Adolescent Mental Health Disorders Research Articles

Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.

Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes. This systematic review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU. Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes. Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU. Family medicine clinicians prescribing pharmacotherapy for mental health should be aware that additional interventions will likely be needed to address co-occurring SU.

Child and adolescent mental health disorders in the GCC: A systematic review and meta-analysis.

BackgroundThe Gulf Cooperation Council (GCC), with a predominant ‘youth bulge’ among its 54 million people, has witnessed an exponential increase in research pertinent to child and adolescent mental health (CAMH). Aside from a few narrative reviews, to date, no critical appraisal examining the magnitude of CAMH has emerged from this region.AimsThis study aimed to report the prevalence rates of CAMH disorders in the GCC through a systematic review of the existing literature followed by a meta-analysis.MethodsA systematic review of the literature from the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) was conducted. The databases used included Scopus, ProQuest, Pubmed, and a final check was performed on Google Scholar to account for any remaining studies that may have still been under review. Meta analytic techniques were then used to estimate prevalence rates of each specific mental disorder, i.e. ADHD, depression, anxiety, stress, eating disorders, and tobacco use disorder.ResultsA total of 33 studies from the six countries were included. The pooled prevalence of ADHD as per the Vanderbilt ADHD Diagnostic Rating Scale (VADHDDRS), clinical judgments, Attention Deficit Disorders Evaluation Scale (ADDES), and the Strengths and Difficulties Questionnaire (SDQ) was found to be 13.125%, 13.38%, 26.135%, and 12.83%, respectively. The pooled prevalence of depressive symptoms solicited by the Patient Health Questionnaire (PHQ-9), Depression, Anxiety, and Stress Scale (DASS), and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) was 44.684%, 45.09%, and 26.12%, respectively. The pooled prevalence of anxiety according to the DASS and the MINI Kid was 57.04% and 17.27%, respectively, while the pooled prevalence of stress as per the DASS was found to be 43.15%. The pooled prevalence of disordered eating solicited by the Eating Attitudes Test (EAT-26) was 31.55%. Lastly, the pooled prevalence of tobacco use disorder per the Global Youth Tobacco Survey was 19.39%.DiscussionTo date, this is the first systematic review and meta-analysis of its kind from the GCC. The prevalence rate of CAMH disorders appears to be in the upper range of international trends. The higher rates could be attributed to the existing studies using suboptimal methodological approaches and instruments to solicit the presence of CAMH.

Microbial Induced Autoimmune Inflammation as a Cause of Mental Illness in Adolescents: A Case Series

The incidence of mental health disorders in adolescents continues to rise. The cause of the increase in mental illness is multifactorial, including both environmental and biological causes. To investigate the latter, ten adolescents at a psychiatric residential treatment center in Colorado with the DSM-5 diagnosis of major depressive disorder (MDD), of whom seven were additionally diagnosed with generalized anxiety disorder (GAD), were chosen at random for further serologic study. Testing revealed exposureto group A Streptococcus(GAS) in 2 of 10 (20%); Borrelia Burgdorferi sensulato (Bbsl)in 2 of 10 (20%); and Bartonella speciesin 3 of 10 (30%). In addition, 9 of 10 (90%) subjects had abnormal Cunningham Panels, which measures levels of antineuronal antibodies that have been associated with psychiatric disturbances. Given the degree of psychological dysfunction in these adolescents requiring intensive residential treatment, this case series lends support to the hypothesis that exposure to infectious agents may play a role, perhaps by autoimmune mechanisms, in the significant and ongoing rise in the rate of neuropsychiatric illness in adolescents. This preliminary report adds to this premise and requires further investigation.

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study

Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11–17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents’ parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents’ dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.

Text Message Interventions in Adolescent Mental Health and Addiction Services: Scoping Review.

BackgroundThe vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions.ObjectiveThe objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents.MethodsA scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications.ResultsWe screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported.ConclusionsThe use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone–based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required.

High prevalence of neurodevelopmental problems in adolescents eligible for bariatric surgery for severe obesity

AimTo assess the prevalence of neurodevelopmental problems in adolescents with severe obesity and their associations with binge eating and depression.MethodsData were collected at inclusion in a randomised study of bariatric surgery in 48 adolescents (73% girls; mean age 15.7 ± 1.0 years; mean body mass index 42.6 ± 5.2 kg/m2). Parents completed questionnaires assessing their adolescents’ symptoms of attention‐deficit/hyperactivity disorder and autism spectrum disorder and reported earlier diagnoses. Patients answered self‐report questionnaires on binge eating and depressive symptoms.ResultsThe parents of 26/48 adolescents (54%) reported scores above cut‐off for symptoms of the targeted disorders in their adolescents, but only 15% reported a diagnosis, 32% of adolescents reported binge eating, and 20% reported symptoms of clinical depression. No significant associations were found between neurodevelopmental problems and binge eating or depressive symptoms. Only a third of the adolescents reported no problems in either area.ConclusionTwo thirds of adolescents seeking surgical weight loss presented with substantial mental health problems (reported by themselves or their parents). This illustrates the importance of a multi‐professional approach and the need to screen for and treat mental health disorders in adolescents with obesity.

Local, Early, and Precise: Designing a Clinical Decision Support System for Child and Adolescent Mental Health Services.

Mental health disorders often develop during childhood and adolescence, causing long term and debilitating impacts at individual and societal levels. Local, early, and precise assessment and evidence-based treatment are key to achieve positive mental health outcomes and to avoid long-term care. Technological advancements, such as computerized Clinical Decision Support Systems (CDSSs), can support practitioners in providing evidence-based care. While previous studies have found CDSS implementation helps to improve aspects of medical care, evidence is limited on its use for child and adolescent mental health care. This paper presents challenges and opportunities for adapting CDSS design and implementation to child and adolescent mental health services (CAMHS). To highlight the complexity of incorporating CDSSs within local CAMHS, we have structured the paper around four components to consider before designing and implementing the CDSS: supporting collaboration among multiple stakeholders involved in care; optimally using health data; accounting for comorbidities; and addressing the temporality of patient care. The proposed perspective is presented within the context of the child and adolescent mental health services in Norway and an ongoing Norwegian innovative research project, the Individualized Digital DEcision Assist System (IDDEAS), for child and adolescent mental health disorders. Attention deficit hyperactivity disorder (ADHD) among children and adolescents serves as the case example. The integration of IDDEAS in Norway intends to yield significantly improved outcomes for children and adolescents with enduring mental health disorders, and ultimately serve as an educational opportunity for future international approaches to such CDSS design and implementation.

Where is the global in global mental health? A call for inclusive multicultural collaboration.

To the editor: Common mental health disorders, like depression and anxiety, account for 45% of the global disease burden on youths aged 15–29.1 This challenge is particularly significant in low and middle-income countries (LMICs) where risk factors such as poverty, limited treatment options and stigma restrict access to care and exacerbate the burden and magnify the impact of mental disorders.2 3 Given these barriers, there is an urgent need for research dedicated to expanding mental healthcare for young people in LMICs. Because of the global public health challenge characterized by adolescent mental health disorders, there have been increased efforts over the last two decades to expand treatment options for youths in LMICs. These efforts-conducted under the umbrella of global mental health research-have improved our understanding of the efficacy and acceptability of various kinds of mental health interventions for young people in LMICs. However, there are concerns that these efforts may risk the imposition of Western values and approaches. Researchers from high-income countries (HICs) may bring assumptions about diagnostic classification, aetiology and treatment that may not be appropriate for LMICs.4 To address this risk, and enhance cultural validity, some investigators have emphasised the value of collaborating with colleagues from LMICs in designing and implementing interventions for these settings.5 Without such collaboration with community partners, well-intentioned efforts may risk relying on false assumptions about the generalisability of Western-derived intervention development and research methods across diverse populations in LMICs.4 A possible consequence of the status quo is that mental health interventions in LMICs may fail to adequately consider and address salient features of adolescent mental health in LMICs. Indeed, scholars have noted several unique obstacles that investigators face when deploying interventions in LMICs. These include a paucity of mental health experts, differences in help-seeking attitudes and cultural factors …

Testing an individualized digital decision assist system for the diagnosis and management of mental and behavior disorders in children and adolescents

BackgroundNearly half of all mental health disorders develop prior to the age of 15. Early assessments, diagnosis, and treatment are critical to shortening single episodes of care, reducing possible comorbidity and long-term disability. In Norway, approximately 20% of all children and adolescents are experiencing mental health problems. To address this, health officials in Norway have called for the integration of innovative approaches. A clinical decision support system (CDSS) is an innovative, computer-based program that provides health professionals with clinical decision support as they care for patients. CDSS use standardized clinical guidelines and big data to provide guidance and recommendations to clinicians in real-time. IDDEAS (Individualised Digital DEcision Assist System) is a CDSS for diagnosis and treatment of child and adolescent mental health disorders. The aim of IDDEAS is to enhance quality, competency, and efficiency in child and adolescent mental health services (CAMHS).Methods/designIDDEAS is a mixed-methods innovation and research project, which consists of four stages: 1) Assessment of Needs and Preparation of IDDEAS; 2) The Development of IDDEAS CDSS Model; 3) The Evaluation of the IDDEAS CDSS; and, 4) Implementation & Dissemination. Both qualitative and quantitative methods will be used for the evaluation of IDDEAS CDSS model. Child and adolescent psychologists and psychiatrists (n = 30) will evaluate the IDDEAS` usability, acceptability and relevance for diagnosis and treatment of attention-deficit/hyperactivity disorder.DiscussionThe IDDEAS CDSS model is the first guidelines and data-driven CDSS to improve efficiency of diagnosis and treatment of child and adolescent mental health disorders in Norway. Ultimately, IDDEAS will help to improve patient health outcomes and prevent long-term adverse outcomes by providing each patient with evidence-based, customized clinical care.Trial registrationISRCTN, ISRCTN12094788. Ongoing study, registered prospectively 8 April 2020 https://doi.org/10.1186/ISRCTN12094788

A Systematic Review of the Effect of Social Support on Post-Traumatic Stress Disorder in Post-Earthquake Adolescents

Introduction: Earthquakes can cause mental health disorders in adolescents, one of which is post-traumatic stress disorder (PTSD). The present study aimed to assess the effect of social support on post-traumatic stress disorder in adolescents after an earthquake.Methods: The study was a systematic review with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. Articles were searched for using the Scopus, ScienceDirect, ProQuest, EBSCO and SAGE databases before classifying them into 3 categories: prevalence, risk factors, social support, and post-traumatic stress disorder. The inclusion criteria regarding the literature were documents that were original; where the source was from a journal; where the article was written in English and where the full text was available. The age of the subjects in the articles was determined to be in the range of 10-20 years old. The publication time limit was 2015 to 2020.Results: Adolescents who experienced an earthquake were found to demonstrate a high prevalence of post-traumatic stress disorder with the proportion in girls being higher than boys. Showing social support has a significant effect on PTSD after an earthquake. The earthquake-related factors that were the most strongly associated with probable PTSD were feeling scared of dying and exposure to an earthquake.Conclusion: Social support and the prevalence rates of PTSD should be observed in more detail. These results indicate that it is important to provide and strengthen the social support available to reduce the risk and severity of post-traumatic stress disorder after an earthquake among adolescents.

Classification System for International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision Pediatric Mental Health Disorders

This study examines how much the Child and Adolescent Mental Health Disorders Classification System of diagnosis overlaps with diagnoses in the Clinical Classification Software and the ICD-9-CM and ICD-10-CM.

Commentary: An updated agenda for the study of digital media use and adolescent development - future directions following Odgers & Jensen (2020).

Odgers and Jensen's (Annual research review: Adolescent mental health in the digital age: Facts, fears, and future directions, Wiley-Blackwell, 2020) review compellingly suggests that a rapid increase in the number of hours adolescents now dedicate to digital media use over the past decade may not be associated with concomitant changes in the prevalence of adolescent mental health disorders. Yet, there are many unexplored questions that deserve attention to fully understand how adolescents' use of digital media has transformed social experiences and adolescent development. In this commentary, we offer an agenda for researchers interested in examining digital media use within a broader developmental psychopathology framework. Specifically, we discuss past theories and emerging findings suggesting both deleterious and beneficial effects of digital media use, a need for greater semantic clarity in the field, and a call for greater methodological precision to fully capture concurrent and prospective associations between digital media use and adjustment. In addition, we suggest that it may be fruitful to dedicate less research attention toward the number of hours that adolescents spend using technology, and more on what specific behaviors teens engage in online. Moreover, more work is needed to understand individual vulnerability or resiliency factors that may impact online experiences. We review opportunities for future work on digital media use that may integrate findings from developmental social neuroscience and also discuss a need to investigate how adolescents' online behavior may be affecting developmental competencies offline. Adolescents' use of digital media is rapidly changing, and this is an important, yet challenging topic that deserves attention from investigators who study adolescent adjustment.

The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol

IntroductionEarly identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach...

4.20 DEVELOPMENTAL COURSE OF PSYCHIATRIC DISORDERS IN ADOLESCENCE: A 3-YEAR FOLLOW-UP

There is little knowledge about the course of mental health disorders in adolescents referred to child and adolescent mental health services (CAMHS). We aimed to assess changes in mental health morbidity, somatic comorbidity, and pain during a 3-year period among adolescents referred to CAMHS.

1.43 PRENATAL ADVERSITY AND ADOLESCENT PSYCHIATRIC RISK: A TEST OF THE CUMULATIVE RISK HYPOTHESIS

Nearly 1 in 5 youth suffer from a mental health disorder, and 50 percent of adult patients with mental illness met the diagnostic criteria for a mental health disorder as a child or adolescent. Exposure to higher levels of postnatal adversity predicts an increased risk of mental health disorders in youth. However, it is unclear whether being exposed to increasing prenatal adversity similarly affects risk. The current study examined whether levels of adverse prenatal exposures are associated with an increased risk of mental health disorders in adolescence.

Prevalence and patterns of mental disorders among primary school age children in Ghana: correlates with academic achievement

Background: There is limited data on the prevalence of child and adolescent mental health disorders (CAMHD) in Ghana. Recent reports suggest a decline in academic achievement in basic education. This paper sought to determine the prevalence of CAMHD in Ghanaian primary school children and to draw correlates with academic achievement.Methods: We conducted a pilot cross-sectional survey of 303 grade 3 pupils aged 7–15 years in the city of Kumasi. The Child Behaviour Checklist (CBCL) and Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) were used to assess for CAMHD in 2016, and data on performance in examinations over the prior academic year were analysed.Results: Overall, current prevalence of CAMHD was 7.25%, with depressive disorder = 1.31%, anxiety disorders = 1%, attention deficit hyperactivity disorder (ADHD) = 1.64%, conduct disorder = 1.97%, and intellectual disability = 1%. Co-morbid disorders, such as seizure disorder (1%), were also noted. There was a greater prevalence of CAMHD in public schools (11.6%) compared to private schools (0.7%), with p < 0.001. Even when adjusted for other factors, children with CAMHD had a lower average academic score by 10.5 units (p < 0.001). Thus, having a dual diagnosis was most predictive of academic underachievement.Conclusions: The results of this study document the prevalence of CAMHD in Ghana for the first time and shows correlates with academic underachievement.

Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda

BackgroundIt is estimated that almost 20% of the world’s adolescents have experienced or are experiencing a mental health problem. Several factors have been associated with the onset of adolescent mental health disorders, including poverty, child abuse and violence, particularly among adolescent girls. This paper examines the effect of participating in a family-based economic strengthening intervention on the mental health well-being of female adolescent orphans impacted by HIV/AIDS in rural Uganda.MethodsData utilized in this study was from the Bridges to the Future Study (2011–2016), an economic empowerment intervention aimed at improving health outcomes of orphaned children. Adolescents were randomly assigned to either the control condition receiving bolstered standard of care services for orphaned adolescents; or one of two treatment conditions receiving bolstered standard of care as well as an economic empowerment intervention comprising of a child development account, a mentorship program and workshops on financial management and microenterprise development. Data was collected at baseline, 12- and 24-months post intervention initiation. Multilinear regression analyses were conducted to examine the impact of an economic empowerment intervention on mental health functioning of female participants over time. Mental health functioning was measured by: (1) the Child Depression Inventory; (2) Beck Hopelessness Scale; and (3) Tennessee Self Concept Scale.ResultsAnalysis results show an improvement in mental health functioning over time among female participants receiving the intervention compared to their control counterparts. Specifically, compared to participants in the control condition, participants receiving the intervention reported a reduction in depressive symptoms from baseline to 12-months follow-up (b = − 1.262, 95% CI − 2.476, − 0.047), and an additional 0.645-point reduction between baseline and 24-months follow-up (b = − 1.907, 95% CI − 3.192, − 0.622). Participants receiving the intervention reported significant improvement in their reported self-concept from baseline to 24 months follow-up (b = 3.503 (95% CI 1.469, 5.538) compared to participants in the control condition.ConclusionsEmpowerment of young girls, either in the form of peer mentorship and/or economic strengthening seems to significantly improve the overall mental health functioning of adolescent girls impacted by HIV and AIDS in low-income settings.

A national child mental health literacy initiative is needed to reduce childhood mental health disorders.

Half of all lifetime mental health disorders emerge in childhood, so intervening in the childhood years is critical to prevent chronic trajectories of mental health disorders. The prevalence of child mental health disorders is not decreasing despite the increased availability of evidence-based interventions. One key reason for the high prevalence and low treatment uptake may be low levels of child mental health literacy in the general community. Mental health literacy refers to knowledge and beliefs about mental health disorders that aid in their recognition, prevention and management. There is emerging evidence of poor recognition of child mental health problems in the community and low levels of parental knowledge about how to seek help, along with high levels of stigmatising attitudes. Although Australia has been a world leader in research and practice in improving mental health literacy for adolescent and adult mental health disorders, particularly depression and anxiety, mental health literacy for childhood disorders has been largely overlooked. In order to improve knowledge of child mental health disorders, reduce stigma, improve appropriate help-seeking and impact on the prevalence of child mental health disorders, we argue that a national initiative focussing on increasing mental health literacy for childhood disorders is urgently needed.

Sleep Disturbances in Child and Adolescent Mental Health Disorders: A Review of the Variability of Objective Sleep Markers.

Sleep disturbances are often observed in child and adolescent mental health disorders. Although previous research has identified consistent subjective reports of sleep disturbances, specific objective sleep markers have not yet been identified. We evaluated the current research on subjective and objective sleep markers in relation to attention deficit hyperactivity disorders, autism spectrum disorders, anxiety and depressive disorders. Subjective sleep markers are more consistent than objective markers of actigraphy, polysomnography, and circadian measures. We discuss the causes of variability in objective sleep findings and suggest future directions for research.