Adult Mental Health Problems Research Articles

Sandplay therapy: An overview of theory, applications and evidence base

Sandplay Therapy (SPT) is a psychotherapy method utilized worldwide, not only in Western countries, but also in Asia and Latin America with an extensive increase in growth over the past 15 years. The nonverbal approach of SPT is especially applicable in working with children, and with adults with trauma, distress, disabilities, and migration issues. This study provides an overview of the theory and practice of SPT in individual and group settings, its application to different groups of clients and mental health problems, and the state of evidence. A systematic search found 16 RCTs and 17 effectiveness studies, which found significant improvements with moderate effect sizes for a variety of child and adult mental health problems. Although further research is warranted, the current state of evidence highlights a range of potential benefits of SPT in clinical practice. SPT seems to have a potential for the treatment of clients with traumatic stress, disabilities or language problems, which are difficult to treat with conventional psychotherapy methods.

Mental Health Trends in Military Pediatrics.

Childhood psychiatric disorders affect current functioning and predispose individuals to more severe adult mental health problems. Provider survey research has suggested that children's mental health problems are increasing; observed changes may be due to increased illness or improved access to care. The authors sought to quantify trends in the prevalence of diagnosed and treated mental health conditions, outpatient treatment, and psychiatric medication prescriptions in a large population of children who were continuously insured. The authors performed a retrospective trend study of diagnosed mental health conditions, treatment, and psychiatric medication prescriptions from 2003 to 2015 in children ages 2-18 who were military dependents (N=1,798,530). Poisson regression analyses and Cochran-Armitage tests determined trends in the prevalence of treated psychiatric diagnoses overall and by subcategory, rates of outpatient mental health visits, and psychiatric medication use overall and by specific class. From 2003 to 2015, the prevalence of children with diagnosed mental health conditions increased from 9.2% to 15.2% (rate ratio=1.04, 95% confidence interval=1.04-1.05, p<0.001). Identified suicidal ideation prevalence increased by 20% a year. Mental health care visits increased by 2% a year, and psychiatric medication prescriptions increased by 3% a year between 2003 and 2015, with larger increases seen among older children. Prescriptions for children with identified mental health conditions did not increase. Diagnosed mental health conditions, pharmaceutical treatment, and outpatient visits all increased across a diverse U.S. pediatric population from 2003 to 2015. Results suggest that use of psychiatric medications kept pace with the increased number of diagnoses and that older children are most affected.

Diet quality and mental health problems in late childhood

ABSTRACT Objectives: There is evidence that diet quality is associated with mental health problems in adults and adolescents. Yet the extent to which overall diet quality (not individual nutrients or dietary patterns) may be associated with mental health problems in pre-adolescent children, a common time for first onset of symptoms, remains unclear. This study examined associations between overall diet quality, using a brief measure, and mental health problems during late childhood, in a large community sample. Methods: Participants were 787 eight and nine-year-old children taking part in the Childhood to Adolescence Transition Study. Parents reported on their child's mental health problems using the Strengths and Difficulties Questionnaire and on their child's diet quality, using a six-item screening tool. Results: Regression analyses were conducted, adjusting for child age, sex, body mass index, and family socioeconomic status. Overall diet quality was significantly associated with children's mental health before (beta = −0.11, 95% CI −0.18 to −0.04, p = 0.004) and after adjustments for age, sex, body mass index and family socioeconomic status (beta = −0.10, 95% CI −0.18 to −0.03, p = 0.007). Conclusion: Concordant with previous literature, results indicate that better overall diet quality is related to more positive mental health in pre-adolescent children. Additionally, these results support the utility and efficacy of a brief (six-item) parent-report questionnaire as an indicator of overall diet quality.

Parenting and the dysregulation profile predict executive functioning in children with acquired brain injury

ABSTRACTBackground: Children with acquired brain injury (ABI) present with high rates of psychological disorders commonly accompanied by deficits in hot and cold executive functions (EFs). Impairments in EFs have been reported to precede mental health problems. Moreover, children who are vulnerable to developing mental health problems in adulthood frequently present with a dysregulation profile in childhood, characterized by impairments in cognitive, behavioral and emotional regulation. Objective: To identify profiles of behaviors associated with impairment in hot and cold EFs and compare injury factors, environmental stressors and dysregulation profile between them. Methods: A latent profile analysis was conducted with 77 children with ABI aged between 6 and 12. Injury factors, child IQ, environmental stressors and the dysregulation profile were compared between these behavioral profiles. Logistic regressions were conducted to predict profile membership. Results: Two profiles were identified: Profile M, with mild deficits (1–2 SD above the mean) in working memory and social skills, and profile C, presenting clinically significant deficits (2–3 SD above the mean) in shift, initiate, working memory, planning and social skills and mild deficits in inhibit, emotional control and task monitor. Proximal environmental stressors (dysfunctional parenting practices, parental stress, parent’s executive dysfunction, anxiety-trait, and depressive symptoms) and dysregulation symptoms predicted profile membership, whereas injury factors, child IQ and distal environmental stressors did not. Conclusion: Following ABI, children with profile C are at risk of mental health problems and present with more proximal stressors. The dysregulation profile may be useful as a proxy for risk for later mental health problems in children with ABI.

Young Adult Unemployment and Later Depression and Anxiety: Does Childhood Neighborhood Matter?

Young adulthood represents a developmental period with disproportionately heightened risk of losing a job. Young adult unemployment has been linked to increased mental health problems, at least in the short term. However, their possible long-term impacts, often referred as "scarring effects," have been understudied, possibly underestimating the magnitude of mental health burden that young adult unemployment generates. This longitudinal study examined whether duration of unemployment during young adulthood is associated with later mental health disorders, after accounting for mental and behavioral health problems in childhood. Furthermore, the current study investigated whether childhood neighborhood characteristics affect this association and if so, in what specific functional ways. Data were drawn from a longitudinal study of developmental outcomes in a community sample in Seattle. Data collection began in 1985 when study participants were elementary students and involved yearly assessments in childhood and adolescence (ages 10-16) and then biennial or triennial assessments (ages 18-39; N = 677 at age 39; 47% European American, 26% African American, 22% Asian American, and 5% Native American; 49% female). The current study findings suggest that duration of unemployment across young adulthood increased mental health problems at age 39, regardless of gender. Childhood neighborhood characteristics, particularly their positive aspect, exerted independent impacts on adult mental health problems beyond unemployment experiences across young adulthood. The current findings indicate a needed shift in service profiles for unemployed young adults-a comprehensive approach that not only facilitates reemployment but also addresses mental health needs to help them to cope with job loss. Further, the present study findings suggest that childhood neighborhoods, particularly positive features such as positive neighborhood involvement, may represent concrete and malleable prevention targets that can curb mental health problems early in life.

Increased stress and altered expression of histone modifying enzymes in brain are associated with aberrant behaviour in vitamin B12 deficient female mice

A sub-optimal nutritional environment from early life can be envisaged as a stressor that translates into mental health problems in adulthood. After considering (a) the widespread prevalence of vitamin B12 deficiency especially amongst women in developing countries and (b) the importance of vitamin B12 in normal brain function, in this study we have elucidated the behavioural correlates of chronic severe and moderate vitamin B12 deficiency in C57BL/6 mice. Female weanling mice were assigned to three dietary groups: (a) control AIN-76A diet with cellulose as dietary fibre (b) vitamin B12 restricted AIN-76A diet with pectin as dietary fibre (severe deficiency group) and (c) vitamin B12 restricted AIN-76A diet with cellulose as dietary fibre (moderate deficiency group). The mice received these diets throughout pregnancy, lactation and thereafter. Nest-building, maternal care, anxiety and depressive behaviours were evaluated. Oxidative stress, activities of antioxidant enzymes and expression of various histone modifying enzymes in brain were investigated to unravel the probable underlying mechanisms. Our data suggests that both severe and moderate vitamin B12 deficiency induced anxiety and impaired maternal care. However, only severe vitamin B12 deficiency induced depression. Oxidative stress and poor antioxidant defense underlie the deleterious effects of both severe and moderate vitamin B12 deficiency. Altered expression of histone modifying enzymes in the brain of severely deficient mice is suggestive of epigenetic reprogramming. This study suggests that chronic vitamin B12 deficiency leads to behavioural anomalies in female C57BL/6 mice and the severity of these outcomes can be correlated to the level of deficiency.

Comparison of age of first drink and age of first intoxication as predictors of substance use and mental health problems in adulthood

BackgroundInternational public policy on age of first alcoholic drink (AFD) has emphasised the long-term benefits of delaying AFD. This study aimed to compare AFD to age of first intoxication (AFI) as predictors of substance use disorder and mental disorder outcomes in adulthood. MethodsData were obtained from a longitudinal birth cohort in Christchurch, New Zealand. Participants were born in 1977. Analysis samples ranged from n = 1025 (age 18) to n = 962 (age 35). Measures of AFD and AFI were generated using parental- and self-report data collected from age 11. Outcomes at age 18–35 were alcohol quantity consumed, DSM-IV alcohol use disorder (AUD) and AUD symptoms, major depression, anxiety disorder, and nicotine, cannabis, and other illicit drug dependence. Covariate factors measured during childhood included family socioeconomic status, family functioning, parental alcohol-related attitudes/behaviours, and individual factors. ResultsThere was a significant unadjusted association between AFD and symptoms of AUD (p < .001) and nicotine dependence (p < .05) but not other outcomes. AFI was significantly (p < .05) associated with all outcomes. After adjustment for covariates, the association between AFD and outcomes was not statistically significant. Conversely, in adjusted models, statistically significant (p < .05) associations remained between AFI and all AUD and substance use disorder outcomes but not alcohol consumption or mental disorder outcomes. ConclusionsAFI was a more robust predictor of adult substance use disorder outcomes than AFD. Public health and policy interventions aimed at prevention of long term harms from alcohol should therefore focus on AFI rather than AFD.

Child sleep problems and adult mental health in those born at term or extremely low birth weight

ObjectivesTo examine associations between parent-reported child sleep walking or talking, nightmares, and trouble sleeping at age eight and psychiatric problems in adulthood (age 30–35) in extremely low birth weight (ELBW; <1000 g) survivors and matched normal birth weight (NBW; >2500 g) control participants. MethodsAt age eight, parents of ELBW survivors and NBW control participants completed sleep items on the Child Behavior Checklist assessing the presence of sleep walking/talking, nightmares, or trouble sleeping. At age 30–35, 98 ELBW and 94 NBW individuals completed the Mini International Neuropsychiatric Interview (MINI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Analyses were conducted in each birth weight group independently. ResultsIn NBW participants, sleep walking/talking in childhood predicted higher BAI and BDI scores, as well as more than three times the odds of having a mood or anxiety disorder (OR = 3.48; 95% CI, 1.26–9.60) at age 30–35. Sex and childhood sleep problem interactions revealed that females who manifested sleep walking/talking as children had higher BAI scores than males. Nightmares in children born at NBW predicted higher BAI scores. These associations persisted despite adjustment for child mental health, sex, socioeconomic status, sexual or physical abuse, and family functioning. Trouble sleeping in childhood did not predict adult mental health problems. Childhood sleep problems did not predict psychopathology in ELBW adults. ConclusionsChildren born at NBW who manifest sleep walking or talking appear to be at increased risk for developing mood or anxiety disorders in adulthood. No associations between child sleep and adult mental illness were noted in those with ELBW surviviors. Childhood sleep walking/talking may be a unique risk factor for mental health problems later in life.

Child maltreatment and mental health problems in adulthood: birth cohort study.

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.AimsTo examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood. The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto). In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n = 91), followed by physical abuse (n = 78), neglect (n = 73) and sexual abuse (n = 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association. Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.Declaration of interestNone.

The prevalence of mental health problems in adults with intellectual disabilities in Japan, associated factors and mental health service use.

People with intellectual disabilities are more likely than people in the general population to experience life events associated with an increased risk of mental health problems. However, there has been little research in Japan on the prevalence of mental health problems in adults with intellectual disability (ID) or on associated factors and access to relevant services. Informants completed the Japanese version of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist, and questions on the use of mental health services, for 126 adults with ID living in Tokyo. A total of 23.8% of adults with ID had scores above the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist threshold score. Mental health problems were associated with age, gender and life events and not associated with the level of ID or living environment. Approximately 60% of participants with mental health problems were treated by psychiatrists and 6% of them received psychotherapy. In the present study, mental health problems occurred in adults with ID at similar frequencies as in previous studies. Adults with ID who experienced mental health problems tended to receive less psychological therapy than the general Japanese population experiencing such problems. This result may indicate poor provision of psychological services for people with intellectual disabilities in Japan.

Fathers’ Childhood Experiences, Adult Mental Health Problems and Perceptions of Interactions With Their 36 Month-Old Children

Perceptions of poor care in the family of origin can relate to adverse mental health and poor adaptation for mothers but there is less evidence about fathers. This study investigated the relevance of fathers’ recollections of their own parents (Generation 1) for their (Generation 2) current mental health symptoms and for interactions with their 3-year-old children (Generations 2/3), in a community sample of 482 British fathers. Recollections of G1 maternal and paternal behaviour were associated in uncontrolled correlations with G2 paternal mental health, but taking family social class and maternal (G2) mental health into account they did not significantly predict G2 fathers’ mental health symptoms at 36 months postpartum, though a trend remained for G1 paternal care. Significant predictors were paternal depression symptoms in the first year postpartum and G2 mothers’ current mental health. Predictors of more dysfunctional father-child (G2/G3) interactions at 36 months postpartum were working class status, recall of more G1 maternal controlling behaviour and more concurrent paternal mental health symptoms; predictors of less G2/G3 dysfunction were G2 paternal use of more positive discipline. Potential implications of the results for parenting support and advice are discussed, recognising that intergenerational transmission of parent-child relationships is likely for fathers.

Depression and anxiety outcomes of offending trajectories: A systematic review of prospective longitudinal studies

BackgroundEarlier research has studied different typologies of offending (e.g., adolescence-limited, late-onset, life-course-persistent), but little is known about the mental health problems of different offender groups. ObjectivesThis paper presents a comprehensive review of the literature on the link between developmental trajectories of offending and adult mental health outcomes (i.e., anxiety and/or depression). MethodsA meta-analysis was carried out to synthesize information on different offender types and associated adult mental health problems. Analyses were based on data from prospective longitudinal studies. ResultsA total of 158 reports relating to 53 longitudinal studies were screened. Twenty-one reports were included in the systematic review and nine reports were included in the meta-analysis. Compared to non-offenders, the odds for mental health problems were nearly three-times higher for life-course-persistent offenders (OR = 2.72; CI: 2.18 to 3.40) and almost twice as high for late-onset offenders (OR = 1.70; CI: 1.37 to 2.12). Adolescence-limited offenders suffered the least mental health problems (OR = 1.41; CI: 1.16 to 1.71). ConclusionsDifferent offender groups face varying probabilities of mental health problems. Implications for policy and practice are discussed. More research needs to empirically investigate how and when poor mental health is related to chronic and persistent offending.

Digit ratio (2D:4D) and behavioral symptoms in primary-school aged boys

The second-to-forth digit length ratio (2D:4D) is considered to be a biomarker for intrauterine androgen levels. It is associated with adult and child mental health problems, primarily with behavioral symptoms and predominantly in males. Using a cross-sectional design, we examined whether 2D:4D was associated with conduct disorder (CD) symptoms in 138 primary-school aged children (54% boys, Mage = 7.70 years) and considered child sex as a moderating factor. Children's digit lengths were measured from hand scans and mothers rated the behavioral/emotional symptoms of their child. The regression analyses revealed that 2D:4D ratios were associated with behavioral symptoms in boys (β = −0.260, p = 0.026), but not in girls (β = −0.040, p = 0.762). Child emotional symptoms, analyzed as a control, were not significantly correlated with 2D:4D. In conclusion, prenatal brain hyperandrogenization - operationalized by the 2D:4D biomarker - could result in behavioral symptoms in boys at early school age, reflecting one predictor for early onset CD. Our data support the use of 2D:4D as a marker of prenatal androgen exposure.

Prematurity at birth linked to adult mental health problems

Prematurity at birth linked to adult mental health problems

Severe interpersonal violence against children in sport: Associated mental health problems and quality of life in adulthood

In a recent large-scale prevalence study of interpersonal violence (IV) against child athletes in the Netherlands and Belgium we found that 9% of adult respondents who participated in organized sports before the age of 18 had experienced severe psychological violence, 8% severe physical violence, and 6% severe sexual violence in various sport settings. While the general literature has repeatedly shown that exposure to IV during childhood is associated with mental health problems in adulthood and to a lesser extent with reduced quality of life (QOL), these relationships have not been demonstrated in (former) athletes. Thus, the current study aims to assess the association of severe childhood IV in sport and adult wellbeing. Depression, anxiety, and somatization were assessed in the same general population sample (N = 4043) using the Brief Symptom Inventory (BSI-18) and QOL with the World Health Organization Quality of Life questionnaire (WHOQOL-Brèf). The association between severe IV in sport and adult wellbeing was investigated using multiple linear regression while controlling for demographics, recent life events, and relatives’ psychological problems. We found severe sexual, physical, and psychological childhood IV in sport to be associated with more adult psychological distress and reduced QOL. Polyvictimization shows the strongest correlation with poorer wellbeing and QOL. Recent life events, relatives’ psychological problems, marital status, and level of education were significant covariates in the psychological symptoms and QOL assessed. We hope that these new insights prompt sport administrators to implement broad spectrum child protection measures and raise the awareness of mental health professionals about the necessity to also screen for adverse childhood experiences in the sport context.

Friendship Attachment Style Moderates the Effect of Adolescent Exposure to Violence on Emerging Adult Depression and Anxiety Trajectories.

Exposure to violence during adolescence is associated with increased risk behaviors and mental health problems in adulthood. Friendship attachment during adolescence may, however, mitigate the negative effects of exposure to violence on trajectories of depression and anxiety in young adulthood. In this study, we used growth curve modeling to examine associations between exposure to violence and mental health outcomes, followed by multi-group analyses with friendship attachment as the moderator. The sample was drawn from a longitudinal study (12 waves; 1994-2012) of 676 (54% female) urban high school students. We found strong positive associations between exposure to violence during adolescence and later self-reported depressive and anxiety symptoms. Notably, securely attached adolescents reported faster decreases in mental health symptoms as a function of violence relative to their insecurely attached peers as they transitioned into adulthood.

1072 SLEEP TRAJECTORIES FROM ADOLESCENCE TO ADULTHOOD AND THEIR RELATIONSHIP WITH HEALTH OUTCOMES

Sleep is linked to physiological and mental health outcomes. However, little is known about sleep trajectories from adolescence to adulthood and their relationship with health outcomes. We examined sleep trajectories and their relationship with cardiometabolic and mental health in a representative sample over 16 years. We tracked participants between 1997 and 2013 from the Panel Study of Income Dynamics study and the Child Development and Transition into Adulthood Supplements (n=3,118; age 10-17y at baseline) who reported their sleep duration up to six times during the study. We used latent class growth modelling to identify distinct sleep trajectories (long sleep (8.7% of the sample), average sleep (72.5%), and short sleep (18.8%)) and assessed their relationship with self-rated health, high blood pressure, obesity, and mental health using logistic and linear regressions controlling for the year of birth. Compared to the average sleep trajectory, both short and long sleep trajectories were associated with higher odds of poor or fair self-rated health (OR (95% CI), p-value): 1.82 (1.16, 2.84), p=0.01 and 1.89 (0.98, 3.63), p=0.06, respectively). Both short and long sleep trajectories also had greater mental health problems in adulthood (OR 1.66 (1.11, 2.49), p=0.01) and 1.99 (1.07, 3.69), p=0.03), respectively). Only the trajectory of short sleep was associated with higher odds of having high blood pressure (OR 1.81 (1.06, 3.12), p=0.03), greater distress (β (95% CI), p-value: 1.51 (0.73, 2.28), p<0.01) and lower mental well-being (β -0.63 (-1.15, -0.10, p=0.02)) compared to average sleep trajectory. We found no significant association between sleep trajectories and obesity. We found evidence that short and long sleep trajectories from adolescence to adulthood are linked to poor physiological and mental health outcomes in adulthood. Individuals that follow a trajectory of short sleep seemed particularly vulnerable to poor mental well-being as young adults. Additional research is needed to extend our understanding of the relationship between sleep trajectories over the lifespan and their effect health outcomes. GG is supported by a postdoctoral fellowship from the Canadian Institutes for Health Research. FJE is supported by a Canada Research Chairs program.

The impact of interpersonal violence in youth sport on adult psychopathology

IntroductionA recent cohort study in the Netherlands and Belgium showed that 38% of children experienced psychological violence, 11% physical violence, and 14% sexual violence in sport (Vertommen et al., 2016). This study aims to explore the long-term consequences on anxiety, depression and somatic complaints in adults who experienced psychological, physical or sexual violence in the specific context of organized youth sport.MethodsA web survey in a representative sample of adults, prescreened on having participated in organized sport before the age of 18 (n = 4043) was conducted. In this sample, depression, anxiety and somatic problems were assessed using the brief symptom inventory. A generalized linear model was used to quantify the impact of experiencing severe interpersonal violence in sport on psychopathology.ResultsAll three types of severe interpersonal violence (psychological, physical and sexual) were significantly associated with the total score and the subscales of the brief symptom inventory. The effect remains significant after controlling for socio-demographics, as well as disability, sexual orientation, adverse childhood experiences outside sport, recent trauma and family history of psychological problems.ConclusionsExperiencing interpersonal violence against in youth sport is associated with mental health problems in adulthood. This is an important finding to consider in child protection policy in sport.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Paediatric headache trajectories - a reappraisal after nine years.

Background The long-term consequences of paediatric headache can involve functional disabilities and mental health problems in adulthood. Objective To analyse the predictive power of paediatric headache trajectory classes for headache and related outcomes in adulthood. Methods In a previous study, a population-based sample (N = 3227, 9-14 years of age at first assessment) was followed across four annual assessment points, and sex-specific headache trajectory classes were identified (girls: "no pain", "moderate pain", "increasing pain", "high pain"; boys: "no pain", "moderate pain"). These trajectory classes were used to predict headache frequency, functional disability, depression, quality of life and self-efficacy nine years later (N = 994). Negative binomial regression analyses and pairwise comparisons were computed. Results Women showing an elevated trajectory ("increasing pain" or "high pain") had a higher adult headache frequency and a poorer outcome on associated variables (functional disability, depression, quality of life, and self-efficacy) than women having a lower-level trajectory. Men of the "no pain" and "moderate pain" trajectory classes differed significantly from one another in their headache frequency and related variables. Conclusion Belonging to an elevated paediatric headache trajectory class involves a considerable risk for headache and headache-related problems in adulthood.

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - ‘Deborah’

This study is the third of a series of seven, and belongs to the second Italian systematic replication of findings from two previous series (Widdowson 2012a, 2012b, 2012c, 2013; Benelli, 2016a, 2016b, 2016c) that investigated the effectiveness of a manualised transactional analysis treatment for depression through Hermeneutic Single-Case Efficacy Design (HSCED). Major Depression and Subthreshold Depression are often in comorbidity with Anxiety disorders in childhood and adolescence and represent a risk factor for ongoing mental health problems in adulthood. The therapist was a white Italian woman with 15 years of clinical experience and the client, Deborah, was a 15-year old white Italian female adoloscent who attended sixteen sessions of transactional analysis psychotherapy. The conclusion of the judges was that this was a good-outcome case: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements were maintained throughout the duration of the follow-up intervals. Furthermore, the client reported significant change in her post-treatment interview and these changes were directly attributed to the therapy. In this case study, the transactional analysis manualised treatment for depression in adulthood has demonstrated its effectiveness also in treating depressive and anxiety symptoms in adolescence.