The Role of Spiritual Health in the Mental Health of Children and Adolescents: Emphasizing the Role of Parents and Educational Environments

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

The Journal of Adolescent Health's current supplement presents the work of a highly active team of researchers who are focusing on developing a strong body of evidence around child and adolescent mental health in Sub-Saharan Africa. The supplement lays out scholarship generated through years of partnership between researchers based in the United States—some of whom are from Sub-Saharan context, specifically Uganda—in connecting applied social work, community mental health for children and adolescents, and family development. The work comprises a series of articles embedded within several National Institutes of Health–funded grants by authors based in the United States in partnership with various academic and nongovernmental organizations in Uganda and Ghana. A rich collection of information and ideas around HIV-associated physical health, psychosocial, and educational challenges across child and adolescent populations are presented. Mental health outcomes and aspects of community and family cohesion, as well as health, are assessed via multimodal interventions. The strength of this group's work is the focus on poverty and ameliorating adversities through structured economic and psychosocial empowerment. The article entitled "The post-intervention impact of Amaka Amasanyufu on behavioral and mental health functioning of children and adolescents in low-resource communities in Uganda: analysis of a cluster-randomized trial from the SMART Africa-Uganda study (2016–2022)", led by Ssewamala et al., presents improvements in depressive symptoms, self-concept, and externalizing behaviors in a school-based multiple family group (MFG) intervention tested in a three-arm cluster randomized controlled trial delivered by parent, peers, or community health workers versus control condition [[1]Ssewamala F.M. Brathwaite R. Bahar O.S. et al.The post-intervention impact of Amaka Amasanyufu on behavioral and mental health functioning of children and adolescents in low-resource communities in Uganda: Analysis of a cluster-randomized trial from the SMART Africa-Uganda study (2016-2022).J Adolesc Health. 2023; : S3-S10Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Another articles led by Nabayinda et al. explored "The relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in Southern Uganda" and found that family cohesion was a protection against depression [[2]Nabayinda J. Kizito S. Ssentumbwe V. et al.The relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in Southern Uganda.J Adolesc Health. 2023; : S11-S17Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. Both articles were built on the same SMART Africa cluster randomized controlled trial. Nabunya et al., in the article "Stigma by Association, Parenting Stress and the Mental Health of Caregivers of Adolescents Living with HIV in Uganda", find that HIV-associated stigma in caregivers of adolescents is associated with poor caregiver mental health and parenting stress [[3]Nabunya P. Namuwonge F. Bahar O.S. et al.Stigma by association, parenting stress and the mental health of caregivers of adolescents living with HIV in Uganda.J Adolesc Health. 2023; : S18-S23Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Byansi et al. extend the focus on adolescents in Uganda in their article "Patterns of and factors associated with mental health service utilization among school-going adolescent girls in southwestern Uganda: A latent class analysis", reporting on latent class analysis findings testing MFG on adolescent girls [[4]Byansi W. Ssewamala F.M. Neilands T.B. et al.Patterns of and factors associated with mental health service utilization among school-going adolescent girls in southwestern Uganda: A latent class analysis.J Adolesc Health. 2023; : S24-S32Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Patterns in attendance of sessions and family demographic factors were associated with improved mental health service utilization. Implications for implementation of intervention are drawn from the approach taken in the article "Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: analysis of a cluster randomized controlled trial (Suubi4Her)" [[5]Filiatreau L.M. Tutlam N.T. Brathwaite R. et al.Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: Analysis of a cluster randomized controlled trial (Suubi4Her).J Adolesc Health. 2023; : S33-S40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Filiatreau et al. present findings of another trial testing youth development account intervention with MFG in a three-arm study, with results suggesting that economic empowerment when augmented with culturally engaged psychotherapy is more efficacious [[5]Filiatreau L.M. Tutlam N.T. Brathwaite R. et al.Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: Analysis of a cluster randomized controlled trial (Suubi4Her).J Adolesc Health. 2023; : S33-S40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. "A Structural Equation Model of the Impact of a family-based economic intervention on ART Adherence among adolescents living with HIV in Uganda" reports findings of an older trial that tests a variety of financial strengthening strategies and finds that these improve treatment adherence and mental health outcomes in young girls [[6]Kizito S. Nabayinda J. Neilands T.B. et al.A Structural Equation Model of the Impact of a family-based economic intervention on ART Adherence among adolescents living with HIV in Uganda.J Adolesc Health. 2023; : S41-S50Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. In the article "The Impact of Family Economic Empowerment Intervention on Psychological Difficulties and Prosocial Behavior among AIDS-orphaned children in southern Uganda", deeper insights are offered around mental health programming infused with family-based economic empowerment for younger orphaned children [[7]Tutlam N.T. Filiatreau L.M. Byansi W. et al.The impact of family economic empowerment intervention on psychological Difficulties and prosocial behavior among AIDS-orphaned children in southern Uganda.J Adolesc Health. 2023; : S51-S58Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. It appears from this article that even small steps toward strengthening routine care and provision of services goes a long way in improving child outcomes. The final article focuses on Ghana and uses the World Health Organization school health survey to identify "Correlates of Suicide Among Middle and High School Students in Ghana" [[8]Azasu E.K. Joe S. Correlates of suicide among Middle and high school Students in Ghana.J Adolesc Health. 2023; : S59-S63Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. The resulting younger age of onset of suicide and disaggregation of various suicide behaviors provide an impetus toward research that addresses suicide risk factors, treatment, and mental health promotion for children and adolescents. The articles make a compelling case around strengthening economic empowerment by directly providing economic incentives to support vulnerable populations and high-risk children and youth. The themes that require more attention with time include addressing more contextualized mental health constructs such as triggers and idioms of distress, understanding child and adolescent development from African cultural perspective, disentangling intersectional stigma and its impact on caregiver and child mental health, and grasping the significance of the adversities these communities and children face by reflecting on economic vulnerabilities and stressors more closely. A system-level appraisal of how these economic strengthening approaches are independently evaluated and evaluation by partners from economic and social development sectors of the Ugandan government or civil society would be important next steps. There is room to report on implementation outcomes that focus on the process of developing these integrated interventions and whether mental health and economic empowerment approaches need a different strategy, community, or youth engagement framework. As a guest editor, my commentary here is to buttress the importance of such well-funded, well-aligned scholarship in Africa and also to highlight that South-to-South partnerships are not only about US-funded research from largely northern partners. It should also become a venture where Southern countries (often "sites of intervention and need") deliberate and build joint priorities, co-create solutions that are relevant to them, and frame research articles in a manner that reflects how multistakeholder priorities were identified and addressed. The title of South-to-South partnerships could be a misnomer when most of the key authors are from limited northern institutions. Southern researchers working within the global north is not the only model for south-south partnerships. Most of these articles are led by individuals based in global North, including senior, first, and second authors. That is where a sea-change is needed. Building capacity to publish more articles within research teams and for improved representation would also serve accomplished teams that are generating enormous evidence-based research in these constrained geographies. How young people will respond to such complex interventions, and if these are designed, vetted, and improved by their feedback, has become a big theme in global health. While developing strong, outcome-informed evidence, we need process indicators. Multilevel community, economic, and family-level analyses that speak to multidimensional and interconnected social determinants would be other opportunities to consider. My hope would be to see more attention to these areas of framing and partnerships. It will be important for funders, publishers, and global health consortiums to ask for a score card on inclusivity, equity, representativeness, and a focused direction toward addressing social determinants of child and adolescent mental health.

BackgroundTransfer of knowledge is an important issue throughout all scientific disciplines, especially in the medical and psycho-social field. The issue of worldwide knowledge transfer in child mental health is one of the aims and goals of the journal Child and Adolescent Psychiatry and Mental Health (CAPMH). The demand for mental health training is high worldwide, and especially in low- to lower-middle income countries, where inadequate access to knowledge resources in the field of child and adolescent mental health (CAMH) is prevalent. At the same time, many of these countries are showing an increased risk for mental health issues in children and adolescents. The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) Textbook of Child and Adolescent Mental Health counters this problem. It is an open-access e-textbook aiming to provide an overview of current and established treatment and practical approaches for child and adolescent psychiatrists, psychotherapists and allied (mental health) professionals worldwide. First published in 2012, the updated and revised version was launched in 2015. The aim of this commentary is to review and disseminate the usefulness and practicability of content and further material included in the new version of the textbook.ReviewOverall, the textbook contains ten sections divided into 59 chapters, with a total of 1435 pages. The original version of the textbook was written in English. The revised version contains translations of 49 chapters into different languages (to date French, Spanish, Hebrew, Arabic, Portuguese, Russian, Norwegian and/or Japanese), with additional material for knowledge dissemination and self-directed learning (e.g. videos and quizzes) for several chapters. The textbook and the add-on materials for dissemination are of high quality and convey a great introduction to important topics concerning mental health. Apart from knowledge transfer, there is a pragmatic focus on clinical practice and on regional and cultural differences.ConclusionThe textbook is a new and unique opportunity for professionals all over the world to improve their knowledge, skills and expertise in CAMH. High-quality, up-to-date and freely accessible materials in the field of CAMH are combined with the opportunity to share insights with colleagues.

BackgroundThe 2019 outbreak of COVID-19, a severe acute respiratory infection caused by the SARS-CoV-2 virus, triggered a global pandemic with far-reaching consequences. Societies worldwide felt the effects of the virus and pandemic related restrictive measures on their economies, healthcare systems, and social fabric. To curb the spread of COVID-19, numerous restrictive measures were implemented. This manuscript summarizes the findings published within the thematic series on Child Mental Health during the Covid-19 pandemic.MethodsBetween May 2020 and June 2024 Child and Adolescent Psychiatry and Mental Health (CAPMH) issued a thematic series on “Child Mental Health during the Covid-19 pandemic.” All manuscripts underwent a prescreening process by the Editor-in-Chief, including checks regarding the compliance with ethical standards compliance with the scope of the journal and the thematic series. Suitable manuscripts were then handled by one of the editors of the thematic series. All suitable manuscripts then underwent a peer review process that included at least two reviews. Different aspects of child and adolescent mental health as well as various aspects of the pandemic - in addition to their findings -were investigated, defined and discussed throughout the manuscripts within the series.ResultsA total of 327 manuscripts were submitted and 85 manuscripts were published within the series. Manuscripts included qualitative and quantitative studies as well as systematic reviews. The manuscripts reported findings from 22 countries from all over the world and various populations. The studies covered the somatic and psychological impacts of the pandemic, including emotional and behavioral consequences, non-suicidal self-injury and suicidal behavior, threat and trauma, parent child separation, school closure and home schooling, physical activity and media use, psychiatric care, as well as digital resources and online therapy. Through its findings, the research also highlighted the multilayered impact the pandemic had, as well as the need to make targeted interventions and evidence-based interventions available to a large audience.ConclusionA broad range of literature in the series submitted from various countries around the world documented the profound impact of COVID-19 on child mental health. The findings can be used as a foundation for conceptualizing targeted programs to counteract the consequences, in addition to helping prepare systems in the event of similar incidents in the future.

The RE-AIM framework was used to assess and analyze the impact of school physical activity on children and adolescents' physical and mental health.A search of PubMed, Cochrane Library, Embase, Scopus, EBSCO, and Web of Science was conducted from when the databases were created until December 2024. Articles included studies on school-based physical activity interventions and physical and mental health of children and adolescents. The screened literature was evaluated for quality, data extraction, standardized mean difference (SMD), Mean difference(MD) and confidence intervals (95% CI) were used as effect indicators. Two researchers independently screened the literature, extracted data, and assessed the risk of bias for the included studies. Preferred reporting items were used using systematic evaluation and meta-analysis guidelines combined with meta-analysis with the RE-AIM framework.A total of 19 studies that met the inclusion criteria were included in the meta-analysis, and the results of the meta-analysis showed that school physical activity improved adolescents' and children's athletic ability (SMD = 0.33, 95% CI = 0.23 ~ 0.43), reduced BMI (MD=-0.50, 95% CI=-0.81~-0.19) and improved Fitness self-perceptions (SMD = 0.31, 95% CI = 0.22 ~ 0.40). In terms of mental health, school physical activity improved children and adolescents' self-reported questionnaire scores (SMD = 0.21,95%CI = 0.12 ~ 0.30) and reduced anxiety, depression and stress levels (MD=-0.53,95%CI=-0.85~-0.22). That is, school physical activity is associated with improvements in both physical health and the mental health of adolescents and children. In addition, the RE-AIM framework reported the effectiveness of sports interventions on health, with higher proportions of the Reach, Efficacy, and Adoption dimensions in the RE-AIM framework than in Implementation and Maintenance.A comprehensive assessment of the impact of school physical activity was conducted through meta-analysis and RE-AIM framework, which showed that school physical activity is associated with improvements in both the physical and mental health of children and adolescents and that RE-AIM framework reported the quality of physical activity interventions to improve the physical and mental health of children and adolescents, achieving a balance of internal and external validity in comparison.

Child and adolescent psychiatry research during the COVID-19 pandemic

The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap. We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services. Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for the effectiveness of the available services. Expansion of primary care's role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and non-governmental sectors are some of the most promising future venues to improve mental health care for the Iranian youth.

Open Science for Child and Adolescent Psychiatry

Responding to the Child Mental Health Emergency: Future Pediatricians to the Rescue?

As in many other countries, child psychiatry in China has gradually developed from general psychiatry. In the early days of the profession, child psychiatry was considered as psychiatry for "little adults". Child psychiatry in China has gradually developed and expanded since the implementation of Professor Guotai Tao's child psychiatric services in Nanjing in the 1930s. In particular, the profession has developed rapidly since its affiliation with the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in 1998. Child psychiatry has been one of the fastest developing advanced international disciplines over the past 10 years. Pediatric psychiatry mainly focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. In 1899, the term ''child psychiatry'' (in French) was used as a subtitle in Manheimer 's monograph Les Troubles Mentaux de l'Enfance. The Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define child psychiatry, in 1933, in terms of diagnosis, treatment, and prognosis within the medical discipline. In 1934, he founded the Journal of Child Psychiatry (1934–1952), which later became Acta Paedopsychiatrica (1953–1994). The first academic pediatric psychiatry department was established in 1930 at the Johns Hopkins Hospital in Baltimore by Leo Kanner (1894–1981). Since then, the clinical practice, research, and teaching of child psychiatry have gradually developed around the world.1 There have been three stages to the development of children's psychiatry in China. The first is the exploration and development period, which occurred mainly during the 1930s to the 1950s. This period was characterized by the introduction of Western models by experts and the exploratory development of child psychiatric services. Professor Yulin Cheng, Guotai Tao, and Yonghe Ling other professors are the pioneers. The second stage is the initial development period, which occurred from the 1950s to the late 1970s. Child psychiatric clinics and/or wards were established in Nanjing, Shanghai, Beijing, Guangzhou, Sichuan, Hunan and other places and child psychiatric teams were formed. Although there was a pause in the early 1970s, child psychiatric service models continued to be developed. The third period, from the late 1970s to the present, was characterized by rapid progress. The development of child psychiatry has been promoted mainly since the economic reform and opening-up in China, with the transformation of the medical model from a pure biomedical model to a biopsychosocial medical model. Psychiatrists, pediatricians, and psychologists have begun to focus on child mental health and have conducted some interdisciplinary research and practice. Following the establishment of the Nanjing Child Mental Health Research Center, many provinces and cities have established child mental health centers. Psychiatric hospitals or mental health institutes affiliated to major medical universities in Nanjing, Beijing, Hunan, Sichuan, Shanghai and other places have successively established Master's and doctoral training sites for child psychiatry and applied psychology. Relevant disciplines and research institutions such as child health care, behavioral pediatrics, special education schools, and autism training centers have successively joined the ranks of child mental health services. In particular, Professor Guotai Tao founded the Nanjing Child Mental Health Research Center in 1984. In August 1987, the center was appointed by the World Health Organization (WHO) as a scientific research and training cooperation center, and was appointed by the Chinese Ministry of Health (now the National Health Commission) as a child mental health guidance center. Many child psychiatrists and mental health workers have been trained, and academic exchanges have been promoted in China and abroad.2 With the rapid development of disciplines, Chinese child psychiatry has reached an internationally renowned and advanced level. Multidisciplinary participation in child psychiatry is good. For example, the psychology of child development, developmental behavior pediatrics, child neurology, child health care, education, and sociology have begun to attach importance to clinical practice and research on mental health. A growing number of universities and colleges offer degrees for social workers in clinical psychology and childcare. In addition, with more primary care centers in the community, primary care physicians can implement screening and follow-up for children with mental health disorders. However, the primary care providers still need more education and training. To address this problem, the National Health Commission has been advocating multilevel collaboration. Pediatricians and primary care physicians across the country are now being trained in early diagnosis and basic treatment for common mental disorders in children. They are taught to screen patients for signs of developmental disorders by checking, for example, whether a 3-month-old baby's eyes can follow moving objects or whether an 18-month-old child can make eye contact. The problem of the shortage of child psychiatrists has been partially solved.3 Children and adolescent mental health problems are related to a country's development and to global changes. About 20% of children and adolescents worldwide experience mental health disorders. The major challenges for children and adolescents with mental disorders are stigma, isolation, discrimination, and the lack of access to health care and education facilities. Obviously, children and adolescents are vulnerable groups; they have no political power and their mental health problems are complicated. The mental health of children and adolescents requires multisectoral cooperation and the attention of the whole society. In particular, the protection afforded by government actions and policies is crucial. Policies must be designed to ensure that children and adolescents can access even the most basic mental healthcare. However, there are few countries worldwide that provide specific policies for the mental health needs of children and adolescents.4 China has a large population of children. Rapid economic development and social reforms in recent years have had a substantial impact on the mental health of children and adolescents. Increasing social pressures and workers migration, and changes in family planning, have changed traditional family structures and social support systems.3 As part of development and progress within China, the Chinese government has initiated a series of policies and regulations to promote mental health. Some of these policies are aimed at promoting mental health in children and adolescents; for example, "The Law of the People's Republic of China on the Protection of Minors", "The Law of the People's Republic of China on the Protection of the Rights and Interests of Women and Children", "The Law of the People's Republic of China on the Protection of Disabled Persons", "Mental Health Law of the People's Republic of China", and programmatic documents such as the "Healthy China 2030 Planning Outline", "National Program of Outline for Action for Child Development in China (2011–2020)", "Guidelines for the Prevention and Treatment of Attention-Deficit/Hyperactivity Disorder'', ''Guidelines for the Diagnosis, Treatment and Rehabilitation of Children with Autism'', and ''Technical Specifications for Children's Mental Health Care''.5-10 These reflect how the support of national policies has driven the development of child psychiatry. Major national basic and clinical research projects have invested in child psychiatry research, such as the National Natural Science Foundation of China, which has supported national research and development plans in key health areas. Research by a team led by Professor Zhang Dai has demonstrated that FMR1, DISC1, EN2, and SHANK3 genes are related to autism. Studies by a team led by Professor Kun Xia and Jingping Zhao have shown that XRXN1, GRIN2B, RELN, and DAB1 genes may be antecedents of autism. Such research has been published in several high quality academic journals in recent years.11, 12 Some research of the National "12th and 13th Five-Year Plan" scientific and technological support projects led by Professor Yi Zheng, on "The Epidemiological Study of Child Mental Disorders in China" and "Comprehensive Intervention Strategies for Chronic Non-communicable Diseases with Attention Deficit-Hyperactivity Disorder". These show that Chinese child psychiatry has become a discipline supported by the national key research project. Traditional research group in child psychiatry include the team led by Professor Guotai Tao, Jie Lin and Xiaoyan Ke about autism, mental retardation and childhood schizophrenia; team led by Professor Yufeng Wang on attention deficit hyperactivity disorder; team led by Professor Xiaoling Yang and Jing Liu about autism spectrum disorders; team led by Professor Xuerong Li, Linyan Su and Xuerong Luo on epidemiological surveys and tool scales for child mental disorders; team led by Professor Rene Xin, Yasong Du and Wenhong Chen on epidemiological investigation of children's behavior problems and related research on child psychology and family therapy; team led by Professor Shiji Zhang, Yi Zheng, Yonghua Cui and Fan He on tics and related disorders; and team led by Professor Youhe Shan, Lanting Guo and Yi Huang on behavioral scales and tic disorders. The above studies have published valuable articles in academic journals and won many awards. Child psychiatrists need to be dedicated. The treatment of patients with mental illness is difficult and often daunting, and children's mental health disorders are particularly difficult to treat. Treatment of children with autism or mania requires tackling difficult problems and good practice in basic clinical skills. In China, child psychiatrists experience low returns and low income. The number of child psychiatric inpatients and outpatients is constantly increasing, and their treatment often relies on the dedication of child psychiatrists. To treat such patients, there are now more than 10 centers, nearly 1000 beds, and dozens of special education centers, such as autism rehabilitation centers. To care for left-behind children, children infected with AIDS, children affected by natural disasters such as earthquakes, and children with substance abuse and internet addiction, many child mental health workers and full-time child psychiatrists have formed competent national and local emergency response teams. Child psychiatrists are now available to help children to cope with a variety of social disasters, such as the Wenchuan earthquake or the "3.01" terrorist incident in Kunming. The development of modern child psychiatry in China is interlinked with foreign exchange. Since Professor Guotai Tao's studies in the United States in 1940, Chinese child psychiatry has been continuously introducing and incorporating foreign advanced diagnosis and treatment and research concepts. At present, Professor Tao has discussed diagnostic issues with international authoritative experts in foreign journals and participated in the preparation of the 11th revision of the International Classification of Diseases (ICD-11). Professor Tao was the first international participant in efforts to promote the integration of child and adult psychiatry and the popularization of the notion of the lifelong effects of mental illness, such as the Cross-Strait Summit Forum, and domestic and foreign academic institutions and academic exchanges, such as the Asian Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Chinese child psychiatrists have attended and contributed to both of the latter societies. Since the 1930s, older generations of individuals, such as Yulin Cheng, Guotai Tao, and Xueshi Chen, have made substantial contributions to the development of the discipline of child psychiatry. In 1989, Professor Jie Lin set up and led the Child Psychiatric Group of the Chinese Medical Association Psychiatry Branch. Professor Guotai Tao served as a consultant of the Group. Almost at the same time, the Chinese Mental Health Association established the Child and Adolescent Professional Committee, with Xuerong Li as director. Xueshi Chen serves as a consultant. Since then, two academic organizations have held annual meetings or training courses. In 1998, Professor Shiji Zhang, Yi Zheng, and Linyan Su participated in the IACAPAP congress and joined this organization, which is the most highly regarded academic organization in international child psychiatry. Chinese child psychiatry is fully in line with international developments in child psychiatry. In 2003, Professor Yi Zheng and Linyan Su attended the WHO Expert Headquarters "Concern for Children and Adolescents with Mental Disorders" meeting as Chinese representatives. In the same year, Professor Yi Zheng participated in the ASCAPAP congress and was elected as an executive member. In 2004, Professor Yi Zheng was appointed onto the IACAPAP executive committee. Professor Yi Zheng created the Cross-Strait Children's Psychiatry Summit Forum, which is held once every 2 years alternately in the mainland of China and Taiwan province, China. The Forum is now in its ninth session and has promoted the rapid development of the discipline. In 2010, the 19th IACAPAP International congress was successfully held in Beijing. This was the first time that this congress had been held in a developing country. Professor Yi Zheng served as Executive Chairman, and Professor Jing Liu served as Chairman of the organizing committee. Xiulian Gu, Zhu Chen, Wenkang Zhang and the country's main health care officials attended the opening ceremony and delivered speeches. More than 1300 foreign scholars and 500 domestic scholars attended the congress. Yi Zheng was elected onto the ASCAPAP executive committee and was elected Chairman, and Jing Liu was elected Vice-Chairman of ASCAPAP. At the 21st IACAPAP Conference held in South Africa in 2014, Professor Yi Zheng was elected Vice-President of IACAPAP and won the International Child Psychiatry Outstanding Contribution Award, indicating that Chinese child psychiatry has played a major role on the international stage.2 China has a population of more than 1.3 billion individuals, of which 238 million are children younger than 15 years of age.13 Though a nationwide prevalence study is lacking, some regional epidemiological studies show that the prevalence of mental health disorders in children is close to the worldwide prevalence of 20%,14-18 indicating that about 50 million children in China require treatment for mental health disorders. However, there is a scarcity of child and adolescent psychiatrists (CAPs) in China, and there are less than 500 full-time CAPs nationwide. Currently, only a national psychiatrist certification system exists, and there is no child psychiatrist certification system. Instead, students must obtain a postgraduate training certificate or a nationally approved Ph.D. or Master 's degree training certificate to become a child psychiatrist. A recent survey showed that training units for CAPs are mainly concentrated in large and medium-sized cities. Moreover, only a small number of medical personnel in China can diagnose and treat children and adolescents with mental health disorders, and these have insufficient training. Currently available training for child psychiatrists contains insufficient scientific, practical, and problem-solving content. Furthermore, current educational training poorly equips child psychiatrists for subsequent teaching and professional scientific research abilities. Therefore, a greater training focus is needed on more comprehensive qualities and abilities, such as dedication. Although CAPs undertake a long process of training, this mainly comprises postgraduate or doctoral Master's degree training; the national specialized certification system for CAPs has only been piloted in major cities. The CAP training system requires further improvements, and more CAPs are needed.19 China still has a shortage of child psychiatrists. To address this, a new type of multilevel collaboration is currently being implemented. Pediatricians and primary care physicians are also receiving training in child psychiatry. In addition, psychotherapists from other countries have been recruited to help train psychiatrists. China is currently exploring all possible ways to strengthen multilevel collaboration to promote the children's physical and mental health.3 The artificial boundary between children and adults with mental health disorders will be removed: more attention and value will be placed upon the treatment of adult attention deficit–hyperactivity disorder (ADHD), adult autism spectrum disorder (ASD), adult tic disorder, and other issues. Gene diagnosis and classification of child neurological and mental development disorders will become a reality: the detection of genes for susceptibility to ASD, ADHD, tic disorders, child schizophrenia, and child bipolar disorder will become possible. The concept of the supremacy of child mental health will gradually be accepted. More and more studies have confirmed that among the main factors for healthy and successful child developmental, child mental health is of paramount importance. As physical health and nutritional issues have been generally resolved in most parts of China, the impact of mental health on the future success of children will be a core health issue. Therefore, mental health should start with children. The multidisciplinary and multisector nature of child mental health will be further improved: medicine, economics, sociology, and other disciplines will pay close attention to child mental health. In particular, the only-child problem, the problems experienced by elderly parents in raising a second child, the problem of left-behind children, AIDS-infected children, Internet addiction problems, youth suicide, and crime prevention problems will become the focus of social attention. There will be new breakthroughs in early diagnosis and interventions for child mental health disorders: the ICD-11 (containing input from Chinese experts) will soon be released. Early warning indicators for child psychological problems and quantitative assessment techniques for child mental health care will be promoted from the national level to the whole country. Like child vaccination, assessments and interventions for child psychological conditions will benefit every child, which will set a global precedent. Treatment methods for child mental health disorders will be qualitatively improved. In addition to the further optimization of the structure and dosage of antipsychotics, research on functional food will make significant progress, and the use of alternative medicine and traditional Chinese medicine for child mental health disorders will be further clarified. In conclusion, the development of child psychiatry in China is still far behind developed countries, but a golden age of rapid development is approaching. Research on prevention and control of major chronic non-communicable diseases in the Ministry of Science and Technology (No: 2016YFC1306100) None.

BACKGROUND: Parents and adolescents are searching online for information about mental health. Google searches are frequently used, but do not always yield accurate and reliable information that is presented in a user-friendly manner. The first step toward the development of a useful online child mental health resource is to examine existing web content and understand parent and adolescent needs from online mental health material. OBJECTIVES: The objectives of this study are two-fold (i) To conduct an environmental scan of existing online repositories of child and adolescent mental health information with respect to both parent and adolescent friendly content on three identified topic areas for the initial phase of the project (Anxiety, Eating Disorders, Suicide Prevention) (ii) To determine parent and adolescent needs from, and perspectives about, current web-based information with respect to site design, content and limitations to inform the creation of a pediatric hospital based web site with a broad range of information pertaining to child and adolescent mental health. DESIGN/METHODS: An environmental scan was conducted to assess available online information about three identified topic areas as described above. As the project continues, the scan will be expanded to include other topic areas in child and adolescent mental health. Parallel parent needs assessment surveys were conducted. As our adolescent section was being developed, adolescents were surveyed for their feedback regarding illustrations and presentation of current content. RESULTS: The environmental scan identified 17 hospital websites for in-depth review. Although some websites had information on diverse mental health topics, few contained comprehensive information on a broad range of topics. For example, only 9 had information about anxiety disorders. Additionally, an overall lack of adolescent specific content was noted. Parent surveys revealed significant interest in a strong stand-alone site where they could access mental health information. Parents also indicated that they would prefer separate parent and teen content areas. CONCLUSION: Current websites providing information regarding child and adolescent mental health, while plentiful, lack sufficient scope, adolescent-friendly content, and interactivity that limit their utility for parents and families. Development of a high-quality and accessible child and adolescent mental health website requires an interdisciplinary collaboration of experts in mental health, website design, and knowledge dissemination. This study has informed the development of a new online resource, interactive elements of which will be shared as part of the oral presentation.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Past Imperfect, Future Tense: Psychotherapy and Child Psychiatry

ObjectivesIncreasingly, paediatricians see children and adolescents with mental health concerns in a variety of clinical settings.1 While mental health features on paediatric postgraduate training curricula nationally and internationally, previous research...

The terms ‘quality of life’ (QoL) and ‘health related quality of life’ (HRQoL) are fraught with preconceptions, misconceptions and, frequently, confusion: How are these terms best defined? What are the best ways to measure them? These challenges, which are present even in the relatively well-studied fields of adult physical health, are magnified considerably when considered in the context of child and adolescent mental health. They are, however, concepts that are being increasingly discussed by child and adolescent mental health clinicians, researchers and service planners. The purpose of this review is to analyse and discuss the concept of QoL and HRQoL (for simplicity we will use the umbrella term QoL in this paper except when there is a need to draw more fine-grain distinctions) as they relate to child and adolescent mental health, and review the various reasons for measuring QoL in this population. The paper is divided into three main sections. First, we introduce the concept of QoL and draw out the issues raised with regard to the field of childhood mental health research and practice. Second, we discuss the range of challenges raised as we move from concept to measurement. Third, we review and contrast some of the many different measurement tools currently available.