Total Difficulties Research Articles

Mental health trajectories in adolescents during Covid‐19: ‘Are we all in this together’?

AbstractThis study used a longitudinal probability sample survey, Understanding Society: Covid‐19, to examine trajectories in adolescents' mental health, via the Strengths and Difficulties Questionnaire, at three timepoints during Covid‐19 with a particular emphasis on vulnerable groups (i.e., young carers, adolescent girls, BAME—Black, Asian and minority ethnic, and adolescents in financially strained households). Generally, self‐reports of emotional and total difficulties remained stable during the pandemic, although adolescents who had limited social support were far more likely to report severe emotional and total difficulties. Young people with pre‐existing mental and physical health conditions appeared more resilient, whereas vulnerable young people were hit the hardest during the pandemic. Compared to their less vulnerable peers, young carers, adolescent girls, Black or mixed‐race young people and adolescents in financially strained households were more likely to report reduced mental health during the pandemic. It is hoped that the findings will contribute to debates about the pandemic unveiling existing mental health inequalities in society, and to public policy in an era of perma‐crises as we currently face a cost of living crisis where public services are under enormous strain to reach those who need them most.

The impact of parental overprotection on the emotions and behaviors of pediatric hematologic cancer patients: a multicenter cross-sectional study.

Parental overprotection may have an impact on children's emotional and behavioral problems (EBPs). As pediatric hematologic cancer patients have compromised immune systems, parents of such children often worry excessively, interfering with their daily lives. Therefore, avoiding overprotection is crucial for the overall physical and mental health of pediatric hematologic cancer patients. The aim of this study was to examine the current status of EBPs in pediatric hematologic cancer patients and analyze their associated risk factors. This work was a multicenter cross-sectional observational and correlational study. We collected data anonymously through parental questionnaires from three pediatric hematologic oncology hospitals in China. The Strengths and Difficulties Questionnaire, the Parental Overprotection Measure (POM) scale, and a general information survey designed by the research team were employed to assess children's EBPs, the degree of parental overprotection, as well as basic demographic and disease-related information. Chi-square tests and generalized linear mixed-effects regression analysis were used to analyze the factors influencing EBPs among the pediatric hematologic cancer patients. Using a convenience sampling method, a total of 202 participants' parents were selected. All participants were invited to complete the questionnaire through one-on-one guidance. Emotional symptoms accounted for the highest proportion of abnormal EBPs in children (27.72%), followed by peer problems (26.24%), prosocial behavior (25.74%), behavioral problems (14.36%), and total difficulties (13.86%). A minority of children had abnormal hyperactivity scores (4.95%). The results of a generalized linear mixed regression analysis showed that age, duration of illness, and parental overprotection were significant factors influencing abnormal EBPs in children (p < 0.05). A POM score threshold of 37 exhibited good sensitivity (74%) and specificity (90%) in predicting abnormal EBPs in children. Pediatric hematologic cancer patients under excessive parental protection are more prone to experiencing EBPs. Healthcare professionals should guide parents to reduce this excessive protection, thus mitigating the occurrence of EBPs in children.

The psychosocial functioning in adolescents with severe obesity evaluated throughout the strengths and difficulties questionnaire (SDQ): a preliminary report.

Childhood obesity is associated with poor psychological adjustment. Severely impacts the psychological adjustment of young patients. To assess the psychological functioning of children and adolescents, several questionnaires have been proposed so far. Although the Strengths and Difficulties Questionnaire (SDQ) is one of the most well-used tools, its application in obesity research is scarce. The study is aimed at assessing the psychological profile of a sample of Italian children and adolescents seeking an in-hospital multidisciplinary body weight reduction program for obesity, via SDQ. One hundred and fourteen consecutive Italian children and adolescents with obesity (43 males/71 females, age range: 11-17 years, mean age ± SD: 15.1 ± 1.66, body mass index-BMI ± SD: 37.4 ± 6.13 kg/m2), were recruited at the Division of Auxology, Istituto Auxologico Italiano IRCCS, Piancavallo (VB). Obese Females reported worse conditions of emotional symptoms (t = 5.48; p < 0.001) and peer problems (t = 2.34; p = 0.021), as well as higher which were associated with greater scores of pro-social behaviors than obese males (t = 3.07; p = 0.003). The total difficulties score (t = 4.00; p < 0.001) and the total impact score (t = 4.53; p < 0.001) were significantly higher in females than males. No statistically significant differences in SDQ variables were found in relation to the degree of obesity (BMI SDS: 2-2.99; BMI SDS: > 3). These findings can contribute to understand the psychological condition of adolescents with obesity in a better way and also to develop effective interventions for the treatment of pediatric obesity which not only take into account the medical and physical aspects but also the emotional and social difficulties expressed by adolescents with obesity.

Emotional and behavioural difficulties among children and adolescents attending “ART teen clubs” in Mzuzu City in northern Malawi: a cross-sectional study

BackgroundWhile triple anti-retroviral therapy (ART) has improved HIV-infected children surviving into adolescence and adulthood, these children remain vulnerable to HIV-related psychological disturbance due to both the direct HIV infection effects on the brain and indirect effects related to coping with a range of medical, psychological and social stresses associated with HIV, which makes it vital to identify their mental health needs. This study assessed the emotional and behavioural challenges of HIV perinatally infected children and adolescents with a completed disclosure process attending “ART teen club” in Malawi.MethodsA cross-sectional descriptive study design was conducted to obtain quantitative descriptive descriptions of emotional and behavioural challenges among HIV-infected children and adolescents between 10 and 22 years of age. They were interviewed on their family socio-demographic characteristics, clinical characteristics as well as emotional, conduct, hyperactivity, peer and prosocial problems using the Chichewa version of the Strengths and Difficulties Questionnaire. Data were analyzed using descriptive analysis and logistic regression.ResultsBased on the four-band categorization of the SDQ, higher scores for total difficulties score were observed in 72.9% of the children. According to the subscales of the SDQ, results show that children had higher scores in peer problems (62.8%), emotional (68.2%), conduct (68.6%) and prosocial (57.8%) subscales while lower scores were identified in the hyperactivity (16.6%) subscale. Results show that within each level, males are having lower frequencies as compared to females. Results from multivariate binary logistic regression indicate that those with a single parent or not as well as the WHO HIV clinical stage had an impact on the mental health status of the children. Children who do not have a single parent (AOR 3.404; 95% CI:1.563–7.416, p = 0.002) had 3.404 odds of having abnormal mental health status unlike those children with a single parent and children who were in WHO HIV clinical stage 2 (AOR 2.536; 95% CI:1.005–6.395, p = 0.049) or 3 and 4 (AOR 8.459; 95% CI:1.5.820-10.544, p < 0.001) had more odds of having the mental disorder as compared with those children in WHO HIV clinical stage 1.ConclusionThe findings of this research underscore the multifaceted nature of mental well-being among children and adolescents living with HIV. Elevated scores in total difficulties, emotional, conduct, and peer problems signify areas of concern, while disparities in hyperactivity and prosocial behavior highlight the nuanced nature of their behavioral challenges. Recognizing the inadequacy of a one-size-fits-all approach, the research emphasizes the necessity of a comprehensive strategy, incorporating factors like religious background, family structure, and clinical HIV stage. Furthermore, the role of “ART teen clubs” in this context is pivotal. Beyond addressing identified risk factors, these clubs must actively foster resilience. Creating an inclusive environment, tapping into individual strengths, and nurturing a sense of community are vital components. By adopting such a holistic approach, Teen support clubs can significantly contribute to the overall mental well-being of adolescents living with HIV, enabling them to navigate challenges effectively and thrive amidst their circumstances.

Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children.

Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.

Negative associations between maternal prenatal hair cortisol and child socioemotional problems

Maternal prenatal distress can participate in the programming of offspring development, in which exposure to altered maternal long-term cortisol levels as measured by hair cortisol concentrations (HCC) may contribute. Yet, studies investigating whether and how maternal prenatal HCC associates with problems in child socioemotional development are scarce. Furthermore, questions remain regarding the timing and potential sex-specificity of fetal exposure to altered cortisol levels and whether there are interactions with maternal prenatal distress, such as depressive symptoms. The subjects were drawn from those FinnBrain Birth Cohort families that had maternal reports of child socioemotional problems (the Brief Infant-Toddler Social and Emotional Assessment [BITSEA] at 2 years and/or the Strengths and Difficulties Questionnaire [SDQ] at 5 years) as follows: HCC1 population: maternal mid-pregnancy HCC measured at gestational week 24 with 5 cm segments to depict cortisol levels from the previous five months (n = 321); and HCC2 population: end-of-pregnancy HCC measured 1–3 days after childbirth (5 cm segment; n = 121). Stepwise regression models were utilized in the main analyses and a sensitivity analysis was performed to detect potential biases. Negative associations were observed between maternal HCC2 and child BITSEA Total Problems at 2 years but not with SDQ Total difficulties at 5 years, and neither problem score was associated with HCC1. In descriptive analyses, HCC2 was negatively associated with Internalizing problems at 2 years and SDQ Emotional problems at 5 years. A negative association was observed among 5-year-old girls between maternal HCC1 and SDQ Total Difficulties and the subscales of Conduct and Hyperactivity/inattentive problems. When interactions were also considered, inverse associations between HCC2 and BITSEA Internalizing and Dysregulation Problems were observed in subjects with elevated prenatal depressive symptoms. It was somewhat surprising that only negative associations were observed between maternal HCC and child socioemotional problems. However, there are previous observations of elevated end-of-pregnancy cortisol levels associating with better developmental outcomes. The magnitudes of the observed associations were, as expected, mainly modest. Future studies with a focus on the individual changes of maternal cortisol levels throughout pregnancy as well as studies assessing both maternal and child HPA axis functioning together with child socioemotional development are indicated.

Chronic Conditions and Resilience: Adolescent Health Behaviors in the Midst of the COVID-19 Pandemic in Thailand.

Objective. To assess the impact of chronic illnesses on risk behaviors and psychosocial adjustments among adolescents during the COVID-19 pandemic in Thailand. Methods. A cross-sectional study was conducted between June 2021 and September 2022, including adolescents aged 10 to 18 years. Participants completed the Thai Youth Risk Behavior Survey and the Strengths and Difficulties Questionnaire (SDQ). Data were analyzed using descriptive statistics, Student's t-test, Chi-square test, and logistic regression. Results. Adolescents with chronic illnesses (n = 120) were more likely to exhibit risk behaviors related to violence (38.3%) and mental health issues (18.3%). They also scored higher on total difficulties (mean = 12.23, SD = 5.14) and emotional symptoms (mean = 3.08, SD = 2.45) than the healthy group (n = 120). Conclusion. During the COVID-19 pandemic, adolescents with chronic illnesses in Thailand demonstrated increased risk behaviors related to violence and mental health issues, highlighting the need for tailored interventions.

Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial.

Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes. The primary outcome assessed was performance time. The secondary outcomes were imaging time, needling time, block onset time, total anaesthesia time, anaesthesia success, and performer difficulty score. Of 59 patients, 30 patients were randomized to Group M and 29 patients were randomized to Group L. We conducted statistical analysis using a modified intention-to-treat approach. The mean ± SD for performance time (in minutes) was 11.9 ± 3.8 in Group M and 9.4 ± 4.1 in Group L with a difference between means (95% CI) of 2.4 (0.3 to 4.5) ( P < 0.05). The median (interquartile range) needling time of Group M was 9.5 minutes (5-16) vs. 7 (4-19) in Group L ( P = 0.035). Among patients, 40%, 26.67%, 33.3% in Group M had grade 3, 2, 1 performer difficulty whereas 10.3%, 37.9%, 51.7% in Group L had grade 3, 2, 1 performer difficulty, respectively ( P = 0.032). The mean performance time was 9.95 minutes in patients with body mass index (BMI) 25 ( P = 0.0243). Our study revealed that the medial approach has no significant advantage over the lateral approach with regards to performance time, imaging time, needling time, and performer difficulty. Both performance time and performer difficulty increase with BMI and depth of the cords, with a larger difference in the medial approach.

Mental health issues and the association of mental health literacy among adolescents in urban Ethiopia.

Epidemiological evidence about the prevalence of adolescent mental health issues and their association with mental health literacy is crucial for sustained mental health promotion strategies. Adolescence is a critical life stage for mental health promotion. However, evidence is not available among Ethiopian school adolescents. Hence, the present study examined the prevalence of adolescents' mental health issues and their correlation with mental health literacy. A cross-sectional study was conducted among adolescents (grades 5-12) in Dire Dawa city, Eastern Ethiopia using multistage random sampling. Data was collected using the Strength and Difficulty Questionnaire, WHO-5 well-being index, and mental health literacy questionnaire. SPSS version 25 was used for the descriptive, Chi-square, binary logistic regression, and correlation analyses. Between 14.0-24.5% of adolescents had reported mental health problems: internalizing problems (14.9-28.8%), emotional problems (10.4-25.5%), and peer relationship problems (17.8-25.5%). These mental health problems were significantly greater among adolescents who had either themselves or their family members used psychoactive substances (p≤0.05). Females from upper elementary (5-8 grade) and lower secondary (9-10) grade levels had a higher prevalence of mental health problems (AOR: 2.60 (0.95-7.10, p<0.05)). The effect of age, parental education, or employment status was insignificant (p>0.05). The prevalence of depression ranged from 18.0-25.5%. Mental health literacy was negatively correlated with total difficulties scores and positively associated with mental well-being scores (p<0.05). The prevalence of adolescents' mental health problems was higher. It implied that promoting mental health literacy could enhance adolescents' positive mental health. Intervention programs should prioritize vulnerable groups and individuals reporting symptoms of mental health difficulties. Future studies should involve qualitative studies and consider effect of other determinants.

Path analysis of digitally empowered mental health services for university students

Abstract We investigate the viability of using data mining technologies to identify college students’ mental health issues in light of the rising number of these issues. To address the limitations of the traditional Apriori algorithm in data mining of mental health problems, an improved Apriori algorithm is proposed using the classification rule mining method. The relationship between various factors and the mental health problems of college students is better explored by this algorithm. Ultimately, the mental health care pathway that was developed during the exploration was used to conduct a comparative trial between those who received mental health services and those who did not. The experimental group’s mean score in the hyperactive concentration inability dimension was 3.25 after getting mental health care for three weeks, which was 22.6% higher than the control group’s mean score. The aspects of emotional symptoms, pro-social conduct, and total difficulty score also showed significant variations (p&lt;0.05). The mean scores of the experimental group in the pro-social behavior and emotional symptoms dimension in the course of the study and the pre-experiment were 2.17 and 0.57, accordingly, which both demonstrated highly significant differences (p&lt;0.01) in the between-group comparison of the differences in scores at different evaluation times with the control group.

Use of Preoperative Lumbosacral Spine X-rays in Developing a Predictor Score for Facilitating Neuraxial Blocks in Patients undergoing Lower Limb Arthroplasty Surgeries: A Cross-sectional Study

Introduction: Due to bony changes and narrow lumbar interspinous spaces, performing a neuraxial block becomes difficult in older patients undergoing lower limb arthroplasties. Aim: To formulate a difficulty predictor score (MUSG score) for anticipating difficult Central Neuraxial Blocks (CNB) and to compare lumbar spine radiological findings with clinical findings. Materials and Methods: A cross-sectional study was conducted on 166 patients admitted for knee or hip arthroplasties from March 2023 to March 2024 in the main operation theatre complex of a tertiary care hospital. All patients were advised to get X-rays of the lumbosacral spine in both anteroposterior and lateral views before surgery. The total difficulty predictor score was calculated from the X-rays based on the presence or absence of scoliosis, bony osteophytes, angulation of spinous processes, calcification of the ligamentum flavum, and the ratio of inner and outer visible interspinous space. The minimum score was 5 and the maximum was 12. The individual score at each interspinous level was calculated and selected the space with the minimum score for the CNB. A comparison was also made with the clinically selected best space, which was identified using the traditional palpation technique. A block was labeled difficult if there were more than two attempts for spinal and epidural block, respectively. All collected data were entered into a Microsoft Excel sheet and analysed using Microsoft Excel software. Results: The study patients had a mean age of 59.83 years. The total difficulty predictor score (MUSG Score) of the lumbar spine was 5 in 3 patients (1.8%), 6-9 in 140 patients (84.3%), and ≥10 in 23 patients (13.9%). However, the minimum score at the best interspinous space was 5 in 15 patients (9%), 6-9 in 151 patients (91%), and none had a score of 10 or more. From radiological imaging, the spaces with minimal scores were in the order of L2-L3 (76), L3-L4 (62), and L1-L2 (28); while on clinical examination, they were – L2-L3 (96), L3-L4 (43), L1-L2 (23). The difference between the two was statistically significant (p-value &lt;0.05). The time required for the block procedure was longer in patients with a score of 6-9 (13.99 minutes) than in those with a score of 5 (11.13 minutes). Haemodynamic changes from baseline were also more pronounced in patients with a score of 6-9 compared to those with a score of 5. Conclusion: CNBs in patients undergoing hip and knee arthroplasties are easier to perform with the help of the difficulty predictor score (MUSG Score). A difficulty predictor score of 5 is associated with an easier block compared to higher scores.

Socio-Emotional Development Among Adolescents Raised in Families With or Without Grandparents in Dharan, Nepal: A Comparative Study

Introduction: Socio-emotional development can be defined by convergence of social and emotional growth. Adolescence, transitional phase of growth and development between childhood and adulthood. Grandparents are often highly involved as secondary caregivers for their grandchildren and may influence children’s psychological and physical health outcomes. Materials and Methods: A comparative cross- sessional study was conducted in a Dharan 17 and samples were selected using the purposive sampling method. A total of 156 adolescents (78 in each group) with an age range of 15 to 17 years were interviewed using the self- rated version of Strength and Difficulty Questionnaire (SDQ) .Data was analyzed using SPSS version 11.6. Questions were in the Likert scale 0 (not true), 1 (somewhat true) and 2 (certainly true). Descriptive statistics were used to describe socio-demographic data. Pearson Chi-square test was used to compare the socio-emotional development among adolescents raised in families with or without grandparents and to find out the association between dependent and independent variables. Results: Pearson chi-square depicts significant difference in socio-emotional development raised in families with or without grandparents in Dharan 17 (p- value&lt;0.05).There was significant association of socio-development with Ethinicity, Per capita income and Occupational status of fathers. By observing the mean values of total difficulties SDQ score, mean for adolescents raised in families with grandparents was 1.33 and for adolescents raised in families without grandparents was 1.56 from which it is concluded that adolescents raised in families without grandparents had more difficulties in compare to adolescents raised in families with grandparents. Conclusion: In this study the findings revealed that adolescents raised in families with grandparents had better socio-emotional development as compare to the adolescents raised in families without grandparents.

Use of electronic media and its association with teenager’s behavior: an analytical cross-sectional study in community clinics of Karachi

OBJECTIVE: To estimate the proportion of electronic media usage among teenagers and identify the association between behavior and the use of electronic media. METHODOLOGY: An analytical cross-sectional study conducted from December 2021 to February 2022. A sample of teenagers (n=340) were selected from primary care clinics of Chanesar Goth and Hijrat Colony, Karachi. Participants were questioned regarding their daily usage of media. Strengths and Difficulties Questionnaire was administered to assess the behavior. Data was analyzed using SPSS 23. RESULTS: A total of 350 teenagers were enrolled in the study, and the distribution of gender was almost equal. Daily usage of media included Television(88.9%), videogames(47.4%), computer/laptop(79%), mobile phone(90.3%) and tablet(20.9%). The content viewed were movies (68.9%), Facebook (72%) and Chats/WhatsApp (76.6%). The mean of total difficulty score in our study population was 19.1 (SD: 4.8). On multivariate analysis, higher difficulty score was positively associated with increasing age (Beta: 0.428, 95% Cis: 0.070 -0.785, p-value:0.019) and total screen time (Beta: 0.003, 95% Cis: 0.001 -0.005, p-value: 0.036) while difficulty score was negatively associated with male gender (Beta: -1.223, 95% Cis: -2.441 -- -0.005, p-value: 0.049). CONCLUSION: Our population's media exposure and difficulty scores are higher than other populations. Media exposure needs to be reduced to control psychosocial problems. KEYWORDS: Electronic media, Behavior, Teenagers, Association, Adolescents, Media usage.

Problematic Smartphone Use and Mental Health Problems: A Network Analysis of Romanian Adolescents

The aim of this study was to assess the pattern of mutual relations within the Problematic Smartphone Use (PSU) (first network) and between adolescent mental health problems and PSU (second network). The invariance of both networks was investigated across age, gender, and severity of symptoms. The participants were 708 Romanian adolescents ( Mage = 16). Analyses were performed in RStudio. The results indicated that the most central node in the PSU network was a preoccupation symptom. The strongest bridge path laid between a reckless symptom and PSU. The networks were invariant with respect to the gender of the adolescents but were different—both in structure and strength—between the adolescents with low vs. high total difficulties. Furthermore, the networks were significantly different in terms of structure between middle and late adolescents. These findings are further discussed.

Screen Time and Socioemotional and Behavioural Difficulties Among Indigenous Children in Canada: Temps d'écran et difficultés socio-émotionnelles et comportementales chez les enfants autochtones du Canada.

To describe screen time levels and determine their association with socioemotional and behavioural difficulties among preschool-aged First Nations, Métis, and Inuit children. Data were taken from the Aboriginal Children's Survey, a nationally representative survey of 2-5-year-old Indigenous children in Canada. Socioemotional and behavioural difficulties were defined using parent/guardian reports on the Strengths and Difficulties Questionnaire. Multiple linear regression analyses were conducted separately for First Nations, Métis, and Inuit participants, and statistically adjusted for child age, child sex, and parent/guardian education. Statistical significance was set at P < 0.002 to adjust for multiple comparisons. Of these 2-5-year-old children (mean [M] = 3.57 years) 3,085 were First Nations (53.5%), 2,430 Métis (39.2%), and 990 Inuit (7.3%). Screen time exposure was high among First Nations (M = 2 h and 58 min/day, standard deviation [SD] = 1.89), Métis (M = 2 h and 50 min [SD = 1.83]), and Inuit children (M = 3 h and 25 min [SD = 2.20]), with 79.7% exceeding recommended guidelines (>1 h/day). After adjusting for confounders, screen time was associated with more socioemotional and behavioural difficulties among First Nations (total difficulties β = 0.15 [95% CI, 0.12 to 0.19]) and Métis (β = 0.16 [95% CI, 0.12 to 0.20]) but not Inuit children (β = 0.12 [95% CI, 0.01 to 0.23]). Screen time exposure is high among Indigenous children in Canada, and is associated with more socioemotional and behavioural difficulties among First Nations and Métis children. Contributing factors could include enduring colonialism that resulted in family dissolution, lack of positive parental role models, and disproportionate socioeconomic disadvantage. Predictors of poor well-being should continue to be identified to develop targets for intervention to optimize the health and development of Indigenous children.

Family structure, socioeconomic status, and mental health in childhood

The changing landscape of family structures over the last decades has led to a growing need to investigate its impact on children's well-being. This study examined differences in mental health among children from different family compositions and how these differences may be affected by familial socioeconomic status (SES). Data were collected within the LIFE Child study. Participants included 2828 children aged 3–17 years raised in traditional families, stepfamilies, or single-parent families. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ (behavioral strengths and difficulties)) and the KIDSCREEN-27 questionnaire (quality of life). Linear regression analyses were applied to examine associations between family structure, SES, and mental health outcomes. Children from single-parent families exhibited worse mental health outcomes than those from traditional families across all domains of the SDQ and the KIDSCREEN-27. Children from stepfamilies showed significantly higher Total Difficulties scores (B = 1.29 and 1.42), with 3- to 10-year-olds displaying higher scores in the Hyperactivity & Inattention (B = 0.61) and Peer Relationship Problems (B = 0.36) subscales, and 11- to 17-year-olds showing higher Conduct Problems (B = 0.31), Emotional Symptoms (B = 0.58), and a worse Parent Relationship scores (B = − 1.82) than children from traditional families (all p < 0.05). After controlling for SES, several associations between family structure and mental health lost significance, while others persisted, particularly among older children. To promote mental health in non-traditional families, interventions should address socioeconomic disparities while also investigating factors contributing to the direct impact of family structure on mental well-being.Trial registration The LIFE Child study is registered on clinicaltrials.gov (No. NCT02550236).

Urban green spaces and behavioral and cognitive development in children: A health impact assessment of the Barcelona “Eixos Verds” Plan (Green Axis Plan)

BackgroundUrban environments lack natural features, while nature exposure in cities has been associated with health benefits, including children's neurodevelopment. Through extensive street greening, Barcelona's Eixos Verds (Green Axis) Plan enhances safety, environment, and climate resilience. We aimed to assess the Eixos Verds Plan's potential impact on children's behavioral and cognitive development due to the increased green space expected under the Eixos Verds implementation. MethodsWe performed a quantitative health impact assessment for Barcelona children at census-tract level (n = 1068). We assessed the Eixos Verds Plan's impact by comparing baseline green space distribution with the proposed plan, translating it into percentage green area (%GA) and Normalized Difference Vegetation Index (NDVI). By combining these exposure metrics with child-specific risk estimates and population data, we estimated potential improvements in children's behavioral and cognitive development due to full Eixos Verds implementation. ResultsWith the full Eixos Verds implementation, citywide, %GA increased by 6.9% (IQR: 6.4%; range: 0–23.1%) and NDVI by 0.065 (IQR: 0.083; range: 0.000–0.194). Child behavioral and cognitive development outcomes are expected to improve compared to the baseline. Based on NDVI increases, children's Total Difficulties and Hyperactivity/Inattention scores, based on the Strengths and Difficulties Questionnaire (SDQ), are projected to decrease by 5% (95% CI: 0–15%) and 6% (95% CI: 0–17%). Working Memory and Superior Working Memory scores are expected to increase by 4% and 5%, respectively, based on the computerized n-back test, while the Inattentiveness score could be reduced by 1%, based on the computerized attentional test (ANT). InterpretationUrban greening as planning tool can improve behavioral and cognitive development in city children. Methods and results of our study are applicable to many cities worldwide, and similar results for children of real-life urban greening interventions can be expected.

Understanding anxiety experienced by young males with Duchenne muscular dystrophy: a qualitative focus group study

In this multi-methods study we explored the characteristics, causes and impact of anxiety in Duchenne muscular dystrophy (DMD) from the perspective of young males with DMD and their parents. Eight young males with DMD (7–18 years) and 14 parents participated in separate focus groups. Perspectives on anxiety were explored using semi-structured interview schedules. Themes were identified using Framework Analysis. Neurodevelopmental, emotional and behavioural symptom scores were obtained using standard instruments including the Strengths and Difficulties Questionnaire and Revised Children's Anxiety and Depression Scale. We identified six common anxiety characteristics: Catastrophic conclusions; Rigidly-held anxieties; Extreme distress; Social anxieties; Physical changes/needs; Unexpected/unfamiliar. Four further themes described influential systemic factors: Individual, Family, and Social responses and Physical environment and service contexts. All DMD participants had significantly higher total difficulties, emotional problems and impact scores than population norms. The Revised Children's Anxiety and Depression Scale showed low sensitivity in identifying anxiety symptoms. Fifty-seven percent (8/14) of parents who had wanted help for their son's anxiety were dissatisfied with the available support. In conclusion, anxiety can severely impact wellbeing and functioning of individuals with DMD. There are important nuances to consider when managing DMD-associated anxiety. We highlight the importance of multimodal assessment considering the multiple contexts within which anxiety arises.

Alexithymia in Adult Autism Clinic Service-Users: Relationships with Sensory Processing Differences and Mental Health.

Mental health difficulties commonly co-occur with autism, especially in autistic people accessing clinic services, impacting substantially on quality-of-life. Alexithymia (difficulty describing/identifying feelings) and sensory processing differences are prevalent traits in autism that have been associated with depression/anxiety in autistic community samples. However, it is important to better understand interrelationships between these traits in clinical populations to improve identification of service-user needs. In this study, 190 autistic adults (65.3% male), seen in a tertiary autism clinic, completed self-report measures of alexithymia (20-item Toronto Alexithymia Scale), sensory processing differences (Adolescent/Adult Sensory Profile) and depression/anxiety (Hospital Anxiety and Depression Scale). Multiple linear regression models and mediation analyses were used to examine associations between alexithymia, sensory processing differences, and depression/anxiety severity. Across the sample, 66.3% of individuals (N = 126) were classified as alexithymic (score ≥ 61). Total alexithymia and difficulty describing/identifying feelings were significantly associated with depression severity (β = 0.30-0.38, highest p < 0.002), and difficulty identifying feelings was significantly associated with anxiety severity (β = 0.36, p < 0.001). Sensory processing differences were also significantly associated with depression severity (β = 0.29, p = 0.002) and anxiety severity across all models (β = 0.34-0.48, highest p < 0.001) Finally, difficulty describing/identifying feelings partially mediated the relationships between sensory processing differences and both depression/anxiety severity. Overall, these results highlight that interventions adapted for and targeting emotional awareness and sensory-related uncertainty may improve mental health outcomes in autistic service-users.

Is it time to revise the SDQ? The psychometric evaluation of the Strengths and Difficulties Questionnaire.

Despite the wide use of the Strengths and Difficulties Questionnaire (SDQ) to assess adolescent mental health, its psychometric functionality is still under debate. This study investigated the structural validity and reliability of the SDQ scores, and the resemblance of the SDQ sum scores and factor scores. Factor one-dimensionality and competing multifactor structures were tested against data. With the best acceptable models, measurement invariance was tested between genders and over time. Subscale reliability and correspondence between subscale sum scores and factor scores were estimated. The nationally representative self-report data from 23,980 Finnish early (12-13 years) and mid- (15-16 years) adolescents (50.4% girls) were collected from two cohorts in 2008 and 2013. The results showed that among early adolescents, the revised SDQ with a controlled method effect had an excellent fit. In contrast, none of the tested models had an acceptable fit among the mid-adolescents. Among early adolescents, strong measurement invariance was achieved between genders and over time. Three of the five subscales were one-dimensional, and all subscales had low reliability. The resemblance between the subscale sum scores and factor scores was alarmingly low. Researchers should be cautious when using the SDQ Total Difficulties sum score or the subscale scores as they may be substantially biased, and practitioners should desist from using the SDQ as a screening tool in its current form. This study strongly supports the revision of the SDQ. In line with the previous findings, we suggest rewording the worst functioning items and revising the reverse-worded difficulties items. (PsycInfo Database Record (c) 2023 APA, all rights reserved).