Mental health symptoms affect children and youths' functioning, quality of life (QOL), and well-being in daily life. While this 'life impact' is a critical outcome, there is a lack of conceptual clarity and widely endorsed outcome measurement instruments (OMI) to support consistent assessment across studies. This scoping umbrella review sought to map OMIs that assess life impact through measures of functioning, QOL, or well-being. Specifically, our aims were to: identify life impact OMIs from existing reviews, compare OMI design characteristics, descriptively appraise essential aspects of development quality for selected OMIs, and assess how consistently reviews identified OMI target constructs. We searched six databases for systematic, scoping, rapid, or narrative reviews of functioning, QOL, or well-being OMIs for 6-to-24-year-olds with primary mental health concerns. We separately retrieved original development/validation reports for each OMI and extracted information on the target construct and key design characteristics. For a subset of OMIs, we descriptively appraised essential features of OMI development quality. We identified 80 OMIs of functioning (n = 35), QOL (n = 33), and well-being (n = 12). Two-thirds were developed for children and youth up to 18 years, but none targeted young adults aged 19-24. Functioning OMIs were frequently designed for multi-informant assessment; QOL and well-being OMIs were mainly self-reported. Most functioning OMIs were originally validated in populations with mental health difficulties, unlike OMIs of QOL and well-being. For over one quarter of OMIs, the target construct was misclassified in at least one review, with frequent conflation of QOL and well-being. Mental health difficulties impact life across functioning, QOL, and well-being. Life impact is a core outcome to track in clinical research and practice. This review provides a roadmap to selecting OMIs of life impact in youth mental health based on OMI design characteristics.

Individual differences in the structure and function of the frontostriatal reward network have been related to depression. However, there is a strong need for prospective, longitudinal studies aiming to understand the role of frontostriatal networks in depression in a developmental context. We aimed to examine bidirectional associations between structural connectivity in the frontostriatal reward network and depressive symptoms in adolescent girls, as well as to determine to what extent the directionality and strength of these associations are dependent on age or pubertal stage. About 596 observations from 174 adolescent girls (up to 4 time points per person, ages 10-17) were included. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression scale for Children and pubertal stage with the Pubertal Development Scale and the Tanner Stage Line Drawings. Probabilistic tractography was done on diffusion-weighted imaging scans to obtain average fractional anisotropy from ventral striatum to orbitofrontal cortex and ventral striatum to ventromedial prefrontal cortex tracts. Linear mixed-effects models showed that frontostriatal connectivity was not associated with subsequent change in depressive symptoms. Depressive symptoms were also not associated with subsequent change in frontostriatal connectivity. Depressive symptoms increased with age and pubertal stage, but the association with connectivity did not vary with age or pubertal stage. This suggests previously reported cross-sectional associations might not pertain to developmental effects in girls. Future research should examine prospective associations between frontostriatal functional connectivity and depression.

Support for violent and non-violent radicalization co-exists in some, but not all, adolescents. Yet, little is known about how adolescents transition towards or away from violent and/or non-violent radicalization over time. Within a socio-ecological framework, this study investigates how Canadian adolescents move from profiles that support violent radicalization to non-violent profiles and vice-versa and whether profile belonging is associated with social-, school- and family-related factors, psychological distress and specific ideologies. High school students (N = 574; Mage = 15.1; SDage = 0.76; 47.7% girls) completed an online survey in 2023 and 2024. A latent transition analysis on scores of support for violent and non-violent radicalization was conducted. Multinomial regression was used to explore the associations between profiles and variables of interest. Adolescents moved significantly across the six identified profiles over time. School unsafety was associated with an increased probability of being in more violent profiles, whereas depressive symptoms were lower in disengaged and violent profiles. Glorification of violence was higher in the more violent and less activist profile. Adolescents reporting more distress related to international conflicts and pro-environmental ideologies were more likely to belong to more activist profiles, including those supportive of violence. Exploration of activism and violence as idioms of protest is common during adolescence and youth's attitudes in this regard are very dynamic, influenced by local and global grievances. Primary prevention efforts should accompany youth in their exploration in order to support non-violent avenues as responses to global conflicts, as well as daily injustices.

Credible long-term outcomes from randomized trials evaluating the effectiveness and cost-effectiveness of preventive programs for mental health problems are needed. We compared long-term effects of the Mind My Mind (MMM) transdiagnostic cognitive behavioral therapy (CBT) program to management as usual (MAU). The study was a pragmatic, multisite, randomized superiority trial (2017-2019) involving youths aged 6-16 years with anxiety, depressive symptoms, and/or behavioral disturbances, recruited through family self-referral. The MMM intervention included 9-13 weekly CBT sessions. The primary outcome was change from baseline in parent-reported impact of mental health problems at 3-year follow-up post-randomization using the Strengths and Difficulties Questionnaire (SDQ) impact scale. Register-based outcomes tracked youths' psychiatric diagnoses in mental health services. To assess cost-effectiveness, we calculated the incremental costs and incremental quality-adjusted life years (QALYs). All primary analyses followed the intention-to-treat (ITT) approach. ID NCT04804917. Among 396 youths randomized (baseline mean [SD] age, 10.3 [2.4] years; 52.0% boys; MMM n = 197, MAU n = 199), the 3-year follow-up (median 167 weeks; range 124-203 weeks) primary outcome data were available in 69.0% and 59.3%, respectively. The decrease in SDQ-impact-score from baseline to 3-year follow-up (4.12→1.79 points [MMM] and 4.21→1.85 [MAU]) was similar (between-group difference, 0.06 [95% CI -0.41 to 0.52]; p = .81). An equal proportion (25%) of youths in MMM and MAU were diagnosed with any mental disorder during follow-up (HR 1.01, 95% CI 0.68-1.50). Total costs over the intervention period were higher in the MMM group (incremental costs 3,014 Euros [95% CI: 2.174-3.855]). Cost-effectiveness analyses favored MMM: QALY net gain 0.121 (95% CI 0.045-0.196); the cost-effectiveness ratio was 24,789 Euro/QALY. Although MMM was potentially cost-effective, the beneficial effects diminished over 3 years post-treatment. The findings highlight the need for strategies to sustain long-term effects.

Youth anxiety disorders are highly prevalent and associated with adverse outcomes. Prior research demonstrated improvement in anxiety symptoms following evidence-based treatment; however, not all youth experience symptom remission, nor do they consistently maintain gains. We examined idiographic changes in youths' perceived ability to cope with individualized anxiety-provoking situations from pretreatment to six-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study. Youth diagnosed with a principal anxiety disorder (N = 488; ages 7-17; 50.4% male) were randomized to cognitive-behavioral therapy (CBT), pharmacotherapy (SRT), combination of CBT and SRT, or pill placebo. Youth's perceived ability to cope (i.e., perceived coping efficacy) was assessed independently using youth self-reports and caregiver-reports on the Coping Questionnaire, an idiographic measure with anxiety-provoking situations individualized to each youth. Changes in perceived coping efficacy were examined across treatment conditions using multilevel models, assessed across six timepoints. Models estimating the quadratic effect of time fit better than models estimating the linear effect. There was a significant interaction between the quadratic effect of time and treatment condition, indicating perceptions of youth coping efficacy increase from pretreatment to six-month follow-up, yet at different times across treatment based on treatment condition; this finding was observed per both youth- and caregiver-reports. Perceptions of coping efficacy did not differ based on treatment condition for either informant at pretreatment or six-month follow-up; however, post hoc analyses revealed significant differences in perceptions of youth coping efficacy at all interim assessments. Results demonstrate that effective treatments for youth anxiety disorders improved youth- and caregiver-reports of perceived coping with youths' individualized anxiety-provoking situations. Future efforts could prioritize idiographic assessments to facilitate effective treatments.

Multi-domain dysregulation in adolescence, indexed by co-occurring affective, cognitive, and behavioural difficulties, is a robust transdiagnostic risk factor. However, its developmental course and neural antecedents are poorly understood. Given heightened emotional reactivity and impulsivity in adolescence, alterations in reward-network connectivity may represent an early neural marker of risk. Adolescents completed four assessments approximately two years apart between ages 9-13 and 15-18 years. Multi-domain dysregulation was assessed at each wave using the Youth Self-Report Dysregulation Profile (YSR-DP), computed as the sum of the anxious/depressed, aggressive behaviour, and attention problems subscales. Resting-state fMRI was acquired at baseline (Mage = 11.34 years). Piecewise linear mixed-effects models (N = 211) characterized trajectories of YSR-DP scores across adolescence. Principal component scores indexing a Latent Dysregulation Factor were used to derive residualised change in dysregulation, and regression analyses (N = 94) tested whether baseline reward-network connectivity predicted this change. YSR-DP scores declined from late childhood to early adolescence, increased from early to mid-adolescence, and then stabilized in late adolescence. Weaker connectivity within the reward network in late childhood predicted greater increases in the latent dysregulation factor from early to mid-adolescence, above and beyond baseline dysregulation. Connectivity in seven large-scale control networks did not predict changes in dysregulation. Multi-domain dysregulation follows a nonlinear trajectory across adolescence, and weaker reward-network connectivity in childhood prospectively predicts subsequent escalation of this phenotype. Prevention and intervention efforts may benefit from targeting reward processing and regulatory skills in late childhood and early adolescence.

Behaviour problems are common in childhood and are associated with higher rates of mental health problems, educational and relationship difficulties throughout life. This study assessed whether a Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) has sustained benefit 6 years after delivery. It had previously been shown to reduce behavioural problems in children aged 2 and 4 years old. The Healthy Start, Happy Start study was a 2-arm, multisite randomised clinical trial conducted in 6 NHS trusts in England. Participants (N = 300) were parents/caregivers of children (aged 12-36 months) at risk of behaviour problems. Participants were randomised to receive either VIPP-SD (n = 151) or usual care (n = 149). Those allocated to VIPP-SD were offered 6 home-based video-feedback sessions. Six-year follow-up data were collected from May 2022 to July 2023. The primary outcome was the total score on Parental Account of Children's Symptoms (PACS). The analysis used prespecified longitudinal Bayesian models to handle missing data, and findings are reported as posterior probabilities of superiority alongside treatment effect estimates with 95% credible interval. Analysis included 294 of the 300 participants, with 6-year primary outcome data available for 244/300 (81%) (106 girls [43%]; mean age, 8.2 years). The probability of superiority for VIPP-SD on PACS was 86%. The mean difference in the total PACS score was -1.23 (95% Cred.I [-3.34, 0.90]); d = -0.11 (95% Cred.I [-0.032, 0.09]), with fewer behavioural problems in children in the VIPP-SD group (mean [SD] score of 25.30 [9.63] vs. 26.36 [11.05]). This trial found a probability of 86% that VIPP-SD was superior for reducing behaviour problems in children up to 6 years later. Taken together with the earlier positive trial findings, this suggests a small enduring positive impact of a brief early intervention with potential for scaling.

Irritability is a common reason for referral to child and adolescent mental health services. However, debate exists as to whether irritability is best conceptualised and treated as a feature of mood disorder, oppositional defiant disorder or a core symptom of ADHD. We use network analyses to examine the relationships betweenadolescent irritability, headstrong/hurtful ODD items, depression and ADHD phenotypes, and polygenic scores (PGS) for depression and ADHD using the Avon Longitudinal Study of Parents and Children (ALSPAC). In primary analysis, irritability, depression, headstrong/hurtful ODD items and ADHD were defined using the Development and Well-Being Assessment (DAWBA) at age 15. In secondary analysis, phenotypes were defined using the Short Mood and Feelings Questionnaire (SMFQ) and the Strengths and Difficulties Questionnaire (SDQ) ADHD and behavioural subscales at age 13. Finally, we tested for network replicability using confirmatory network analysis in the Millennium Cohort Study (MCS). Results of network analyses using the DAWBA in ALSPAC indicated irritability was most strongly associated with headstrong/hurtful ODD items, followed by ADHD and depression. When including PGS, we observed an edge between irritability and depression PGS but not between irritability and ADHD PGS. Irritability appeared to be the primary pathway between ADHD and depression as well as between headstrong/hurtful ODD items and depression. Results were similar using SMFQ/SDQ in ALSPAC and confirmatory network analysis indicated excellent model fit in MCS. Although irritability appears to be transdiagnostic, phenotypically, it was most strongly associated with headstrong/hurtful ODD items and broader behavioural problems, which favours the ICD-11 approach of including irritability as a specifier of ODD. However, irritability appeared to be a key connector between both ADHD and behavioural problems to depression; thus, is important to monitor and treat in affected youth with ADHD or behavioural problems.

Gender minority adolescents are more likely to report emotional and behavioural difficulties compared to their cisgender peers. However, little is known about these experiences for adolescents with specific gender minority identities. Cross-sectional data were obtained from the 2021/22 Student Health and Well-being survey, a national survey of 11-16-year-olds in Wales, UK. Emotional and behavioural difficulties were measured using the Strengths and Difficulties Questionnaire. Gender identity and assigned sex at birth were self-reported. Multivariable linear regressions with robust standard errors were used to examine associations between gender identity and emotional and behavioural difficulties, adjusting for age, ethnicity, household-level affluence and correction for multiple testing. Of the 122,766 participants, 2.0% (2,455) identified as a person with a gender minority identity. Twenty-eight gender minority identities were self-reported, with the most prevalent being transgender boy and nonbinary assigned female at birth (both 0.6%). Young people assigned female at birth comprised 80% of gender minority adolescents. In the adjusted model, emotional and behavioural difficulties were reported most frequently by people who identified as non-binary (B = 7.66, 95% CI 7.25, 8.06) and another gender identity (B = 7.86, 95% CI 7.34, 8.38), then transgender (B = 5.05, 95% CI 4.58, 5.51), when compared to cisgender adolescents. Female sex assigned at birth was associated with more reported difficulties than male sex assigned at birth for adolescents with a transgender or cisgender identity, but not a nonbinary identity. In this population-based study, emotional and behavioural difficulties were reported most frequently by adolescents who identified as nonbinary and another gender identity, then transgender, then cisgender. Health and educational practitioners need to be aware that emotional and behavioural difficulties differ across gender minority identities.

To examine, using repeated measures, whether prenatal serotonin/norepinephrine reuptake inhibitor (SRI) antidepressant exposure is associated with increased anxious behaviors at kindergarten age and anxiety and/or depression behaviors after kindergarten and into adolescence. This population-based retrospective cohort study included all live singleton infants delivered in British Columbia, Canada between January 2001 and December 2012 with complete outcome data. Follow-up lasted until December 2022. Logistic regression models were used to estimate unadjusted and adjusted odds ratios (OR). To minimize confounding, high-dimensional propensity score adjustment and a matched discordant sibling-pair analysis were conducted. Prenatal SRI exposure was associated with increased anxious behaviors in kindergarten (OR 1.77 [95% CI 1.59-1.97]) and anxiety and/or depression diagnostic codes in later childhood or adolescence (OR 2.09 [95% CI 1.97-2.22]). These associations attenuated but remained positive after high-dimensional propensity score adjustment; however, the associations did not remain in the conditional logistic regression of discordant sibling pairs (aORs 0.92 [95% CI 0.61-1.37] and 1.02 [95% CI 0.79-1.33]). Regardless of SRI exposure, children with high levels of anxious behaviors at kindergarten were more likely to receive anxiety and/or depression diagnostic codes later on (SRI exposed: aOR 1.59 [95% CI 1.24-2.06]; SRI unexposed: aOR 1.64 [95% CI 1.51-1.77]). The associations of prenatal SRI exposure with increased internalizing behaviors at kindergarten and into adolescence are likely due to shared genetics or environmental factors. Findings also suggested kindergarten as a time for targeted interventions to address developmental vulnerabilities and prevent later development of anxiety and/or depression.