Child and Adolescent Mental Health最新文献

Ambient voice technology has been proposed as a promising approach to reduce documentation burden in child and adolescent mental health services and neurodevelopmental settings. In response to Dineley and colleagues' discussion of responsible implementation and evidence gaps, this letter argues that ambient voice technology should be evaluated as a care-pathway intervention rather than merely as a note-generation tool. We emphasize the importance of outcome-accountable implementation, including measurement of documentation time, clinician cognitive load, note correction burden, error severity, therapeutic alliance, patient and carer experience, equity, and downstream care decisions. Particular attention is needed in multilingual, family-based, and neurodevelopmental consultations, where multispeaker attribution, atypical speech, and culturally specific expressions of distress may challenge automated systems. Ambient voice technology should protect clinical reasoning, preserve uncertainty, and remain subject to auditable human oversight. Its value in CAMHS should be judged by safety, equity, experience, and meaningful clinical improvement.

There is growing concern that smartphones and social media (S/SM) disrupt adolescent sleep, wellbeing and cognition, yet causal evidence from robust interventions is limited. To assess the acceptability of a total 21-day S/SM detox, we conducted a preregistered (https://osf.io/79zd2) pilot randomised controlled trial with 82 adolescents aged 13-18 years from UK schools. Participants were randomly assigned to a total S/SM detox (N = 26), total S/SM detox with access to a basic 'brick' phone (N = 26) or a business-as-usual control (N = 30). Pre-and post-intervention measures of sleep, wellbeing and cognition were collected using surveys, wearables and cognitive tasks. Retention was high, with 13% attrition across groups. At 21-days, one or both detox groups showed tentative improvements in sleep duration, daytime sleepiness, depressive symptoms, perceived stress and working memory relative to the controls, however, these changes were not maintained at a 2-month follow-up. Open-ended post-detox reflections encompassed a range of both positive and negative experiences, with reported challenges including boredom, functional reliance on smartphones and fear of missing out. Nevertheless, 83% endorsed the need for government action. Digital detoxes appear feasible for generating causal evidence; however, they can also pose functional challenges to young people. Fully powered trials should address these challenges, potentially via more targeted intervention approaches (e.g. switching off the internet on smartphones, particularly at bedtime).

Background: In England, 18% of children and young people (CYP) experience clinical levels of mental health difficulties. CYP who are involved in children's social care, either receiving in-home care (i.e. child protection plans; CPP) or out-of-home care (i.e. children looked after; CLA), may experience higher prevlance than peers. Less is known about actual contacts with mental health services. This study aimed to provide an account of the contacts with mental health services for children with and without CPP and CLA, and reasons for referral.

Methods: Data were extracted from NHS Digital for all CYP in England in contact (e.g. through referral, appointment, support) with mental health services between April 2016 and March 2021, and included sociodemographic information, CPP or CLA status and referral reason.

Results: In total, 1,984,827 CYP were in contact with mental health services. The most common referral reasons were anxiety (13%), 'in crisis' (10%) and depression (7%). Contacts tended to increase each year for all groups. Overall, CPP and CLA were between 2 and 3 times more likely to be in contact with mental health services compared to peers. However, this represented between 9% and 18% of CPP and CLA.

Conclusion: The findings suggest that there are wide discrepancies between mental health needs and contacts with services. CPP and CLA have particularly high levels of unmet need. While these data indicate escalating demand, service contacts have not increased significantly, suggesting an increased threshold for access in a stretched clinical service.

Background: Memory bias, the tendency to retrieve specific memories, is an established phenomenon in adults with depression. However, evidence on the link between depression and memory bias in children is mixed. This systematic review aimed to synthesize current knowledge examining memory bias and depression in children and adolescents.

Methods: Systematic searches were conducted in February 2025 in six databases (MEDLINE, Embase, APA PsycINFO, CINAHL Plus, Child Development & Adolescent Studies, Scopus). Studies measuring memory bias for autobiographical memory, emotional faces, words, and pictures in children and adolescents (≤18 years) with depression were included. Included studies were peer-reviewed and of cross-sectional or longitudinal design. Random effects meta-analyses of study outcomes were performed. The Joanna Briggs Institute Critical Appraisal Tools assessed study quality.

Results: Thirty-six studies, comprising 4293 adolescents (mean age 14.5 ± 1.3 years, age range: 12-17 years; 65% female), were included. Compared with controls, participants with depression exhibited better recall of overgeneral memories (g = 0.86; 95% CI: 0.42, 1.30) and poorer recognition of sad faces (g = -0.43; 95% CI: -0.79, -0.06) and neutral pictures (g = -0.48; 95% CI: -0.93, -0.03). No differences in recognition of happy, fearful, angry, or neutral faces, as well as emotional words or pictures, were observed.

Conclusion: Associations between memory bias and depression in adolescents were observed, but were fewer compared to the more established literature association of memory bias and depression in adults. Increased recall of overgeneral memories may represent an isolated therapeutic target for adolescents with depression.

Background: Mental-health-disorders in children/young adults increased post-pandemic; however, the absence of linkage to COVID-19 registries made direct attribution of psychological sequelae to acute infection challenging.

Methods: Healthcare-claims databases in Singapore were utilised to evaluate rates of new-incident mental-health-disorders in children/young adults aged 6-25 years from January 1st, 2012 to 29th February, 2024. Influence on monthly observed new-incident mental-health-disorders across various pandemic phases was modelled using negative binomial regression, accounting for seasonality and overall increasing trend (year). Separate linkage with the national COVID-19 database allowed construction of contemporaneous SARS-CoV-2-infected/test-negative cohorts. Cox regression, with overlap weights applied, was utilised to estimate risks of new-incident medically-diagnosed mental-health-disorders 31-300 days post-infection versus test-negatives.

Results: Overall, there was no significant increase in risk for any new-incident medically-diagnosed mental-health-disorders (adjusted-hazards-ratio, aHR = 1.01 [95% CI = 0.90-1.12]) amongst SARS-CoV-2-infected children/young adults (N = 456,034) versus test-negatives (N = 482,588); with the sole exception that of stress/anxiety disorders (aHR = 1.20 [95% CI = 1.02-1.40]). Only infections during the pandemic-containment-phase were associated with significantly increased risk of stress/anxiety, but not during the pandemic-resiliency-phase when restrictions were lifted (pandemic-containment: aHR = 1.25 [95% CI = 1.02-1.54]; pandemic-resiliency: aHR = 1.15 [95% CI = 0.89-1.48]). Risk of stress/anxiety was elevated amongst COVID-19 cases with a concurrently-infected adult household contact. A 10% increase in new-incident mental-health-disorders was observed amongst Singaporean children/young adults during the pandemic-containment-phase, but this subsequently normalised in the pandemic-resiliency-phase.

Conclusions: Increase in medically-diagnosed mental-health-disorders amongst Singaporean children/young adults at the height of pandemic restrictions did not persist into endemicity. Increased incidence of medically-diagnosed stress/anxiety post-COVID-19 in children/young adults at the pandemic height may be mediated by initial infection severity and concurrent household infection.

Background: School absence is associated with mental health problems in adolescents, but most studies are cross-sectional. Longitudinal studies where school absence precedes mental health problems are needed to infer whether school absence is associated with later mental health problems. We aimed to investigate the association between school absence among 14- to 15-year-olds and later mental health problems at ages 16-17 in England.

Methods: A retrospective cohort study using an existing linkage between the Millennium Cohort Study (MCS) and the National Pupil Database (NPD), representing 8438 adolescents. We explored different absence thresholds and used logistic regression to examine associations between school absence and later mental health problems.

Results: A threshold of >10% of half-day school sessions missed identified 18% of adolescents who reported mental health problems at follow-up. At this threshold, high school absence was associated with increased odds of later mental health problems after adjusting for covariates (girls = 1.44, 95% CI 1.05-1.98; boys OR = 1.49, 95% CI 1.04-2.13). The strength of associations between absence and later mental health problems increased with longer durations of absence.

Conclusion: We found a longitudinal association between high levels of school absence (>10% of sessions) and later mental health problems in a nationally representative sample of adolescents in England. High levels of school absence can be used as an early marker of increased risk of mental health problems in the general population. School absence may contribute to the development of later mental health problems in adolescents.

In institutional settings, adolescents are often asked to perform identity rather than explore it. Poetry - particularly brief, metaphor-rich forms - can function as a developmental bridge, creating conditions in which identity can be explored gradually, relationally, and on their own terms. This paper reflects on a six-session, school-based poetry curriculum for adolescents at elevated risk for behavioural and emotional concerns, organised around specific poetic forms as narrative tools for adolescent identity formation. We consider how six-word stories, sentence stems, persona-based writing, unsent letters, and group poems shape what can be said and how identity can be held, shared, and revised. In doing so, the paper suggests that poetic forms offer adolescents a safer, more agentic pathway into identity exploration with meaningful implications for school-based mental health practice.

Background: Concerns over self-diagnosis of mental disorders among adolescents have been increasing, but very little empirical research exists to understand what clinicians think about this phenomenon or how it might impact psychological therapy.

Methods: Semi-structured one-to-one interviews were conducted with 16 mental health professionals, exploring their experiences with and attitudes towards self-diagnosis of mental disorders in adolescents. Reflexive thematic analysis was used to analyse the data.

Results: Five themes were generated. The first two focused on factors contributing to the rise in self-diagnosis: (1) Self-diagnosis stems from an inherent need to be understood and (2) Access to diagnostic language has proliferated. The latter three focused on the impact of self-diagnosis on therapy: (3) Self-diagnosis is meaningful therapeutic material; (4) When adolescents feel validated, self-diagnosis often fades over time; and (5) Self-diagnosis becomes a barrier to change when it is inflexible.

Conclusion: The study indicates that, in most cases, clinicians do not consider self-diagnosis as problematic and report it can sometimes help understand the adolescent's concerns. However, our study also supports concerns about harm to the individual when self-diagnosis is inflexible, and how self-diagnosis could be harmful on a population level if it trivialises psychiatric language and suffering. These findings suggest the need for careful management of self-diagnosis in clinical settings and addressing public discourse that promotes self-diagnosis.

Background: Anxiety disorders are highly prevalent in childhood and adolescence, but access to treatment is limited. Internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective treatment to increase accessibility to evidence-based treatment.

Objective: This systematic review and meta-analysis aimed to investigate the efficacy of ICBT for children and adolescents with anxiety disorders and explore moderating effects of control conditions, age, parental involvement, and therapist support on treatment outcomes.

Methods: Systematic searches were conducted in PsycInfo, PubMed, SCOPUS, Embase, and Web of Science to identify randomized controlled trials comparing ICBT with control conditions controlling for the effects of time or nonspecific effects of treatment. Studies should include children and adolescents aged 6-18 years with anxiety disorders.

Results: The searches identified 1241 papers, of which 11 studies met the inclusion criteria. The adjusted pooled effect size estimate for the random-effects meta-analysis demonstrated a medium statistically significant effect in favor of ICBT over control conditions (g = 0.740, 95% CI 0.555-0.925). The overall quality of evidence (GRADE) was rated as low due to risk of bias and inconsistencies in reporting. No significant moderators of treatment effects were identified.

Conclusion: This meta-analysis supports the use of ICBT as a treatment option for children and adolescents with anxiety disorders. Additionally, the results suggest that therapist support format may be a relevant treatment component to explore in future studies. However, all findings must be subjected to additional testing, and more high-quality studies including long-term follow-ups are needed to assess the effects of ICBT and clarify the impact of moderators.

Background: Evidence on the association between paternal smoking and attention-deficit hyperactivity disorder (ADHD) in offspring is inconsistent. We conducted a systematic review and meta-analysis to synthesise the available evidence.

Methods: This meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Pooled odds ratios with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. The heterogeneity among studies was assessed using the I² test. Publication bias and the presence of small study effects were evaluated using funnel plots and Egger's test. Sensitivity and subgroup analyses were also performed.

Results: Twenty observational studies involving over 294,236 study participants from 16 different countries were included. We found that paternal smoking was associated with a 22% increased risk of ADHD in children (RR = 1.22, 95% CI: 1.12, 1.33). Our subgroup analysis revealed that this association was not evident among studies that accounted for maternal smoking (OR = 1.14, 95% CI: 0.98, 1.33), paternal alcohol use (OR = 1.02, 95% CI: 0.79, 1.33) and education (OR = 1.14, 95% CI: 0.98, 1.34).

Conclusion: The observed association between paternal smoking and the increased risk of ADHD in children may be confounded by maternal smoking, paternal education and other shared familial and socioeconomic factors. Future studies should incorporate maternal-paternal comparisons to disentangle the independent and combined effects of parental smoking on ADHD risk in children, while more rigorously controlling for confounding.