Adolescent Psychiatric Services Research Articles

Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care

Background Psychotic-like experiences (PLEs) are common in clinical adolescent samples and form a continuum based on their frequency and intensity. PLEs can have harmful effects on both behaviour and affect. Methods Prevalence and subjective distress due to PLEs were assessed with the Prodromal Questionnaire-Brief (PQ-B) and depressive symptoms with the Beck Depression Inventory (BDI-21A) among adolescents (N = 399; 71.7% female, mean age 14.9 years, range 13–18) entering specialized adolescent psychiatric services. Various PQ-B Distress scale cut-off points were tested for their ability to detect high and low BDI scores using the superiority index, the effect size for mean difference, and spline regressions. Results The mean number of endorsed PLEs assessed with the PQ-B was 3.27 (SD 3.64; males: M 1.75; SD 2.78; females: M 3.89; SD 3.78), while mean PQ-B Distress scores were 20.33 (SD 18.03; males: M 11.84; SD 13.90; females: M 23.74; SD 18.40). The most common PLE within both genders were experiences of paranoia and suspiciousness, with a prevalence of 59.9%. BDI scores and PQ-B distress scores were strongly associated (r = 0.534, p<.001). Superiority indices, effect sizes, and spline regressions indicated that a low PQ-B Distress cut-off of 2 or 3 was most informative both when using BDI as a continuous variable and when dichotomized as mild depression (≥10) or major depressive disorder (≥16). Conclusion PLEs are common among adolescent entering psychiatric care. Even a relatively small amount of distress due to PLEs indicates clinical levels of depressive symptoms.

Internalized stigma and traumatizing effects of psychiatric hospitalization in adolescents: Is there any difference between being hospitalized in adult or adolescent inpatient psychiatric services?

Psychiatric hospitalization serves as a critical treatment modality. However, hospitalization may pose risks of traumatization or stigma. This study primarily examined the internalized stigma and traumatizing effects of psychiatric hospitalization on adolescents. Additionally, the treatment of adolescents within adult inpatient psychiatric services may yield differing stigmatization and posttraumatic stress disorder (PTSD) symptomatology. Hence, the secondary objective was to discern the variance in stigmatization and PTSD symptoms between adolescents treated in adult inpatient psychiatric services (AIPS) and those in child and adolescent inpatient psychiatric services (CAIPS). The cohort consisted of patients from Akdeniz University's Adult Psychiatry Inpatient Service (n = 29) and Uludağ University's Child and Adolescent Psychiatry Inpatient Service (n = 28), matched for age and gender. Assessments using the Child Posttraumatic Stress Disorder-Reaction Index and the Internalized Stigma Scale for Children and Adolescents (ISSCA) were conducted 6 months after discharge. 36.8% and 10.5% of adolescents exhibited "mild" and "very severe" PTSD symptoms, respectively. Adolescents treated in CAIPS had higher Child Posttraumatic Stress Disorder-Reaction Index scores than those in AIPS. However, there was no significant difference between the AIPS and CAIPS groups regarding ISSCA-self and ISSCA-perceived scores. The current findings underscore that psychiatric hospitalization can lead to traumatic experiences in adolescents, especially those treated in CAIPS. Providing informed care and emotional support during hospitalization could bolster resilience and facilitate recovery among these individuals. While adolescents are sometimes placed in AIPS, it is crucial that professionals are adequately trained and supported in managing this vulnerable population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patients and family attitudes about clinical and research sharing of electronic clinical data

Purpose To access the attitudes of service users about the sharing of health records for research and to foster collaboration between municipal health services and the specialist health services in Norway. Methods Members (n ≈ 2000) of the Norwegian mental health service users’ organizations (SUO’s), ADHD Norway, the Autism Association and the Tourette Association, representing Central Norway, participated in the study, (N = 108, 5.4% response rate). Descriptive statistics were used to evaluate distributions of responses to the questionnaire. Results Service users reported being aware that municipal health services collaborate with the specialist health service (62%), with mental health care in the specialist health service (57%), and child and adolescent psychiatric services (61%). A large proportion of individuals were aware of the benefits of sharing their health records (93%), have trust in the use of data by health authorities (81%), and were willing to share records to benefit fellow patients (84%). Personal experience (69%) and impressions from mainstream media (55%) had the most influential impact on users’ views of the Health Platform, an electronic health communication system. A majority of users had a negative perception of the Health Platform, even though some expect it to become a valuable tool in the future (50%). Conclusions Service users are aware of and positive about benefiting others by sharing health records. They trust the health authorities, however, have negative attitudes about the Health Platform, apparently based on personal experiences and media influence. However, service users can see the potential usefulness of the Health Platform in the future.

Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study

A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families.

Nurses’ Perceptions of Telephone Triage in Child and Adolescent Psychiatric Services – An Enhanced Critical Incident Technique Study

In Sweden, units managed by nurses specialised in counselling and telephone triage, have been developed within the Child and Adolescent Mental Health services (CAMHS). This study has a qualitative design and illuminates the nurses’ perceptions of what helps or hinders their assessments and telephone triage. The Enhanced Critical Incident Technique was utilised, eight nurses were interviewed in depth, to identify factors influencing triage. The study is the first to provide a comprehensive description of helpful and hindering factors while performing telephone triage. It illuminates telephone triage in Swedish CAMHS settings and provides insights how to enhance and implement this practice.

Morbidity and mortality after adolescent eating disorders requiring inpatient care

Purpose This retrospective study utilized comprehensive Finnish national register data to examine the course and mortality of eating disorders among Finnish adolescent inpatients. Methods The study population (N = 17,112) comprised of all subjects admitted for the first time to psychiatric hospital care at age 13–17 in 1980–2010. In 10-year follow-up, morbidity and mortality were compared between those admitted for eating disorders (ED group) and other psychiatric patients (non-ED group). Results Of the study population, 1081 were ED patients (1031 female and 50 male). Mean age was 15 (SD = 1) in both ED and non-ED groups, and the mean follow-up time was 7.7 (SD = 2.2) and 8.4 years (SD = 2.1), respectively. Over 50% of the patients had readmissions during follow-up, the ED group having a higher risk for readmissions. Crude mortality rate (CMR) was 1.5 in the ED group and 2.9 in the non-ED group. Suicide was the most common cause of death: 43.8% in the ED group vs. 52.9% in the non-ED group (p = .28). In multivariate analyses, ED at index admission predicted rehospitalizations but, compared to other disorders, was not associated with increased mortality. Conclusion In the ED group, psychiatric readmissions were more common, but in contrast to earlier reports, mortality was not higher than in other psychiatric disorders. The subjects were treated in specialized adolescent psychiatric services. The prognosis of adolescent onset EDs may improve when treatment is developmentally sensitive.

Prevalence and factors associated with non-suicidal self-Injury and suicidality in children and adolescent attending Emergency department in Oman

IntroductionNon-suicidal self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry (1). NSSI is defined as intentional destruction of one’s body tissue without suicidal intent and has a prevalence rate in adolescents of approximately 30–40% in clinical samples (2). Suicide prevalence is around 24–33% (3).There are many factors leading to suicidal or self-harming behavior. A prior history of self-injurious behavior is one of the strongest predictors of future suicidal behavior, both cross-sectionally and longitudinally (6) . Additionally, longitudinal studies have found that a previous suicide attempt increases the risk of a future suicide attempt threefold.Suicide and NSSI have a significant impact on families and communities. Hence, considerable required clinical attention is warranted to develop preventive strategies.ObjectivesThe aim of this study is to investigate the prevalence of non-suicidal self-Injury (NSSI) and suicidality among children and adolescents presenting in emergency department of the tertiary psychiatric services and to study their demographic and clinical characteristics.MethodsThis is a retrospective cross-sectional analytical study included all children and adolescent patients attended the emergency department at Sultan Qaboos University Hospital between June 2021 to March 2016. The data was collected using the hospital´s electronic database to retrieve the medical records of children and adolescents who visited the emergency department. Patients who were 18 years of the age or younger were included in the study. The included patients must had been evaluated by psychiatrist during their presentations in the emergency department.ResultsDuring the 63 months of observation, 114 patients attended the emergency department and required psychiatric evaluation, 44.7%(n=51) of patients presented with NSSI and/or SA. The mean age was 15.7. 80.4%(n=41) were females while 19.6%(n=10) were males. 37.3% had a primary diagnosis of major depressive disorder (MDD) and 21.5% had comorbid medical illness. 44% of suicidal attempts were with drug overdose, mostly paracetamol overdose, while the most used method for NSSI was cutting the body with a razor, 57%.19 patients had a primary diagnosis of major depressive disorder, 17 patients had no clear diagnosis at presentation.22% of the patients had other medical comorbidities, 5 patients with epilepsy. 51% of the patients had positive family history of mental illness.ConclusionsConsidering that NSSI and suicidality were found to be the main reasons for presenting to a child and adolescent emergency psychiatric service, it seems crucial for physicians at PEDs to provide proper crisis intervention and referral to mental health services when appropriate. Early identification of risk factors is highly recommended.Disclosure of InterestNone Declared

Associations between autism traits and family functioning over time in autistic and non-autistic children.

Little is known about family functioning over time when raising a child with autism traits, with or without a clinical autism diagnosis. Therefore, we asked caregivers-mostly parents-of a group of 168 children about the family functioning and the child's emotional and behavioral characteristics, as well as autistic traits, twice with about 1 year in between. For numerous reasons, the children were referred to youth mental health care centers, including child and adolescent psychiatric services. Care as usual was offered after the diagnostic assessment if a clinical diagnosis was the assessment outcome. Caregivers reported less problematic family functioning in children with fewer autism traits over time. The child's additional emotional or behavioral characteristics did not seem to influence this relation. Furthermore, we split the whole group into autistic children with a clinical autism diagnosis (58%) and non-autistic children with autism traits but without a clinical diagnosis (42%) to see whether we would find the same results in both groups. Surprisingly, the relation between family functioning and the level of a child's autism traits only held for the subgroup of non-autistic children with autism traits. Thus, raising children with autism traits without a clinical diagnosis may affect family functioning over time. We think that families might have difficulty understanding and adjusting to the autism traits of their children but are lacking the support that is exclusively offered to families of children with a clinical autism diagnosis. We must be cautious because we do not know whether there is a causal relation. Although further research is needed to explore and learn to understand this result, clinicians might consider offering support to families of children with subthreshold autism to prevent problems in family functioning. Because high autism trait levels in non-autistic children may be of a different origin than autism, for example, other neurodevelopmental or mental health problems, family training or support should be tailored to the child's underlying difficulties.

Problematic screen media use in children and adolescents attending child and adolescent psychiatric services in a tertiary care center in North India.

The present clinic-based study aimed to evaluate screen media use among children and adolescents who had a mental disorder. Two hundred twelve parents of children and adolescents attending the child and adolescent psychiatric services were approached. They were asked to rate the screen media use of their child brought for psychiatric consultation using the Problematic Media Use Measure-Short Form (PMUM-SF). The DSM-5 criteria of internet gaming disorder (IGD) were applied using the PMUM-SF, which contained nine items equivalent to nine items of IGD. The mean age of the patients was 13.16 years (SD: 4.06; range: 0.8-18). Only 28.3% (n = 60) were aged less than 12 years. The most common primary diagnosis was neurodevelopment disorder (n = 82; 38.7%), followed by neurotic disorder (n = 62; 29.2%) and mood disorder (n = 30; 14.2%). The most common screen media used was television (n = 121; 57.1%) followed by the mobile phone (n = 81; 38.2%). The average screen time was 3.14 hours, with a range of 0.5-7 hours, and more than two-third of children and adolescents used screen gadgets for more than the recommended duration. Slightly more than one-fourth (22.2%) of children and adolescents with mental disorders fulfilled the DSM-5 criteria of IGD. When those with and without screen media addiction were compared, those with screen media addiction were more often male, from joint or extended families, more often diagnosed with neurodevelopmental disorders and disruptive disorder, and were less often diagnosed with neurotic disorders. About one-fourth of the children and adolescents with mental disorders had screen media addiction, and two-thirds of them used screen media for more than the recommended duration.

Treatment Motivation and Burden of Stress among Parents of Adolescents with Non-Suicidal Self-Injury Presenting to a Child and Adolescent Psychiatric Emergency Service

Introduction: The successful treatment of adolescents almost always requires parents’ involvement in the treatment process. Thus, parental involvement will impact further treatment, especially concerning the acute management of self-harming behavior of their children. Parental burden or low parental motivation for treatment can significantly affect the success of the intervention. Therefore, this study aimed at investigating how especially motivational factors of the adolescents and parents, as well as stressors of the parents, affect the course of non-suicidal self-injury (NSSI) after an acute psychiatric emergency presentation. Methods: Ninety-six adolescents aged 11–18 years who have been presented to an emergency service at a child and adolescent psychiatry clinic for suicidal and/or NSSI behavior were recruited together with their accompanying parents within the framework of a specified diagnostic procedure. This included detailed questionnaire and interview procedures for psychiatric assessment. The extent of parental stress and parents’ motivation for treatment and its relations to adolescents’ NSSI and own treatment motivation have been investigated in a follow-up examination in the aftermath of the acute presentation. We predicted adolescents’ NSSI at follow-up based on their own motivation and parental motivation and stress. Results: Data analysis demonstrated that higher adolescents’ treatment motivation was associated with higher parental stress. Also, higher parental treatment motivation was correlated with a higher degree of parental distress. Furthermore, parents showed lower treatment motivation when their children engaged in NSSI for a longer duration. Finally, lower adolescents’ motivation and lower parental stress due to own parental concerns were predictive for higher adolescents’ NSSI frequency at follow-up investigation. Discussion/Conclusion: Patients as well as their parents who present for an emergency service are especially likely to be exposed to increased stress and strain factors. During treatment, additional focus should be placed on parental stress and parental and adolescents’ treatment motivation. Identifying and addressing deficits in motivation, increases in parental stress, as well as offering support could favorably impact future NSSI behavior.

2.26 Impact of the COVID-19 Pandemic on the Child and Adolescent Psychiatric Consultation-Liaison Service (CL) in a Large Urban Hospital

The objective is to assess the impact of the pandemic on patients seen by the Psychiatry Consultation-Liaison (CL) service in a tertiary care hospital in Dallas, Texas. Our hypothesis was that an increased number of patients diagnosed with depression, anxiety, and suicidal ideation (SI) with and without attempts were seen during the pandemic.

Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States.

To estimate the number and geographic distribution of children and adolescents in the United States who reside in counties with neither child and adolescent psychiatrists nor sufficient Internet broadband to support telepsychiatry services. This analysis combined data from the Health Resources and Services Administration's Area Health Resource Files on child psychiatrist workforce with Federal Communications Commission information on broadband coverage to generate a composite of in-person and digital access to child psychiatric services throughout the United States. Using multivariable fixed-effects Poisson regression analysis, we estimated the number of children and adolescents (aged 5-19 years) without access to psychiatric services and examined disparities across counties in the United States. We estimate that 6,035,402 children and adolescents in the United States (approximately 10%) have inadequate in-person and digital availability of child psychiatric services within their counties. Although this was true for only 3% of children and adolescents in urban counties, this applied to more than half (51%) in rural counties (adjusted odds ratio [AOR]= 2.71; 95% CI= 1.94, 3.78; p< .001). Likewise, only 3% of children and adolescents in high-income counties had insufficient digital and physical access, compared to more than 4 in 10 children and adolescents (41%) in low-income counties (AOR= 0.43; 95% CI= 0.30-0.61; p< .001). Counties with a higher density of Black and Hispanic residents had greater likelihood of service availability (p< 0.001), potentially a function of living in metropolitan communities. Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.

Substance-Use Disorders in Children and Adolescents.

The most common substance use disorders in childhood and adolescence have to do with alcohol and cannabis. These disorders begin as early as puberty, are often accompanied by other mental disorders, and, if untreated, very frequently persist into adulthood. This review is based on pertinent publications retrieved by a selective search in PubMed on substance use disorders in children and adolescents. Substance use disorders are among the commonest mental disorders in childhood and adolescence. In Germany, approximately 10% of adolescents have tried cannabis at least once. The prognosis is negatively affected by individual (bio-)psychological traits, mental comorbidities, laws that facilitate consumption, socioeconomic disadvantage, consuming peers, and parental substance use disorders. A timely diagnosis, motivation by the pediatrician, and referral to specialized child and adolescent psychiatric services helps assure that those affected receive appropriate treatment, with the goal of abstinence from the substance as well as improvement in emotional regulation, affectivity, and attention. According to studies from the English-speaking countries and considering all treatment forms, treatment is completed by approximately 60% to 65% of children and adolescents; 20% to 40% of these patients are abstinent six months after the end of treatment. No studies of this type have been carried out to date in Germany. As the results of treatment are generally poor, there is a major need for research on the treatment and care of children and adolescents with substance use disorders. In particular, the interfaces between outpatient and inpatient care need further improvement.

Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. Asurvey of the demand situation

Ein steigender kinder- und jugendpsychiatrischer Versorgungsbedarf ist in den letzten Jahren deutlich zu beobachten. Die vorliegende Studie befasst sich mit 20 Kinder- und Jugendhilfeeinrichtungen im Industrieviertel (Niederösterreich) und dem kinder- und jugendpsychiatrischen Behandlungsbedarfs der 439 dort fremduntergebrachten Kinder und Jugendlichen. Es zeigen sich bei 270 (62 %) der Kinder und Jugendlichen psychiatrische Auffälligkeiten und bei 220 (50,1 %) ein oder mehrere psychiatrische Diagnosen. Davon sind 200 Kinder und Jugendlichen bereits in einer kinder- und jugendpsychiatrischen Behandlung. Bei elf Einrichtungen besteht ein Behandlungsbedarf von 80–100 % der fremduntergebrachten Kinder und Jugendlichen. Es ergibt sich daraus ein hochbelastetes Helfer:innensystem und eine große Versorgungsnotwendigkeit in den Einrichtungen. Eine intensivere Vernetzung und Zusammenarbeit der involvierten Institutionen bzw. Helfer:innensysteme und einer Weiterentwicklung des Kinder- und Jugendpsychiatrischen Angebots wäre wünschenswert, um den steigenden psychiatrischen Behandlungsbedarf bei Kindern und Jugendlichen adäquat begegnen zu können.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s40211-022-00419-y) enthalten.

Suicidal Behavior in Emergency Child and Adolescent Psychiatric Service Users Before and During the 16 Months of the COVID-19 Pandemic.

BackgroundSlovenia is among the countries with the highest suicide rates in the world. The COVID-19 pandemic has had a significant impact on the mental health of children and adolescents. Our hypothesis is that the school closure during the pandemic with a gradual transfer to virtual schooling had an important impact on children's and adolescents' suicidal behavior. Therefore, we aimed to determine possible changes in the frequency of assessments as well as frequency and severity of suicidal behavior in the population of Slovene children and adolescents seeking emergency psychiatric help in correlation with the progression of the pandemic and online schooling.MethodsWe performed a retrospective observational analysis of medical records of all children and adolescents referred to the only 24-h emergency in- and outpatient child and adolescent psychiatry service in Slovenia from March 2019 through the end of July 2021. We extracted number of assessments, number of patients with suicidal ideation and with attempted suicide. A comparison between the same periods prior to the pandemic and during the pandemic was made. The months of school closure due to the COVID-19 restriction measures and the months without closures were also compared.ResultsDuring this period, 1966 children and adolescents were assessed. There was no statistically significant difference in the observed frequency of emergency visits when we compared all the months with to all the months without school closures, or when individual corresponding months with and without school closures were compared. However, there were statistically significantly more patients with suicidal ideation [t(16) = −2.739, p = 0.015; W = 25.0, p = 0.016] and patients who had attempted suicide [t(16)= −3.412, p= 0.004; W = 14.5, p =0.006] during the pandemic as individually compared to the corresponding pre-pandemic months.ConclusionsOur results show that the number of Slovene children and adolescents who required emergency psychiatric help with suicidality and attempted suicide increased during the COVID-19 pandemic. The increase was shown only after the first year of the pandemic. The observed increase did not appear to directly correspond to the school closures, but was more likely related to the duration of the pandemic.

The 10-year treatment outcome of open dialogue-based psychiatric services for adolescents: A nationwide longitudinal register-based study.

To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003-31 December 2008, and who were aged 13-20 at onset (n=44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n=780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finland (n=44 088). The primary outcome variables were psychiatric treatment and/or disability allowances at the end of the 10-year follow-up, or death. The secondary outcome variables were treatment and disability expenses. Generalized linear models weighted by inverse probability of treatment were used to study the association between OD and the primary outcomes. Population proportions were used to evaluate the cost-effectiveness of the approaches. Treatment that commenced outside OD was associated with higher odds of continuing to receive treatment (adjusted odds ratio [aOR] 1.4; 95%CI 1.2-1.6) and disability allowances (aOR 1.6; 95%CI 1.2-2.1) at the end of the 10-year follow-up. No significant difference in the mortality ratio emerged. The cumulative 10-year expenses per capita were lower under OD. OD associated with favourable long-term outcomes, but due the observational design and possible residual confounding, further studies with a more robust research design are required.

Rationale and Description of Implementation of Regional Collaborative Service Model for Enhancing Psychosocial Wellbeing of Children and Families-Oulu Collective Impact Study.

BackgroundThe psychosocial wellbeing of children and adolescents is an ongoing global concern. Despite positive outcomes of child- and family-focused programs, the fragmentation of services presents challenges. To enhance harmonization and diminish fragmentation of service policies, we implement a preventive collaborative service model for children and families. The rationale for our study is based on analyses of national and local data before implementing the service model in the pilot area.MethodsThe need for a preventive service model for children and families was demonstrated using national and local data sources. First, a national school health survey was utilized to screen adolescents' perceptions of their depressive symptoms and support. Second, time trends in child and adolescent psychiatric and child protection service use were investigated. For these aims, epidemiological data of the study area (city of Oulu) were compared with data from the whole country (Finland). Third, local usage data of the preventive stand-alone Let's Talk About Children (LT) intervention before the service model implementation were evaluated. After these analyses, Let's Talk About Children Service Model (LT-SM) implementation in the pilot area is described in detail.ResultsThe background data showed that 17% of the adolescents in the study area had reported depressive symptoms, and almost half of them had not received professional help. Child and adolescent psychiatric outpatient visits had increased during the last decade, but the number of visits remains lower in the study area compared with the country as a whole. The number of adolescent psychiatric inpatient days had increased contrary to a decreasing national trend. The number of urgent child welfare placements was also higher compared with the whole country. The local LT intervention data revealed very low utilization rates. These results indicated a necessity to enhance preventive and collaborative support for children and their families. This article describes the implementation of the LT-SM.DiscussionWe demonstrated excessive use of curative services in social and health care and insufficient usage of the stand-alone preventive intervention. The LT-SM is now piloted in one regional service area of the city of Oulu. Its effectiveness will be evaluated when enough data have been accumulated for statistical analyses.

Trajectories of Healthcare Utilization Among Children and Adolescents With Autism Spectrum Disorder and/or Attention-Deficit/Hyperactivity Disorder in Japan.

BackgroundEarly intervention and prevention of psychiatric comorbidities of children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are urgent issues. However, the differences in the diagnoses of ASD and ADHD and psychiatric comorbidities associated with age, long-term healthcare utilization trajectories, and its associated diagnostic features have not been fully elucidated in Japan.MethodWe conducted a retrospective observational study using the medical records. Member hospitals of three major consortiums of hospitals providing child and adolescent psychiatric services in Japan were recruited for the study. Children who accessed the psychiatry services of the participating hospitals in April 2015 were followed up for 5 years, and data on their clinical diagnoses, consultation numbers, and hospitalizations were collected. Non-hierarchical clustering was performed using two 10-timepoint longitudinal variables: consultation numbers and hospitalization. Among the major clusters, the differences in the prevalence of ASD, ADHD, comorbid intellectual disability, neurotic disorders, and other psychiatric disorders were assessed.ResultsA total of 44 facilities participated in the study (59.5%), and 1,003 participants were enrolled. Among them, 591 diagnosed with ASD and/or ADHD (58.9%) and 589 without missing data were assessed. The mean age was 10.1 years, and 363 (70.9%) were boys. Compared with the pre-schoolers, the school-aged children and adolescents had fewer ASD, more ADHD, and fewer comorbid intellectual disability diagnoses, as well as more diagnoses of other psychiatric disorders. A total of 309 participants (54.7%) continued consultation for 2 years, and 207 (35.1%) continued for 5 years. Clustering analysis identified three, two, and three major clusters among pre-schoolers, school-aged children, and adolescents, respectively. The largest cluster was characterized by early termination of the consultation and accounted for 55.4, 70.6, and 73.4% of pre-schoolers, school-aged children, and adolescents, respectively. Among the school-aged children, the diagnosis of ADHD was associated with a cluster that required longer periods of consultations. Among the adolescents, comorbid psychiatric disorders other than intellectual disability and neurotic disorders were associated with clusters that required hospitalization.ConclusionContinuous healthcare needs were common and psychiatric comorbidities were associated with complex trajectory among adolescents. The promotion of early intervention and prevention of comorbidities are important.

An Exploration of the Possibilities of Current Mental Health Services to Tackle Transgenerational Effects of Parental Mental Illnesses on Offspring Adjustment in Lithuania.

The topic of mental health and mental disorders is very sensitive and delicate in families and the society. Stigma is one of the main reasons for little help-seeking for mental disorders. Transgenerational effects of mental disorders is the utmost sensitive theme that brings difficulties for service organization and research. By emphasizing the importance of the effects of parental mental illnesses on the health of offspring and their adjustment, together with sharing the international experience between professionals, both the administration of services and society could provide opportunities for further positive change in this little-studied but utmost actual field. There is still a lack of appropriate long term systematic programs and ways to overcome complex organizational challenges. Sharing international experience and research could help find ways that best fit the situations in each country. After a descriptive analysis of the current system of mental health services in Lithuania, opportunities were sought to meet the needs of children and adolescents whose parents have mental disorders by ensuring their healthy psychosocial development. Child and adolescent psychiatry services are a more favorable and less stigmatized area in Lithuania than adult psychiatry, so assistance and specialized programs for children of parents with mental health problems could be organized using the country's relatively well-developed network of child and adolescent psychiatric and pediatric services. For such a small country with limited resources, there could be a possibility to use and strengthen the existing network of services together with finding opportunities for mixed models of financing and cooperation with non-governmental initiatives and organizations. A unique network of primary mental health outpatient centers that provide services for adults and children/adolescents could serve as a reasonable basis for the systematic implementation of specialized programs and initiatives in this field. This network is still not adequately used in the organization of mental health prevention, early intervention, and complex treatment services for the children of parents with mental illness.

Early onset externalizing behaviors among forensic psychiatric patients: Identification in child and adolescent psychiatric services

Forensic psychiatric patients constitute a heterogeneous patient group, with common comorbidity within the externalizing spectrum. Increased knowledge on early antecedents in the pathway to severe mental illness and criminality is needed. In this study, we investigated early onset externalizing behaviors in three groups of forensic psychiatric patients 1) patients without contact with child and adolescent psychiatry (CAP), 2) patients with CAP contact, and 3) patients with both CAP contact and institutional placement. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden between 2016 and 2020. Data were collected through file information and semi-structured interviews and analyzed with a Bayesian approach. A history of CAP together with an institutional placement during childhood or adolescence was associated with more externalizing disorders, a higher number of convictions over the lifetime, a lower age at first conviction, and a lower age at first self-reported crime. Our findings provide further insight into the importance of early-onset adverse behaviors in the development of later externalizing behaviors, and may be of particular use for practitioners within social services and CAP services.