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Children
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Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition
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Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Mental Health".

Deadline for manuscript submissions: closed (1 December 2024) | Viewed by 21174

Special Issue Editor

Prof. Dr. Oana A. David

E-Mail Website
Guest Editor
Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University Cluj-Napoca, Cluj-Napoca 400015, Romania
Interests: cognitive behavioral therapy; digital mental health promotion; clinical psychology; psychopathology; parenting; cognitive science; psychometrics; psychotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is currently global concern regarding the mental and emotional health of youths. Emotional disorders that have an early onset come with high lifetime persistence as well as immense personal and societal consequences.

The aim of this Special Issue is to stimulate urgently needed research on the mechanisms and innovative interventions for addressing "Depression, Anxiety and Stress in Children and Adolescents". We welcome original research studies (e.g., experimental, randomized controlled trials, mixed methods) and meta-analyses on the topic. It is encouraged that the focus of the research be to either validate innovative assessment systems for youth stress, anxiety and depression; investigate understudied mechanisms and risk factors connected to current world changes and stressors for such conditions; or to evaluate accessible (e.g., digital) interventions aiming to prevent or reduce depression, anxiety and stress in children and adolescents.

We look forward to receiving your contributions.

Prof. Dr. Oana A. David
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • depression
  • anxiety
  • stress
  • children and adolescents
  • digital interventions
  • emotion regulation

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Published Papers (10 papers)

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15 pages, 472 KiB  
Article
An Attachment-Based Family Therapy for Anxiety and Depression in Children: A Mixed-Methods Evaluation of BEST-Foundations
by Kim Lee Kho, Andrew J. Lewis and Renita A. Almeida
Children 2024, 11(12), 1552; https://doi.org/10.3390/children11121552 - 20 Dec 2024
Viewed by 303
Abstract
Background/Objectives: Parent–child attachment and family relationships have been identified as risk factors for childhood internalising symptoms such as anxiety and depressive symptoms. This mixed-methods evaluation examined the feasibility of a recently developed attachment-based family intervention, Behaviour Exchange Systems Therapy-Foundations (BEST-F), delivering 16 h [...] Read more.
Background/Objectives: Parent–child attachment and family relationships have been identified as risk factors for childhood internalising symptoms such as anxiety and depressive symptoms. This mixed-methods evaluation examined the feasibility of a recently developed attachment-based family intervention, Behaviour Exchange Systems Therapy-Foundations (BEST-F), delivering 16 h of therapy over 8 weeks to treat internalising symptoms in children aged between 3 and 11 years. Methods: The quantitative outcomes of this uncontrolled study of 17 families were based on the parent-reported Child Behaviour Checklist (CBCL) measure, completed at four-timepoints (baseline, pre-, post-intervention, and follow-up), while qualitative data were collected from interviews with participants at follow-up. Results: Pre- and post-BEST-F intervention results demonstrated a significant change in internalising symptoms from the borderline and clinical range to the normal range, with a large effect size (d = 0.85). Notably, additional reductions in internalising symptoms were reported two months after cessation of treatment, with a very large effect size (d = 1.85). Furthermore, there were substantial reductions in child externalising symptoms and parental mental health symptoms, with large effect sizes ranging from d = 0.80 to 1.12. Qualitative reports were consistent with these quantitative findings. Conclusions: These pilot results suggest that children presenting with clinical-range internalising symptoms may benefit from family-based approaches where the parent–child relationship is a focus. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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14 pages, 2952 KiB  
Article
Prevalence of Antidepressant Prescription in Adolescents Newly Diagnosed with Depression in Germany
by Nimran Kaur, Corinna Doege and Karel Kostev
Children 2024, 11(10), 1246; https://doi.org/10.3390/children11101246 - 16 Oct 2024
Viewed by 1056
Abstract
Background: Depression is the most common mental illness in the world, found in nearly three in ten adolescents globally. This study aims to evaluate the prevalence of antidepressant prescriptions and the types of antidepressant therapy administered among adolescents diagnosed with depression in Germany. [...] Read more.
Background: Depression is the most common mental illness in the world, found in nearly three in ten adolescents globally. This study aims to evaluate the prevalence of antidepressant prescriptions and the types of antidepressant therapy administered among adolescents diagnosed with depression in Germany. Methods: This retrospective cohort study, based on data provided by 30 child and adolescent psychiatrists, included adolescents aged 13–17 years with an initial diagnosis of depression between 2010 and 2022 (index date) documented in the IQVIATM Disease Analyzer database. Kaplan–Meier curves were used to investigate the one-year cumulative incidence of antidepressant prescriptions stratified by age, sex, and depression severity. Multivariable Cox regression analyses were used to assess the association between age, sex, depression severity, co-diagnoses, and antidepressant drug prescription. Results: A total of 6338 adolescents (mean age: 16 years, 67% female, 59% with moderate depression) were available. The cumulative incidence of antidepressant prescriptions was 61% and increased with age from 13 years old to 17 years old. Fluoxetine was the most prescribed drug, followed by Sertraline, Escitalopram, Serotonin and Norepinephrine reuptake inhibitors, herbal medications, and Mirtazapine. Obsessive–compulsive disorder and eating disorders were found to be significantly associated with antidepressant prescriptions within the spectrum of co-diagnosed conditions. Conclusions: Higher age, depression severity, and a co-diagnosis of an obsessive–compulsive disorder or eating disorder were significantly positively associated with antidepressant prescriptions in adolescents. Fluoxetine was the most frequently prescribed drug for depression. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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14 pages, 307 KiB  
Article
Reliability of an “At-Home” Method for Monitoring Resting and Reactive Autonomic Nervous System Activity in Children: A Pilot Study
by Rachel Venn, Joseph M. Northey, Nenad Naumovski and Andrew McKune
Children 2024, 11(7), 835; https://doi.org/10.3390/children11070835 - 9 Jul 2024
Viewed by 922
Abstract
Background: Heart rate variability (HRV), an index of the functional status of the autonomic nervous system (ANS), provides an opportunity for early detection of ANS dysfunction. Lower resting, vagally related HRV parameters are associated with increased risk of physical and mental illness. External [...] Read more.
Background: Heart rate variability (HRV), an index of the functional status of the autonomic nervous system (ANS), provides an opportunity for early detection of ANS dysfunction. Lower resting, vagally related HRV parameters are associated with increased risk of physical and mental illness. External factors influencing the ANS, such as the testing environment, may impact the interpretation of HRV. This study’s main aim was to determine the reliability of HRV resting and reactivity tests performed at home with children aged 4–9 years. Methods: Fourteen healthy children (female n = 8) aged 6.8 ± 1.5 years participated. Two HRV tests were performed at home via online supervision 7 days apart using a Polar H10 heart rate monitor. The absolute and relative reliability of the pre-exercise resting (5 min) and sub-maximal exercise step test recovery (4 × 30 s segments) HRV time and frequency domains were calculated. Results: The Pearson correlation coefficients for day 1 versus day 7 for the vagal activity HRV domains (RMSSD log) at rest and in the first 30 s and 30–60 s of recovery indicated good-to-excellent relative reliability (r > 0.8, p < 0.01). Absolute reliability was moderate for the resting RMSSD log, with a coefficient of variation (CV) of 5.2% (90% CI: 3.9, 7.8%), high for the first 30 s of standing recovery, with a CV of 10.7% (90% CI: 8.2, 15.7%), and moderate for 30–60 s of recovery, with a CV of 8.7% (90% CI: 6.6, 12.9%). Conclusions: The findings of this pilot study indicate that the resting and exercise recovery HRV measures of vagal activity can be measured reliably at home in children. This represents a novel “at-home” protocol for monitoring ANS health and development in children. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
11 pages, 1259 KiB  
Article
Positive Youth Development, Mental Stress and Life Satisfaction in Middle School and High School Students in Portugal: Outcomes on Stress, Anxiety and Depression
by Marina Carvalho, Cátia Branquinho, Barbara Moraes, Ana Cerqueira, Gina Tomé, Catarina Noronha, Tânia Gaspar, Nuno Rodrigues and Margarida Gaspar de Matos
Children 2024, 11(6), 681; https://doi.org/10.3390/children11060681 - 3 Jun 2024
Cited by 2 | Viewed by 1202
Abstract
The relation between positive youth development and stress, anxiety and depression was studied considering the mediator role of psychological symptoms and life satisfaction. A total of 3109 students included in the “Psychological Health and Well-being” study of the School Observatory participated, including 1618 [...] Read more.
The relation between positive youth development and stress, anxiety and depression was studied considering the mediator role of psychological symptoms and life satisfaction. A total of 3109 students included in the “Psychological Health and Well-being” study of the School Observatory participated, including 1618 females and 1491 males aged between 11 and 18 years old (M = 14.45; SD = 1.88), belonging to different school groups in different regions of the country. Adolescents with higher stress, depression and anxiety levels reported lower levels of competence, confidence and connection, as well as more psychological symptoms and lower life satisfaction. The results also showed that adolescents with higher levels of competence, confidence and connection reported less psychological symptoms and more life satisfaction. Two separate mediation analyses were performed to analyse the role of mental distress and life satisfaction on the relationship between positive youth development indicators and stress, anxiety and depression. These analyses confirmed the predicted relationships and partial mediations between mental distress and life satisfaction. These results should be taken into account in public policies concerning young people’s health and education that should involve both targeted and indicated prevention strategies, including school and community-based interventions, in order to be effective. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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10 pages, 253 KiB  
Article
Cognitive Regulation Strategies Used by Children with Reading Difficulties
by Carmen David, Cristina Costescu, Alina Frandeș and Adrian Roșan
Children 2024, 11(3), 288; https://doi.org/10.3390/children11030288 - 28 Feb 2024
Viewed by 1752
Abstract
(1) Background: Children with reading difficulties may experience negative emotions and social isolation. The cognitive emotion regulation strategies that they use in different reading tasks can make them more vulnerable in the stressful situations. Using adaptative emotion regulation strategies may help them overcome [...] Read more.
(1) Background: Children with reading difficulties may experience negative emotions and social isolation. The cognitive emotion regulation strategies that they use in different reading tasks can make them more vulnerable in the stressful situations. Using adaptative emotion regulation strategies may help them overcome stressful reading situations. (2) Methods: Children identified with poor reading comprehension skills were compared to children without reading comprehension difficulties on measures of self-evaluation and thought in relation to task, and on cognitive coping strategies relevant to performance. The effect of some relevant demographic factors was also investigated, such as gender and urban/rural setting. (3) Results: Our results indicate that children that have poor reading comprehension skills present higher scores on negative self- evaluation and off-task thoughts that are in relation to performance anxiety. Also, in what concerns cognitive coping strategies, students with difficulties in reading comprehension display a greater use of blaming others strategy, which is in relation to the negative self-evaluations. Also, they displayed less use of putting into perspective. No effect of gender and setting emerged for off and on task thoughts and cognitive coping strategies, except for lower scores of students from rural setting in positive self-evaluation. (4) Conclusions: students presenting difficulties in reading comprehension tend to use more negative self-statements and disengagement through off-task thoughts and employ coping strategies directed to protect self-worth. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
11 pages, 375 KiB  
Article
Integrating “Super Skills for Exams” Programme in the School Curriculum to Support Adolescents Preparing for Their National Examinations in Turkey
by Bilge Uzun, Asli Orman and Cecilia A. Essau
Children 2024, 11(2), 180; https://doi.org/10.3390/children11020180 - 1 Feb 2024
Viewed by 1256
Abstract
Examination stress is the most common stressor reported by adolescents across the globe. Exam stress involves mental distress related to anticipated academic challenges or fear of failure in the examinations, test anxiety, or fear of being unable to meet certain expectations of themselves [...] Read more.
Examination stress is the most common stressor reported by adolescents across the globe. Exam stress involves mental distress related to anticipated academic challenges or fear of failure in the examinations, test anxiety, or fear of being unable to meet certain expectations of themselves or others. The aim of this study was to determine the effectiveness of a transdiagnostic resilience program (Super Skills for Exams; SSE), when integrated in the school curriculum and delivered by the school counsellors, in reducing exam stress among adolescents who are preparing for their national examinations. SSE is based on the principles of Cognitive Behaviour Therapy (CBT), behavioural activation, and social skills training, and includes sessions in promoting healthy lifestyles. Participants were 7129 (3661 female and 3468 male) adolescents in grades 7 and 8, from all the 245 secondary schools from Ugur College in seven regions and 31 cities across Turkey. All the participants completed a set of questionnaires to measure self-efficacy for learning and test anxiety, academic stress, emotion regulation, and lifestyles. Results revealed significant reduction in academic stress (i.e., test anxiety, work pressure, self-expectation, and despondency) and maladaptive emotion regulation strategies, and significant increase in self-efficacy and adaptive regulation strategies following the intervention. Adolescents who participated in SSE reported an increase in the consumption of healthy food. This study provides preliminary empirical support for the integration of SSE within the school curriculum for helping adolescents cope with exam stress as they prepare for their national exams. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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13 pages, 663 KiB  
Article
Supportive Relationships Mitigate the Effect of Cumulative Exposure to Adverse Childhood Experiences on Depression, Anxiety, Stress, and Suicide Considerations—The Arizona Youth Risk Behavior Survey
by Bin C. Suh, M. Shayne Gallaway and Martin F. Celaya
Children 2024, 11(2), 161; https://doi.org/10.3390/children11020161 - 26 Jan 2024
Cited by 1 | Viewed by 2337
Abstract
Declining adolescent mental health is a significant public health concern during the COVID-19 pandemic. Social distancing and stay-at-home orders have led to missed social connections with peers and adults outside households, and this has increased the risk of mental health problems in children [...] Read more.
Declining adolescent mental health is a significant public health concern during the COVID-19 pandemic. Social distancing and stay-at-home orders have led to missed social connections with peers and adults outside households, and this has increased the risk of mental health problems in children and adolescents, particularly those with adverse childhood experiences (ACEs). Studies have shown that strong interpersonal support improves adolescent mental health. We examined the association between ACEs and poor mental health (including stress, anxiety, and depression) and how the presence of interpersonal support from caring adults and friends and school connectedness can mitigate this relationship among adolescents in Arizona. This study analyzed data from the 2021 Arizona Youth Risk Behavior Survey (YRBS; n = 1181), a population-based survey conducted biennially across the United States. The Arizona sample included high school students in grades 9–12 who were enrolled in public and charter schools. This study revealed that nearly three of four adolescents experienced an ACE, and one of five experienced ≥4 ACEs. Compared with adolescents who experienced zero ACEs, those with ≥4 ACEs experienced less interpersonal support from caring adults, friends, and school and more frequently reported poor mental health and suicidal thoughts. However, adolescents with interpersonal support consistently reported lower rates of mental health issues, even with exposure to multiple ACEs. Post-pandemic programs to improve social relationships with adults, peers, and schools are critical, especially for adolescents with multiple adversities. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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12 pages, 1059 KiB  
Article
The REThink Online Therapeutic Game: A Usability Study
by Ioana Alexandra Iuga, Cristina Teodora Tomoiaga and Oana Alexandra David
Children 2023, 10(8), 1276; https://doi.org/10.3390/children10081276 - 25 Jul 2023
Cited by 3 | Viewed by 1653
Abstract
Background: Children and adolescents’ help-seeking behaviors are often limited by fear, uncertainty, and stigma, as well as challenges with finding the right intervention, help, and a lack of familiarity with the process. A promising direction for the development of therapeutic interventions targeted at [...] Read more.
Background: Children and adolescents’ help-seeking behaviors are often limited by fear, uncertainty, and stigma, as well as challenges with finding the right intervention, help, and a lack of familiarity with the process. A promising direction for the development of therapeutic interventions targeted at children is embedding them into gamified interventions, known as therapeutic or serious games. The aim of this paper is to describe the protocol of the beta REThink therapeutic game and to evaluate the usability of the game in a sample of children and adolescents. Methods: The study was delivered in schools, where 137 children and adolescents aged between 9 and 16 years old played the levels of the REThink game, followed by filling in the usability questionnaire. Findings: The results show above average evaluations for all levels of the game, for every dimension evaluated, namely presence/immersion, enjoyment, learning effectiveness, narratives, goal clarity, adequacy of learning material, and motivation. This study contributes to the literature on the usability of cognitive behavioral therapy-based therapeutic games for improvements in the emotion regulation abilities of children and adolescents, which can guide researchers interested in testing the REThink game in different protocols, as well to encourage its use by mental health specialists and parents. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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9 pages, 1489 KiB  
Brief Report
Investigation of the Association between Sleep Disorders with Subsequent Depression in Children and Adolescents—A Retrospective Cohort Study with 62,796 Patients
by Nimran Kaur, Céline Vetter, Marcel Konrad and Karel Kostev
Children 2024, 11(7), 758; https://doi.org/10.3390/children11070758 - 22 Jun 2024
Viewed by 908
Abstract
Background: Poor quality of sleep is a widespread issue in modern society, and even children are being diagnosed with sleep disorders nowadays. Sleep disruption in children can lead to poor mental health in the long term. The present study aimed to evaluate the [...] Read more.
Background: Poor quality of sleep is a widespread issue in modern society, and even children are being diagnosed with sleep disorders nowadays. Sleep disruption in children can lead to poor mental health in the long term. The present study aimed to evaluate the association between sleep disorders and subsequent depression in children and adolescents. Methods: This retrospective cohort study used electronic medical records from the IQVIATM Disease Analyzer database. It included children and adolescents aged 6–16 with an initial diagnosis of a sleep disorder and age- and gender-matched patients without sleep disorders treated by one of 274 office-based pediatricians in Germany between January 2010 and December 2022. The five-year cumulative incidence of depression in the cohorts with and without sleep disorders was studied with Kaplan–Meier curves using the log-rank test. Multivariable Cox regression analyses were used to assess the association between sleep disorders and depression. Results: The present study included 10,466 children and adolescents with and 52,330 without sleep disorder diagnosis (mean age 10 ± 3 years, 48% female). Within five years after the index date, 5% of sleep disorder patients and 2% of the matched non-sleep disorder cohort had been diagnosed with depression. A strong and significant association was observed between sleep disorders and subsequent depression (HR: 2.34; 95% CI: 2.09–2.63). This association was stronger in adolescents (HR: 3.78; 95% CI: 3.13–4.56) than in children. Upon the exclusion of depression diagnoses in the first year after the index date, the association between sleep disorders and depression remained strong and significant (HR: 1.92; 95% CI: 1.68–2.19). Conclusions: This study indicates a strong and significant association between sleep disorders and depression. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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33 pages, 863 KiB  
Systematic Review
Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis
by Evgenia Gkintoni, Elias Kourkoutas, Vasiliki Yotsidi, Pilios Dimitris Stavrou and Dimitra Prinianaki
Children 2024, 11(5), 579; https://doi.org/10.3390/children11050579 - 11 May 2024
Cited by 5 | Viewed by 8657
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, [...] Read more.
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)
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