clozapine's introduction to June 1, 2022. There were 2825 reports of clozapine, including 42 fatal outcomes (relative lethality = 1.5% vs. 11.7% in all ages). After 280 cases were excluded (clozapine exposure during pregnancy, accidental exposure or unclear age), 2455 were included with ADRs during therapeutic use. Decreased white blood cell (WBC) count provided the most frequent aggregated ADR, accounting for 934 cases (37% of 2545), with only 1 fatal outcome (0.01%, 1/934). Suicide explained 7 of 27 (26%) non-duplicated fatal outcomes. Next in importance was clozapine-induced gastrointestinal hypomotility (CIGH) with 3 cases (11% of 27) and neuroleptic malignant syndrome with 2 cases (7% of 27). Agranulocytosis, aspiration, myocarditis, myocardiopathy and ventricular arrythmia led to single fatal cases. Based on these new findings and recent literature in all ages, to prevent fatal outcomes, child and adolescent psychiatrists need to shift their focus from severe neutropenia to other ADRs including pneumonia, respiratory aspiration and CIGH. In spite of its potential toxicity during overdoses, clozapine may have specific and strong anti-suicidal effects when compared with other antipsychotics. Child and adolescent psychiatrists need to take extreme precautions to avoid intentional overdoses when prescribing clozapine to patients with suicide risk.

Trans youth reports reveal a predominance of assigned female at birth (AFAB) people (i.e. transmasculine people) over assigned male at birth (AMAB) people (i.e. transfeminine people). It has been suggested that "social contagion" through social media could be more frequent in AFAB people, causing a hypothesized "rapid-onset gender dysphoria" (ROGD) in adolescence, with detrimental correlates to health. We aim to test (1) whether the suggested effect of ROGD on an AFAB predominance in adolescence could have an alternative explanation such as the effect of national LGBT policies; (2) the suggested effects of ROGD by which transmasculine people who had a more rapid development of their trans identity in adolescence would use more often social media to connect to peers and would have a lower health status. Regarding our methods, we used the cross-sectional LGTI Survey II (2019) of the European Union Agency for Fundamental Rights (137,553 LGBT people) and the ILGA-Europe's Rainbow Index (2019) of national LGBT policy scores. We calculated the chances to recognize and share an LGBT identity for AFAB/AMAB cis/trans people, expected sex ratios for cis/trans people at every age given equal total AFAB and AMAB populations, and national AFAB vs. AMAB differences in ages of LGBT identity-sharing adjusted by their ages of self-perception. We tested among adolescent respondents whether belonging to the hypothesized ROGD population was associated with social media use or poorer self-assessed health. As regards our findings, we predicted a predominance of AFAB trans adolescents as well as AFAB LGB cis adolescents in accordance with our observation that AMAB youth shared their identity later than AFAB youth in all 30 countries, their age of self-perception being held equal. We found that national differences in ages of identity-sharing significantly correlated with ILGA-Europe's Rainbow Index. We did not find that transmasculine people who had a rapid development of a trans identity in adolescence used more social media or had worse health. However, when we restricted the sample to those who were adolescents in the survey (N = 6209), we found that transmasculine youth who had a more rapid affirmation (< 1 year) used more frequently social media, though they did not have poorer health. To conclude, the AFAB predominance in adolescence may not be trans-specific. The effect of social influence on the emergence of LGBT identities in adolescence may exist at the micro level (social media use by transmasculine adolescents) but also at the macro level (state laws). These findings give support to some of the ROGD hypothesis features but contradict others, and plead for more research on how gender minority stress affects the likelihood of LGBT people to disclose their identity.

Translation of biomarkers to clinical practice is hindered by the significant overlap in neurobiological measures between ADHD cases and controls. A risk-informed design can enhance the utility and validation of ADHD biomarkers by highlighting differences between individuals with ADHD and those without at differential risk. Participants were 2511 children and adolescents (aged 6 to 14 years) from the Brazilian High Risk Cohort for Mental Conditions. We calculated risk for ADHD among unaffected individuals using a multivariable clinical and sociodemographic risk model. We compared measures of three proposed ADHD biomarkers (polygenic scores, subcortical volumes, and executive function) between participants with vs. without ADHD, and ADHD vs. without ADHD with a high- vs. low-risk loading for ADHD. Compared to the unaffected group, children and adolescents with ADHD had higher ADHD polygenic scores (cohen's d = 0.17), smaller subcortical volumes (d = - 0.25), and poorer executive function (d = - 0.22). Separating the unaffected group into low- and high-risk subgroups revealed more pronounced differences (Cohen's d = 0.20 to 0.60) and nearly doubled the overlap-free area for these three neurobiological measures between the low-risk group and the other two groups. Upon adjustment for the number of ADHD symptoms, simple ADHD vs. without ADHD differences vanished, while the risk-informed analyses remained significant. Here, we demonstrate that a risk-based design increases effect sizes when comparing candidate biomarkers for ADHD. Our study provides a model that may hold promise for evaluating similar contrasts in other mental disorders and samples.

Stimulant medication is effective in alleviating overall symptom severity of attention-deficit/hyperactivity disorder (ADHD), yet interindividual variability in treatment response and tolerability still exists. While network analysis has identified differences in ADHD symptom relations, the impact of stimulant medication remains unexplored. Increased understanding of this association could provide valuable insights for optimizing treatment approaches for individuals with ADHD. In this study, we compared and characterized ADHD symptom networks (including 18 ADHD symptoms) between stimulant-treated (n = 348) and untreated (n = 70) individuals with ADHD and non-ADHD controls (NACs; n = 444). Moreover, we compared symptom networks between subgroups defined by their stimulant treatment trajectory (early-and-intense use, late-and-moderate use). Stimulant-treated individuals with ADHD showed stronger associations between symptoms, compared with untreated individuals with ADHD and NACs. We found no differences in symptom networks between the stimulant treatment trajectory subgroups. Prospective longitudinal studies are needed to disentangle whether the identified differences stem from treatment or pre-existing factors.

Adolescence increases vulnerability to mental ill-health, particularly anxiety disorders like Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD). Still, the understanding of Psychological Flexibility/Inflexibility (PF/PI) as a transdiagnostic framework relevant to explaining these difficulties and the efficacy of Acceptance and Commitment Therapy (ACT) in addressing adolescent SAD and GAD remains limited. Hence, this study has two aims: examining the role of PI/PF on adolescents' mental health and assessing ACT's efficacy for adolescent SAD and GAD. We will collect data from 400 community adolescents and employ network analysis to explore connections between PI/PF processes, anxiety, and flourishing. We will also investigate pathways linking PI/PF processes with flourishing and anxiety across samples (clinical SAD, clinical GAD, and mentally healthy groups), expecting to find similar patterns. Furthermore, a Randomized Controlled Trial with three groups (control, SAD experimental and GAD experimental), each comprising 29 participants, and four assessment moments (pre- and post-intervention and 3- and 6-months follow-up) will be conducted. Similar improvements are anticipated in both experimental groups, driven by changes in PI/PF processes. Findings from this work will provide valuable evidence to PI/PF as accurate conceptualizations of human suffering and expand the transdiagnostic application of ACT to adolescents with anxiety disorders.

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality.

The aim of this study was to examine the neurocognitive deficits associated with the first episode of major depressive disorder (recent onset depression, ROD) in adolescents as compared to adult patients. Cross-sectional neurocognitive data from the baseline assessments of the PRONIA study with N = 650 (55.31% females) were analyzed. Based on a principal component analysis of eleven neurocognitive tests, we constructed an overall neurocognitive performance (NP) score. We examined mean score differences in NP between the groups of healthy controls (HC) and ROD and between adolescents (15-21 years) and adults (22-40 years) within a GLM approach. This accounts for unbalanced data with focus on interaction effects while controlling for effects of medication and educational years. Our results show lower NP for the ROD as compared to the HC group (d = - 0.29, p = .046) and lower NP for the adolescent group as compared to the adult group (d = - 0.29; p < .039). There was no interaction between these two group effects (F = 1.11; p = .29). Our findings suggest that the detrimental effect of ROD on neurocognitive functioning is comparable in adolescent and adult patients, since lower scores in adolescent patients are explained by effects of age and education. Neurocognitive impairment is an under addressed issue in clinical treatment guidelines for adolescent MDD. We suggest efficient monitoring in clinical practice by using an aggregate of the Digit Symbol Substitution Test and the Trail Making Test B, which highly correlated with the overall score of NP (r = 0.82).

Anxiety symptoms and eating disorder symptoms commonly co-occur in adolescents. However, there is divergent evidence on the prospective relationship between the two factors. This systematic review and meta-analysis summarises the existing literature on the prospective and bi-directional relationship between anxiety symptoms and eating disorder symptoms in adolescence. A systematic search across six databases was conducted on the 11th June 2024. Studies were included if they assessed the prospective relationship between anxiety symptoms and eating disorder symptoms, or vice versa, in adolescence. 19,591 studies were screened, of which 54 studies met inclusion criteria and were included in the full review. Four meta-analyses were conducted. Anxiety symptoms were associated with subsequent eating disorder symptoms, increases in eating disorder symptoms, and higher odds of eating disorders, including their onset. Conversely, eating disorder symptoms were associated with subsequent anxiety symptoms, increases in anxiety symptoms, and higher odds of subsequent anxiety disorders. Current evidence suggests that anxiety symptoms and eating disorder symptoms do not merely co-occur during adolescence, but are prospectively and bi-directionally linked. Further research is needed to understand the underlying mechanisms of this relationship, as well as individual differences in symptom trajectories.

A threatened preterm labour (TPL) represents an adverse prenatal event with potential long-term consequences on the offspring's neurodevelopment, regardless of prematurity condition. This study aimed to assess TPL's impact on children's psychomotor and socioemotional development at 2 years of age. A cohort of mother-infants was recruited at the time of TPL diagnoses and followed up until 30 months of children's corrected age. Participants were classified into three groups regarding gestational age at delivery: Full-term TPL (n = 35), Late Preterm TPL (n = 67), and Very Preterm TPL (n = 41). A Control group (n = 62) of mothers without TPL and their infants born at term completed the sample. Children's assessment was performed using the Ages & Stages Questionnaires for psychomotor development, the Early Childhood Behavior Questionnaire-Very Short Form for temperament, and the Behaviour Rating Inventory of Executive Function-Preschool Version for executive functions. Then, MANCOVAs were conducted to detect differences between groups. TPL children, regardless of delivery time, showed worse emotional regulation (ps < .03) and more inhibition problems (ps < .02) than control ones. In addition, Very preterm TPL children exhibited lower psychomotor development (ps ≤ .040), more difficulties in working memory (ps ≤ .002), and planification/organization (ps ≤ .003) domains. TPL per se may represent a risk factor for children's neurodevelopmental disturbances, specifically in emotional regulation and inhibitory control competencies, even in the absence of prematurity.

Many adolescent girls desire to have a thinner body, including those of normal weight. However, it is not fully known if this reflects solely a preference for a particular body type/size, or also is influenced by holding a distorted perception of one's body size. The current series of studies aimed to examine the (in)accuracy of body size perception among adolescent girls, as well as the extent to which distorted perceptions of body size extended to perceptions of other girls' bodies. In Study 1, 48 pairs of girls who desired to be thinner were asked to estimate the circumferences of three parts (arm, waist and thigh) of their own body and that of a study partner. Participants generally overestimated the circumferences of both their own and their partner's bodies, with this overestimation stable over a four-month follow-up. In contrast, in Study 2, no body size overestimation was observed for self or partners among 44 pairs of girls who were satisfied with their body size. Study 3 further revealed significant correlations between body size overestimation and disordered eating symptomology among 43 pairs of girls who desired to be thinner. As a whole, findings demonstrated that body size overestimation was limited to adolescent girls who were dissatisfied with their body size, and that body size overestimation was associated with disordered eating symptomology. Thus, perceptual distortions in body size may play a role in both body size dissatisfaction and disordered eating among adolescents.

Attention-deficit/hyperactivity (ADHD) guidelines recommend that the need for continued stimulant medication treatment of children and adolescents needs to be reviewed at least annually. We aimed to assess the outcomes in clinical practice of placebo-controlled discontinuation trials after long-term methylphenidate treatment. We asked clinicians to implement N = 1 randomized, double-blind, placebo-controlled, cross-over discontinuation trials after at least one year of methylphenidate treatment of children and adolescents (n = 26, 6-15 years of age). We analyzed the effectiveness of ongoing methylphenidate treatment compared to placebo on symptoms of ADHD, oppositional defiant disorder, and conduct disorder according to both parents and teachers, and the global improvement or deterioration according to the clinicians. We also assessed the proportion of individuals who continued using methylphenidate after the discontinuation trial. Teacher-rated hyperactivity and impulsivity symptoms were significantly lower during methylphenidate treatment compared to placebo (β = 3.80, SD = 1.69, t = 2.25, p =.04). No other significant differences were found between methylphenidate and placebo. Almost two-thirds (n = 16, 61.5%) of individuals continued using methylphenidate after the discontinuation trials, of which seven did not deteriorate during placebo according to their clinician. Our findings support the need for regular evaluations of methylphenidate treatment effectiveness and emphasize the importance of including the school setting when evaluating treatments. Better guidance for clinicians when to continue or cease methylphenidate treatment is urgently needed.

School attendance problems (SAPs) are heterogenous in nature and thus warrant rigorous assessment prior to intervention. The Inventory of School Attendance Problems (ISAP) is a new instrument that supports a comprehensive assessment of SAPs. This study is the first evaluation of the Swedish version of the ISAP. A web survey comprising the ISAP, School Refusal Assessment Scale-Revised (SRAS-R), and the Strengths and Difficulties Questionnaire (SDQ) were administered to a Swedish community sample (n = 399) of secondary school students aged 12-16 years. We employed a cross-sectional design to test the factor structure of the Swedish ISAP using confirmatory factor analysis (CFA). Additionally, we evaluated internal consistency using Cronbach's alpha and omega total, and we evaluated convergent validity by comparing the ISAP with subscales from the SRAS-R and SDQ. Factor analysis yielded support for a predicted 13-factor model. Despite the Chi-square test indicating a significant misfit, the remaining fit indices suggested an adequate model fit. In this sample, there was adequate internal consistency for most scales. Correlations between ISAP factors and related constructs were generally large and positive. Overall, the findings support the reliability and validity of the Swedish ISAP, indicating its potential as a valuable tool for understanding SAPs among students in community samples. Further research is needed to explore its applicability in clinical samples.

Children with autism spectrum disorder (ASD) are highly heterogenous in their language abilities. A number of studies have shown neural correlates of language deficits in children with ASD, but the underlying neuroanatomical foundation of early language deficits in ASD remains largely elusive. In this study, we analyzed MRI data from a cohort of Chinese children with ASD (n = 67) and typical development (TD, n = 37) aged 1.5 to 6.5 years. The ASD sample was classified into two subgroups based on the median of the language scores: ASD with moderate language deficits (ASD, n = 34) and ASD with severe language deficits (ASD, n = 34). We tested the group differences in the brain volumes between TD and two ASD subgroups, and also examined the associations between cortical grey matter volume and language abilities in TD and ASD subgroups, separately. We observed significant group differences in grey matter and white matter volume, with post-hoc analyses specifically indicating significant differences between TD and ASD subgroup. Significant correlations between grey matter volume and language scores were observed exclusively within the ASD subgroup, including positive associations in the bilateral superior temporal gyrus, hippocampus, and left inferior parietal lobe, and negative correlations in the bilateral precuneus. These findings provide novel evidence for the neuroanatomical basis related to language ability in an ASD subgroup with moderate language deficits, and offer new insights into the heterogeneity of language deficits in children with ASD.

Parental mental health problems can impact child mental health, as well as treatment of child mental health problems. The aim of this study was to investigate self-reported mental health problems in parents of children referred to outpatient child and adolescent mental health services (CAMHS) and to compare child mental health problems, family variables, treatment received and parent participation in treatment planning between parents above and below the cut-off for elevated mental health problems. The sample included N = 111 parents of N = 98 children. Parental reports covering their own and their children's mental health problems, family functioning, adult relationship satisfaction, and previous treatment for mental health problems were collected at the time of the child's intake appointment. Questions concerning contact with CAMHS were completed one year later. At the time of the intake appointment, 44% of the children had a parent who reported elevated mental health problems. In these families, children reportedly had significantly more mental health problems and problematic family functioning was more common than in families where parent mental health problems were not elevated. Parents with elevated mental health problems received group-based parent support/education to a greater extent during the first year of contact with CAHMS and reported less participation in treatment planning compared to parents without elevated mental health problems. To conclude, findings indicate that co-occurring mental health problems are common in parents when their child is referred to CAMHS, and in these families, it is reported that children have more symptoms, and more families experience problematic functioning. These factors merit consideration in assessment and treatment planning, indicating increased treatment needs in this group of families.

Given the increased demand for mental health resources in the child and adolescent population, this study aims to describe the emergency psychiatric care of the children and adolescents and to explore factors associated with multiple visits and hospital admissions. All patients < 18 years of age who visited the psychiatric ED(ED) of a University Hospital in Madrid, Spain, during 2022 were included. Data were collected by the attending psychiatrist upon first 2022 ED visit (index visit) and during any ED revisit. Electronic health records of all included patients were revised to contrast information and complete missing data. Logistic regressions and correlation analyses were used to explore factors associated with multiple ED visits and hospitalisations. N = 397 patients were included. Factors associated with multiple ED visits were: being LGTBQ+, having eating problems, substance use, consulting for psychosis upon first visit, having a history of suicidal behaviour, previous mental health service use or previous hospitalisations, having two or more psychiatric diagnoses, and being diagnosed of eating disorders or depression. Factors associated with hospitalisation include female gender, older age, LGTBQ+, family conflicts, first or second-generation migrants, history of abuse, eating problems, drug use, history of suicidal behaviour, previous mental health service use or previous hospitalisations, psychiatric comorbidity, and eating disorders diagnosis. Identifying predictors that lead to different clinical pathways and use of mental health services can improve clinical outcomes and resource use.

Non-suicidal self-injury (NSSI) behavior is a common issue in youth with depression while lacks a prognostic prediction model. This study aims to develop a nomogram for NSSI in youth with depression. A total of 701 patients were included in the analysis based a youth depression cohort. They were further divided into a training set and a validation set. The Lasso regression and binary logistic regression were used to select variables for the nomogram. The nomogram's discrimination, calibration, accuracy, clinical applicability, and generalization involved the use of metrics such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (HL) test, Brier score, calibration curve, decision curve analysis (DCA), and internal validation. The Delong test was employed to compare the ROC performance between the two models. These patients had an average age of 19.3+/-3.3 years, and 101 (20.6%) individuals reported NSSI. Five risk factors for NSSI were identified: age, age at first medication, previous instances of NSSI, academic stress score in the Adolescent Self-rating Life Events Check List (ASLEC), and somatic anxiety of the 14 item Hamilton Anxiety Rating Scale (HAMA-14). The training set and validation set of binary logistic regression-based model showed good discrimination (area under the curve (AUC) 0.781, 95% CI: 0.735 ~ 0.827; and 0.757, 95% CI: 0.682 ~ 0.831, respectively), calibration (P = 0.421 and 0.175, respectively), and accuracy (Brier score 0.119 to 0.155 and 0.109 to 0.168, respectively). A prognostic nomogram was developed and validated to assist clinicians in predicting NSSI of youth with depression.

The attention-deficit/hyperactivity disorder (ADHD) clinical phenotype has limitations for deciphering ADHD etiology and predicting prognosis. Although relative to the clinical phenotype, intermediate phenotypes may have better explanatory and prognostic power, the extent to which ADHD intermediate phenotypes are associated with ADHD risk and prognosis is unknown. The aim of this study was to evaluate evidence for event-related potential (ERP) measures of reward anticipation as ADHD risk and prognostic biomarkers. We examined, whether (1) in a sample of adolescents (N = 304; M = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity and depression, ERPs are associated with ADHD polygenic risk scores (PRSs) (ADHD risk) and (2) in a sample of adolescents at-risk for ADHD (n = 99; M = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity, depression, and baseline outcome values, ERPs are associated, prospectively, with alcohol misuse (ADHD prognosis). In adolescents, greater ADHD PRSs were associated with lower electrophysiological anticipatory attention to motivationally relevant feedback (b = -0.115, p = .046 95%CI [-0.228; -0.002]). The predictors accounted for 5% of the variance in the outcome. In adolescents at-risk for ADHD, at 18-month follow-up, lower electrophysiological anticipatory attention to motivationally relevant feedback was associated with greater alcohol consumption (b = -7.454, p = .007, 95%CI [-12.873; -2.034]). The predictors accounted for 31% of the variance in this outcome. These findings were replicated in sensitivity analyses with behavioral performance variables added as covariates. The current findings support the hypothesis that ERP amplitudes of reward anticipation may be ADHD risk and prognostic biomarkers and suggest that intermediate phenotypes may confer advantages over the ADHD clinical phenotype in delineating etiology and predicting prognosis.

Primary nocturnal enuresis (PNE) is a disease characterized by involuntary urination during sleep after the age of five, causing inconvenience and psychological burden to children and their families. The onset of PNE is related to many factors, and in recent years, delayed central nervous system maturation has been considered one of the important causes of PNE. Previous studies have demonstrated functional changes in multiple brain regions in children with PNE. However, these studies either focused on changes in local brain regions or the functional connection (FC) between specific brain regions, and there is currently a lack of research on the whole brain FC in children with PNE. This study analyzed functional connectivity density (FCD) across the entire brain based on voxels and comprehensively evaluated the global FCD (gFCD), local FCD (lFCD), and long-range FCD (lrFCD). Decreased gFCD and lFCD were found in the left temporal lobe and the right posterior cerebellum in the children with PNE compared with the HC. The FCD values in these regions were negatively correlated with the scores of hyperactivity/impulsivity in the children with PNE. This study may help to reveal the neural mechanisms underlying the onset of PNE in children from a new perspective.

Many adolescents use internet games, and some of them experience psychological and social difficulties due to excessive gaming. Although there have been many studies on the onset and associated factors of internet gaming disorder (IGD) , research focusing specifically on its relapse is scarce. Considering that addictive disorders often have a chronic course with frequent relapse, this study prospectively observed adolescents from the general population to explore IGD recurrence rate and associated factors of recurrence. In this prospective cohort study, from 1587 middle school gaming users, 1452 (91.5%) were followed up at 12 months and 24 months. The results showed that the cumulative recurrence rate of IGD was 16.1%, which was higher than the initial incidence rate of 3.6%; the adjusted incidence rate ratio was 2.43 with 95% CI 1.21-4.87 (P = 0.012). In addition, starting internet gaming before entering primary school was associated with a higher risk of relapse (P = 0.004). Limiting internet gaming for children before they enter primary school may reduce the risk of relapse of IGD that they may encounter during their adolescent years.

Emotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: "Treatment for Adolescents with Deliberate Self-harm"; http://ClinicalTrials.gov/;NCT00675129.

Migration has been associated with both adverse and potentially beneficial mental health outcomes, with varying impacts on adolescents. With great flux in European migrations streams, an update is required of its effects on adolescent mental health. This systematic review provides an overview of the relationship between migration background (first, second, and third generation) and psychopathology for youth aged 12-25 living in Europe. A systematic search based on four concepts (i.e., mental health, human migration, European Union, and adolescents) carried out on Pubmed, Embase, Web of Science, Scopus, PsycArticles and Proquest Central led to the retrieval of 51 relevant studies published between April 2013 and August 2024. The present study was conducted and reported according to the PRISMA 2020 Checklist. Our systematic search found some evidence for the increased risk of mental health problems in people with a migration background, showing overall elevated risks for the development of psychotic experiences, psychosomatic symptoms, eating disorders, substance-related disorders and suicidal actions in the migrant population. Little consistent high-quality evidence was found for the effects of migration on any other mental health problems. Identified risk factors for adolescents with a migration background included being a first-generation migrant, low socio-economic status, low ethnic identification, and perceived discrimination. Results are mixed, but suggest that, overall, adolescents with a migration background have a mental health disadvantage. Intervention and prevention programs can be strengthened, not only by focusing more specifically on adolescent migrants, but also by considering the different contexts and experiences that put them at increased risk.

Depression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22-12.83), anxiety disorders (4.05; 1.77-9.27), suicidality (5.37; 2.28-12.66), and AUD (7.68; 2.59-22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21-0.95) and AUD in adulthood (0.18; 0.07-0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.

Rising rates of internalizing disorders and rising rates of school failure among adolescents are growing concerns. Despite the strong association between academic achievement and internalizing disorders, possible links between these two trends have not been investigated. Thus, the aim of this study was to investigate the development of the cross-sectional associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018.

The COVID-19 pandemic has had profound effects on the mental health of children and adolescents worldwide, exacerbating existing challenges and introducing new stressors. This paper explores the impact of risk and protective factors on the mental well-being of young individuals during the pandemic. Using data from the German nationwide, population-based, longitudinal COPSY study (n = 2,471, girls: 50.0%, age 7-17 years) spanning nearly three years, this study investigates how factors such as gender, age, parental education, parental depressive symptoms, family cohesion, and social support influence mental health. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Latent growth analysis and structural equation modeling were employed to analyze cross-sectional and longitudinal data collected at five measurement points (initial response rate: 46.8%). Findings revealed that boys and younger children are at a higher risk for mental health problems. Additionally, low parental education, single parenthood, parental burden due to the pandemic and parental depressive symptoms were significantly linked with mental health problems in children. Conversely, personal resources, family cohesion, and social support were associated with less symptoms. Family cohesion additionally buffered against the negative impact of parental depressive symptoms. The study underscores the importance of multi-level interventions that consider individual, familial, and societal factors in promoting positive mental health outcomes among children and adolescents during challenging times. Continued research and collaborative efforts are needed to develop evidence-based strategies for supporting the resilience of young individuals in the face of future adversities.

It is unclear whether DNA methylation underlies the association between childhood maltreatment (CM) and non-suicidal self-injury (NSSI) in early adolescents. We aim to explore the mediation of specific DNA methylation sites in the associations of CM and its subtypes with NSSI, following investigation on the association between specific DNA methylation sites and NSSI. A case-control study was conducted to examine 155 adolescents aged 12-14 years who were identified to have engaged in NSSI and 201 controls. CM and its subtypes were evaluated by using the Childhood Trauma Questionnaire. The EPIC 850 k Bead Chip was used to discover differential methylation sites (DMSs) in the peripheral blood between 10 NSSI cases and 10 controls. Targeted pyrosequencing was employed to detect the levels of specific DMSs among the total study population, which were selected based on bioinformatics analyses and literature review. We discovered 456 DMSs between NSSI cases and controls, 219 were hypermethylated and 237 were hypomethylated. After controlling for potential confounders, CM or its subtypes, and the methylation of cg04622888 and cg05037505 were all significantly associated with NSSI (all P < 0.05). The total association of CM and its subtypes with NSSI were all significantly (all P < 0.05), with the standardized coefficient (β) ranged from 0.12 for physical neglect to 0.24 for emotional neglect and CM. Significant indirect association of physical neglect with NSSI through methylation of cg04622888 was observed and the mediating proportion was 0.14 (95%CI 0.06-0.23). Significant indirect associations of emotional abuse, emotional neglect, and physical neglect with NSSI through methylation of cg05037505 were also observed, and the mediating proportions were 0.09 (95%CI 0.04-0.14), 0.08 (95%CI, 0.03-0.14) and 0.19 (95%CI 0.07-0.32), respectively. Data of this study suggested that methylation of cg04622888 and cg05037505 were independently associated with NSSI among early adolescents, and they partially mediated the associations of emotional abuse, emotional neglect, and physical abuse with NSSI.