Search Results (6,836)

Child and adolescent mental health (CAMH) is a global concern that is increasingly recognized and prioritized. Worldwide, mental health conditions affect a significant number of children and adolescents; however, access to CAMH services remains limited. This study sought to explore the implementation of child and adolescent mental health services in the rural Chris Hani District of the Eastern Cape province, South Africa, from the perspectives of health professionals and teachers, focusing on strengths, weaknesses, opportunities, and threats. Using a qualitative approach, a sample of 36 participants (12 health professionals and 24 teachers) was purposively recruited. Data were collected through face-to-face, semi-structured individual interviews and focus group discussions. Thematic analysis identified several strengths, including effective screening and identification of CAMH problems, training in psychiatry and psychology, teacher support, collaboration with stakeholders, and the availability of policy and guidelines. Key weaknesses included inadequate CAMH training, a limited CAMH workforce, personal barriers, guidelines primarily oriented toward physical health, and insufficient basic infrastructure. Opportunities for improvement include enhancing the skills of the existing workforce, increasing engagement in extramural activities, and empowering parents with knowledge of available CAMH services. Identified threats included the normalization of CAMH symptoms, challenges involving parents and feeder schools, stigma, poor stakeholder collaboration, and inadequate guidelines. Overall, the analysis of strengths, weaknesses, opportunities, and threats reflects the broader challenges present in low-resource settings that hinder the implementation of CAMH services. It also highlights the need for integrative approaches to implementing CAMH services in rural contexts, while identifying opportunities to improve service delivery. Full article

Background: Adolescence is a critical developmental period for emotional health, and anxiety disorders are a major public health concern. Adherence to the Mediterranean diet has been associated with improved mental health outcomes in adults; however, evidence in adolescents remains limited. Methods: We analyzed data from 86 adolescents participating in the KLOTHO birth cohort. Dietary quality was assessed using the KIDMED index, whereas maternal adherence to the Mediterranean diet during pregnancy was evaluated using a Mediterranean diet score. Psychological outcomes included behavioral difficulties (Strengths and Difficulties Questionnaire), anxiety symptoms (Spence Children’s Anxiety Scale), and mood-related outcomes (Mood and Feelings Questionnaire). Associations were examined using Spearman’s correlation analyses and multivariate linear regression models adjusted for sex, body mass index (BMI), sleep duration, and physical activity. Results: Higher adherence to the Mediterranean diet in adolescents was inversely associated with anxiety levels in correlation analyses (ρ = −0.294, p = 0.029). However, after adjustment for sex, body mass index, sleep duration, and physical activity, the association with total anxiety score was attenuated and no longer statistically significant associated with lower anxiety levels in correlation analyses (ρ = −0.294, p = 0.029). In adjusted models, the KIDMED score was not associated with total anxiety score but was independently associated with lower scores in specific anxiety domains, including social phobia and separation anxiety. Maternal adherence to the Mediterranean diet was associated with lower overall anxiety in offspring but not with specific anxiety subdomains. Conclusions: Adherence to the Mediterranean diet during adolescence is modestly associated with lower levels of specific anxiety symptoms, suggesting a modest domain-specific association between dietary patterns and emotional health. Full article

Introduction: Advances in pediatric oncology have transformed cancer into a condition with chronic and long-term developmental consequences. While survival rates have improved significantly, the literature on psychosocial outcomes remains fragmented and inconsistent, with a notable lack of person-centered analyses that account for the heterogeneity of adaptive trajectories. Current evidence fails to explain why survivors with similar clinical profiles exhibit divergent psychological phenotypes, particularly regarding the late effects of multimodal treatments. The aim of this study was to identify heterogeneous psychosocial profiles among adolescent cancer survivors and to examine their associations with treatment complexity and quality of life. Materials and Methods: This cross-sectional study included 165 adolescents aged 12–18 years (mean age: 14.64 years) who were in clinical remission following oncological treatment. Standardized assessment tools were used: the Children’s Depression Inventory 2 (CDI-2™) to measure depressive symptoms, the KIDSCREEN-10 index to assess health-related quality of life (HRQoL), and a scale evaluating satisfaction across 14 life domains. Adaptive profiles were identified using a Two-Stage Cluster Procedure, and risk factors were examined using multinomial logistic regression. Results: Four clusters were identified in the study population: a depressive–dysphoric profile, an anhedonic-withdrawn profile, a highly adaptive profile, and a mixed (struggling) profile. Treatment complexity was identified as a significant independent predictor of membership in the high-distress (depressive) cluster. While each additional therapeutic modality beyond standard chemotherapy was associated with a markedly increased risk (OR = 8.91; p < 0.001), the relatively wide confidence interval (95% CI: 3.27–24.31) suggests that the exact magnitude of this effect should be interpreted with caution. The high lower bound of the interval (3.27), however, strongly supports the directional association of cumulative iatrogenic burden with psychological adaptation. Subjective quality of life functioned as a protective factor against depressive symptoms (OR = 0.57); however, paradoxically, higher self-reported quality of life increased the likelihood of classification into the anhedonic group (OR = 1.81). This divergence between high self-reported HRQoL and social withdrawal potentially suggests a ‘well-being paradox’. It is hypothesized that standard HRQoL instruments may primarily capture physical remission and relief from acute somatic symptoms, potentially masking underlying social–emotional deficits. This suggests that HRQoL scores in survivors should be interpreted with caution and complemented by specific affective screenings. Conclusions: The absence of a uniform pattern of psychological response to cancer among adolescent survivors supports the validity of a patient-centered approach. The burden associated with intensive multimodal treatment significantly increases the likelihood of full-syndrome depression during adolescence. Moreover, the identification of a cluster suggestive of anhedonic and socially withdrawn features highlights the limitations of standard screening tools focused solely on the detection of overt sadness. This heterogeneity underscores the need for personalized psycho-oncological care and the implementation of intensified monitoring for patients at high medical risk. Full article

Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. Methods: A cross-sectional survey was conducted among ALHIV (N = 251) aged 10–19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. Results: Most participants were aged 15–19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14–3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. Conclusions: Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents’ confidence in managing treatment. Full article

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes. Full article

Background: Inter-arm blood pressure difference (IAD) ≥ 10 mmHg is an established marker of cardiovascular risk in adults; however, evidence in paediatric populations remains limited. Handgrip strength (HGS) is increasingly recognized as a simple and reliable indicator of neuromuscular fitness and cardiometabolic health during growth and development. Objectives: We aimed to investigate the association between IAD and HGS in children and adolescent athletes and to explore the influence of anthropometric characteristics. Methods: Forty-one non-professional athletes aged 6–16 years participated in this cross-sectional study. Anthropometric characteristics, bilateral resting BP, and bilateral HGS were assessed using standardized protocols. Inter-arm differences in systolic and diastolic BP were calculated. Results: An inter-arm systolic BP difference ≥ 10 mmHg was observed in 12.2% of participants. Dominant-arm systolic BP and HGS were significantly higher compared with the non-dominant side (p < 0.05). HGS showed a positive association with systolic BP, particularly in boys, whereas weaker associations were observed with diastolic BP. In regression analysis, BMI emerged as a significant predictor of systolic blood pressure. Conclusions: In young athletes, dominant-arm superiority in both muscular strength and systolic BP was evident. Bilateral BP assessment combined with HGS measurement may provide information during cardiovascular evaluation paediatric athletic populations. Full article

This pilot clinical trial evaluated the feasibility and changes following the BeBuddies, which is a school-based program designed to promote mental health Literacy (MHL) among adolescents, based on MHL being a key protective factor for well-being in adolescence. Twenty-eight adolescents (57% girls; Mage = 16.46) were randomly assigned to either an intervention (n = 14) or a control group (n = 14). Participants were asked both qualitatively and quantitatively about their perception of acceptability, usability and satisfaction regarding each intervention session; they were also asked to fill in self-report questionnaires at pre-intervention, post-intervention, and follow-up. Program satisfaction and acceptability were consistently high, highlighting its potential to bind participants due to its experiential and dynamic nature. About changes over time, preliminary findings suggest that the BeBuddies yielded improvements primarily in symptom recognition and problem-solving, with more favorable change patterns in the intervention group. A slight reduction in stigma was also observed in the intervention group, in contrast with a small increase in the control group. These results are consistent with the existing literature and point to the feasibility and potential benefits of structured, school-based interventions focused on promoting MHL programs in adolescence. Full article

Over the past two decades, the concept of physical literacy (PL) has gained increasing attention across research and policy domains. Grounded in holistic and embodied theoretical frameworks, PL encompasses physical, affective, cognitive, and social dimensions that underpin lifelong engagement in movement. Global policy frameworks, including the World Health Organization’s Global Action Plan on Physical Activity (2018–2030) and UNESCO’s Guidelines for Quality Physical Education, highlight PL as a foundation for health and wellbeing. Despite this recognition, research examining the associations among PL, physical activity (PA), and mental health in Mediterranean contexts remains scarce. This study examined the interrelationships among perceived PL, PA, and MH in a sample of 542 Cypriot children and adolescents aged 6–18 years. Participants completed the Perceived Physical Literacy Instrument (PPLI), the Physical Activity Questionnaire for Older Children (PAQ-C), and the Depression, Anxiety, and Stress Scale (DASS-21). Structural Equation Modelling (SEM) was used to test direct and indirect effects, and multi-group analyses explored measurement and structural invariance across gender and age. Results indicated that higher perceived PL was associated with better MH, both directly and indirectly through increased PA. Boys and younger participants reported higher PA levels, whereas adolescents displayed higher symptoms of depression, anxiety, and stress. However, the structural relationships among PL, PA, and mental health were consistent across genders. The findings highlight the role of PL as a multidimensional determinant of youth wellbeing and underscore the importance of promoting physical literacy aligned behaviours from early childhood within educational and community settings. Full article

Objectives: This study aimed to investigate the impact of the food environment surrounding schools on nutritional status and body mass index (BMI) of children and adolescents, offering insights for developing evidence-based policies to promote healthier school surroundings. Methods: Based on 357,782 physical examination records from 140,578 children and adolescents aged 6 to 19 in the Shenzhen Student Health Surveillance System for the 2018–2025 academic years, this study employed latent class mixed models to analyze BMI Z-score trajectory changes among children and adolescents. Furthermore, multinomial logistic regression and logistic regression models were utilized to examine the association between the number of catering points of interest (POIs) near schools, including total number, fast-food restaurants, pastry shops, and beverage stores, and the nutritional status and BMI trajectories of children and adolescents, respectively. Data from Huairou District, Beijing, was used to verify the applicability of the findings in Northern China. Results: 20.71% of children and adolescents in Shenzhen were overweight or obese, and 44.70% were consistently overweight from 2018 to 2025. The increase in catering POIs around schools was significantly associated with nutritional status and overweight trajectory, with pastry shops having a particularly pronounced effect. Each interquartile range (IQR) change in pastry shop was associated with 4.25% (95% CI: 2.96%, 5.56%) increase in the odds of overweight compared with the normal nutritional group, and with 5.03% (95% CI: 3.62%, 6.45%) increase in the odds of the overweight trajectory compared with the normal weight trajectory. Moreover, schools in above-median GDP regions required more attention. A similar association between the number of catering POIs near schools and long-term overweight among children and adolescents was observed in Huairou District, Beijing. Conclusions: The food environment surrounding schools might play a contributory role in shaping the BMI trajectories of children and adolescents. The study emphasized the importance of focusing on the food environment near schools, providing insights for weight management interventions among children and adolescents as well as healthy urban planning. Full article

Background: Adolescence is a critical period for emotional well-being, and individuals with gluten-related disorders (GRDs) may face additional psychological challenges. This study aims to explore the relationship between emotional well-being and GRDs in adolescents. Methods: A cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviours, and associated determinants, collected in secondary education centres. The final analytical sample consisted of 9265 students aged 12 to 18 years. Data were collected from October 2021 to June 2022. The dependent variables relate to emotional well-being and are assessed through a series of mood-related questions. The independent variables included were having GRDs, health behaviours and socioeconomic factors. Poisson regression models with robust variance were used to assess the association between the impact of GRDs and emotional states, providing prevalence ratios with 95% confidence intervals. Results: Prevalence of adolescents with GRD was 1.15%, with a higher rate in girls (1.51%) compared to boys (0.79%) (p < 0.001). While there were no significant emotional differences between adolescents with and without GRDs overall (p > 0.05), Poisson regression models with robust variance showed that those with digestive symptoms had a significantly higher prevalence of emotional distress, most notably in feeling sad or depressed (PR = 2.52; 95% CI: 1.64–3.88) and fatigue (PR = 1.90; 95% CI: 1.51–2.38). Conclusions: The presence of digestive symptoms in adolescents with self-reported GRDs is associated with a higher prevalence of emotional distress. Public health strategies should specifically target this symptomatic subgroup to address their psychological and nutritional needs. Full article

Non-suicidal self-injury (NSSI) is a major concern in adolescent mental health, yet the psychometric properties of the Inventory of Statements About Self-Injury (ISAS) have not previously been examined in a Greek adolescent inpatient sample. This preliminary study evaluated the internal consistency, factorial structure, and construct validity evidence of the ISAS in 95 Greek adolescents receiving inpatient psychiatric care (mean age = 14.69 years, SD = 1.30; 86.3% female). Data were obtained retrospectively from clinical records. Psychometric evaluation included Cronbach’s alpha coefficients, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlations with the Youth Self-Report (YSR). The ISAS showed satisfactory internal consistency at the higher-order factor level, with alpha coefficients of 0.82 for the interpersonal factor and 0.85 for the intrapersonal factor, although Autonomy and Interpersonal Boundaries showed weak reliability. EFA supported a broad two-factor intrapersonal–interpersonal structure. CFA findings were exploratory and mixed. The original CFA models showed inadequate fit, whereas exploratory modified and post hoc sensitivity models showed improved but non-definitive fit. Convergent validity evidence was modest and was supported by associations between the original broad ISAS intrapersonal score and YSR self-harm behavior, suicidal ideation, internalizing-related dimensions, and Total Problems. Discriminant-pattern evidence was limited. Overall, the findings provide preliminary support for the clinical usefulness of the ISAS as an adjunctive assessment tool in this population, but they do not constitute definitive validation. Further prospective validation in larger, more diverse, and independent samples is needed. Full article

Driven by the Confucian cultural ideal of “wang zi cheng long”—the fervent hope that one’s child will rise like a dragon (i.e., achieve extraordinary success)—Chinese parents commonly engage in intensive academic involvement, such as frequent homework checking. However, the mechanisms through which this high-intensity monitoring affects adolescent mental health, and whether its effects are culturally specific, remain underexplored. Drawing upon the stimulus–organism–response (SOR) theory and the stress process model, this study used data from the 2022 China Family Panel Studies (CFPS) on 1831 adolescents aged 9–15 to examine the impact of parental homework checking frequency on adolescent loneliness, the mediating role of academic pressure, and the moderating role of parental educational expectations. The results show that parental homework checking frequency was positively associated with academic pressure, which in turn was positively associated with loneliness. The mediating role of academic pressure was significant. Parental educational expectations significantly and negatively moderated the relationship between homework checking and academic pressure, and the moderated mediation was significant. Simple slope analysis indicated that the positive association between homework checking and academic pressure was stronger. In the Confucian cultural context that emphasizes academic achievement and filial responsibility, frequent parental homework checking is associated with adolescent loneliness through increased academic pressure. Unexpectedly, high parental expectations served as a buffer—a pattern that differs from typical findings in Western individualistic cultures, where high expectations often directly increase psychological distress. These findings suggest that interventions in Chinese family education should distinguish controlling from supportive monitoring and transform high expectations into emotional support and resource investment, thereby reducing adolescents’ academic pressure and loneliness. Full article

Background: Childhood high blood pressure (HBP) represents a significant risk for long-term cardiovascular health. However, the role of body mass index (BMI) trajectories from birth in shaping early-life blood pressure (BP) remains poorly understood. Methods: Data derived from a prospective birth cohort comprising 886 children (433 boys), followed from maternal pregnancy to a mean age of 9.11 years (SD = 0.71), were analyzed. Group-based trajectory modeling (GBTM) was used to identify distinct childhood BMI trajectories. Binomial regression models were applied to examine the associations among maternal pre-pregnancy overweight, childhood BMI trajectories, and the risk of HBP. Mediation analysis was used to examine the potential modulating role of BMI trajectories in the association between maternal pre-pregnancy overweight and childhood HBP. Results: Five distinct BMI trajectories were identified. Children in the “persistent overweight” (RR = 2.52, 95% CI: 1.50–4.26, p < 0.001) and “persistent obesity” (RR = 3.34, 95% CI: 1.76–6.36, p < 0.001) trajectories demonstrated significantly increased risks of HBP (The “stable normal weight” group, RR = 1). Mediation analysis revealed that BMI trajectories were associated with the linkage between maternal pre-pregnancy overweight and offspring HBP, with an indirect effect size of 0.029 (95% CI: 0.017–0.040), accounting for 34.9% of the total effect (p < 0.05). Furthermore, among children exposed to maternal pre-pregnancy overweight, those in the persistent overweight (RR = 3.35, 95% CI: 1.57–7.12, p < 0.001) and persistent obesity (RR = 4.02, 95% CI: 1.60–10.08, p < 0.001) trajectories exhibited particularly strong associations with HBP. Conclusions: Maternal pre-pregnancy overweight was linked to the elevated risk of childhood HBP, and childhood BMI trajectories may be associated with the linkage. Full article

Background/Objectives: Structured transition care models for adolescents with congenital heart disease (CHD) are increasingly advocated, but methodological evidence to support the design of adequately powered randomized trials remains limited. This pilot randomized study was designed primarily to assess the feasibility of repeated patient-reported outcome (PRO) collection and to generate empirical parameters for planning a future confirmatory trial, rather than to formally evaluate intervention efficacy. Methods: This was a single-center, parallel-group, pilot randomized controlled trial conducted at Meyer Children’s Hospital, Florence, Italy, within the TELEMACO project (NCT05713591). Twenty-three adolescents with CHD were randomized 1:1 to a structured transition care intervention (n = 11) or usual care (n = 12). PROs, including the SF-12 Physical (PCS12) and Mental (MCS12) Component Summaries, health engagement, life satisfaction, and healthcare needs, were collected at baseline and at 3, 6, 9, and 12 months. Pre-specified exploratory analyses addressed retention, missingness, linear mixed-effects models, intraclass correlation coefficients (ICCs), and sample size scenarios. Results: Retention at 12 months was 63.6% (intervention) and 58.3% (control), with substantially lower completion rates at intermediate assessments (T2–T3: 27–50%), directly affecting the reliability of longitudinal estimates at those time points. Mixed-effects models showed no significant time-by-group interaction for PCS12 (p = 0.13) or MCS12 (p = 0.39); unadjusted contrasts suggested nominally higher PCS12 values in the intervention group at selected assessments. ICCs were approximately 0 for PCS12 and 0.56 for MCS12, indicating fundamentally different variance structures. Conclusions: Repeated PRO collection was feasible, though retention across intermediate assessments was inconsistent. The pilot generated empirically grounded estimates for the design of a future confirmatory trial. Sample-size scenarios were highly sensitive to uncertainty in the PCS12 variability estimate, ranging from approximately 25 to 115 analyzable participants per group, depending on the true standard deviation. Within this pilot dataset, PCS12 at 12 months, analyzed cross-sectionally with baseline adjustment, emerged as a provisional endpoint option requiring further evaluation in an adequately powered confirmatory trial. Full article

Background: Adults closest to children, including parents and caregivers, teachers, and therapists, are major determinants of child mental health outcomes. However, access to high-quality psychological training for these groups remains severely limited and inequitable. Artificial intelligence (AI) tools may offer a scalable, accessible, and low-cost route to training delivery. This review aimed to provide the first systematic synthesis of evidence on AI tools used to train caregivers, educators, and therapists/practitioners in psychological approaches relevant to child and adolescent mental health. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261336167). Five databases, MEDLINE, PsycINFO, Embase, Web of Science, and ERIC, were searched from inception to March 2026, supplemented by reference hand-searching and forward citation tracking. Studies were eligible if they evaluated an AI-based training tool used with adults in caregiving, educational, or therapeutic roles involving children or adolescents aged 0–18 years, delivered a defined psychological approach, and reported at least one training outcome. Owing to substantial methodological and outcome heterogeneity, findings were synthesised narratively, and meta-analysis was not undertaken. Results: Twenty-four studies from nine countries, published between 2019 and 2026, met inclusion criteria. Studies were grouped into caregiver training (Group A, 5 papers), educator training (Group B, 3 papers), and therapist/practitioner training (Group C, 16 papers). Identified AI modalities included natural language processing (NLP)-based chatbots, generative AI/large language model (LLM) systems, AI-integrated virtual reality (VR), and AI-based feedback and analysis tools. Feasibility and acceptability findings were generally positive across groups. However, the evidence base was limited by pervasive methodological weaknesses, including small samples, with most studies enrolling fewer than 30 participants, reliance on unvalidated self-report outcomes, and the absence of follow-up data beyond one month. Conclusions: AI tools show early promise as scalable approaches to psychological training, particularly for procedural skill acquisition and enhancement of practitioner self-efficacy. However, the current evidence base is insufficient to support claims of effectiveness. A structural credibility–accessibility paradox characterises the field: tools with the strongest controlled evidence are the least scalable, while the most accessible tools have the weakest empirical support. Adequately powered, independent randomised controlled trials (RCTs) using validated outcomes, active comparators, and follow-up extending over multiple months are needed across all three population groups. Full article