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To assess the effectiveness of the ‘Weet wat je eet’ (‘Know what you eat’) school-based nutrition education programme on behavioural determinants and behaviour among students aged 12–15 years. A quasi-experimental study design was used, collecting data at baseline and after implementing the programme in both an intervention and control group (in total 611 students) across the Netherlands. Students from eighteen Dutch secondary education schools completed two consecutive questionnaires, assessing knowledge, self-efficacy, attitude, subjective norm, intention, and behaviours related to healthy, safe, and sustainable nutrition. Multilevel regression analyses were conducted corrected for gender, grade, education level, and school location. The intervention group showed a significant higher increase in self-efficacy, attitude, intention to drink water (all three P < 0.01), and a significant higher decrease in the consumption of sugary drinks, snacks, and meat (all P < 0.05) than the control group. Both the groups scored significantly higher on knowledge during the post-test (both P < 0.05), although the intervention group not significantly higher than the control group (P = 0.14). No significant effects were observed for subjective norm, intention, and fruit, vegetable, and whole grain bread consumption. The results of this study showed positive effects of the ‘Weet wat je eet’ school-based nutrition education programme on self-efficacy and attitude towards healthy, safe and sustainable nutrition, intention to drink more water, and various healthy eating behaviours among secondary school students. Further research is necessary to assess the long-term sustainability of these results.
A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations.
Aims:
The current study’s aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents.
Method:
The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors.
Results:
Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η2p=0.047, p=0.005), Impaired Autonomy and Performance (η2p=0.074, p<0.001), and Impaired Limits (η2p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η2p=0.046, p=0.005) and Excessive Responsibility and Standards (η2p=0.054, p=0.002).
Conclusions:
Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.
At a time of increased demand for specialist mental health services, a more nuanced understanding of how adolescents navigate systems of care and support is essential. We mapped ‘networks of care’ to explore patterns of mental health help-seeking alongside the perceived helpfulness of support accessed.
Methods
We examined data from 23 927 adolescents aged 11–18 years who participated in the 2023 OxWell Student Survey, an English school-based, repeated cross-sectional survey of mental health and wellbeing. Students self-reported past-year access to 18 types of support across informal (e.g. friends and family), semi-formal (e.g. school and charities), and formal (e.g. health and social care) domains, alongside how helpful they found the support. We used a network approach to explore interconnections between sources of support accessed and perceived helpfulness.
Results
One in four (27.0%, 6449/23927) adolescents reported past-year access to mental health support, of which 56.7% (3658/6449) reported accessing multiple types. Informal networks were the most commonly accessed (23.1%, 5523/23927), followed by semi-formal (9.7%, 2317/23927) and formal (6.8%, 1623/23927) supports. Informal sources had high acceptability, with around 80–90% reporting them as helpful, whereas child and adolescent mental health services (CAMHS), helplines, and online supports were perceived to be the least helpful. The networks also identified groups who might not be optimally served by current systems, including gender diverse adolescents and adolescents who found mental health support from their parents unhelpful.
Conclusions
Adolescents are accessing mental health support across informal, semi-formal, and formal sources of care. Services can no longer be developed, delivered, or evaluated in isolation from these networks.
In adolescence, an important challenge for parents is to keep track of their adolescents’ behaviors and to create conditions in which adolescents disclose relevant information about themselves. According to Self-Determination Theory (SDT), dynamics of autonomy play a central role in both the effectiveness of parental monitoring and adolescents’ willingness to disclose toward parents. This chapter provides a review of SDT-based studies on parental monitoring and adolescent disclosure. This research begins to show that, whereas autonomy-supportive communication increases the potential benefits associated with parental monitoring, controlling communication of monitoring is rather counterproductive. Further, adolescents disclose more often toward parents and do so more willingly when parents are perceived as autonomy supportive (rather than controlling). In conversations about unfamiliar topics, adolescents additionally benefit from parental support for competence (i.e. guidance). Studies also highlight adolescents’ agency in the dynamics of monitoring and disclosure. Implications for practice and directions for future research are discussed.
Adolescents’ ability to access health care depends on sharing accurate information about concerns, needs, and conditions. Parents and other adults serve as both resources and gatekeepers in adolescents’ ability to access and manage care. Understanding information sharing between adolescents and parents, adolescents and providers, and parents and providers is thus critical. This chapter distinguishes between adolescents’ routine and self-disclosure of information. The former refers to sharing information required for the partner to perform their role. The latter refers to voluntarily sharing more information than required. Because the roles of parent and provider are distinct relative to the adolescent, disclosure decisions can conflict. These differences are discussed in the context of communication privacy management theory and the literature on legitimacy of authority. A framework for understanding information sharing processes is developed that considers stage of care, type of care, stigma/privacy associated with the condition, and the age of the adolescent.
This chapter focuses on adolescents’ use of strategies to conceal information about their whereabouts, behaviors, and activities from parents. The chapter describes the concealing strategies assessed by researchers, adolescents’ relative use of strategies, and adolescents’ reasons for concealing information from parents. Concealment strategies range from partial disclosure to secrecy to lying. Most adolescents use partial and passive concealment strategies (e.g. omitting details) more often than active concealment strategies (e.g. lying). Adolescents conceal activities they believe to be personal and to avoid punishment. The chapter also summarizes research on potential implications of concealment for both the parent–adolescent relationship and the adolescent’s adjustment. Research evidence links the use of concealing strategies with poorer quality parent–adolescent relationships and with poorer behavioral and psychological adjustment. Recommended future directions include integrating research on concealment with the literatures on self-disclosure, lying, and secrecy outside the parent–child relationship, and further tests of the hypothesized benefits of concealment.
Although lying is frequently associated with problem behaviors, recent research also suggests that lying to parents is part of a normative developmental process that serves important functions for the growth and maintenance of adolescent autonomy and reflects complex and mature moral reasoning. This chapter examines adolescent lie-telling as an information management strategy and a form of everyday resistance that adolescents engage in as they strive for autonomy and increased independence in their relationships with parents. Connections between adolescent lie-telling and the development of their autonomy and moral evaluations are considered in detail. The chapter examines adolescent lying as a concealment strategy and situates lying among other information management techniques discussed in this volume. Literature on the developmental trajectory of lying is discussed, with an eye toward the changing alchemy of the adolescent–-parent relationship as children enter and move through adolescence.
This chapter profiles a description of the paths that shaped research on parental monitoring and adolescents’ information management. As these areas developed, accounts of the interplay between parents’ attempts to regulate their adolescents’ behavior and adolescents’ responses grew in breadth and in detail. In this chapter, we introduce readers to the constructs and frameworks that have come to represent monitoring and information management research, including related topics that have been probed in diverse attempts to better understand parenting and adolescents’ behaviors. We track developments in the field from the initial challenges to research on parental monitoring, to the rapid shift emphasizing adolescents’ information management and challenging assumptions about monitoring specifically and parental control more generally. Finally, we not how these broad examinations of monitoring and parental control have led to theory development and offer suggestions for continuing these efforts.
There is strong evidence for a general psychopathology dimension which captures covariance among all forms of psychopathology, yet its nature and underlying association with personality remain unclear. This study examined the co-development of general psychopathology and four high-risk personality traits: anxiety sensitivity, negative thinking, sensation seeking, and impulsivity. Data from two large Australian school-based randomised controlled trials of substance use prevention programs were analysed (N = 2,083, mean age at baseline = 13.49 years). Adolescents completed self-report measures of psychopathology symptoms and personality at baseline, one-, two-, and three-years post-baseline. Latent curve models with structured residuals, were used to examine the co-development of general psychopathology (extracted from a higher-order model) and personality traits from 13 to 16 years of age, controlling for age, sex, and cohort. Higher than usual levels of anxiety sensitivity and impulsivity were associated with higher than usual levels of general psychopathology at subsequent time points, and higher than usual levels of general psychopathology were associated with higher than usual levels of negative thinking at later time points. Sensation seeking was unrelated to general psychopathology. These findings enhance our understanding of the meaning and validity of general psychopathology, highlighting potential personality-based prevention and intervention targets.
Neglect remains understudied compared to other forms of maltreatment. While studies have shown that neglect has negative effects on mental health in adolescence, yet unresolved is whether these impacts result from critical period or cumulative effects. In the present article, we use a novel approach to compare these two hypotheses from the impact of two types of neglect, failure to provide (FTP) and lack of supervision (LOS), on adolescent depression and internalizing symptoms. Data derive from the LONGSCAN consortium, a diverse, multi-site, prospective study of children from approximately age 2–16. Despite our hypothesis that the critical period of early childhood would have the greatest impact on adolescent internalizing mental health, exposure to neglect during the critical period of adolescence (ages 12–16) was the best-fitting model for the effects of FTP neglect on depression, and the effects of LOS neglect on both depression and internalizing symptoms. The cumulative model (exposure across all time periods) best explained the effects of FTP neglect on internalizing symptoms. Results were robust to the addition of control variables, including other forms of maltreatment. These findings demonstrate that responding to neglect into adolescence must be considered as urgent for child welfare systems.
Although childhood maltreatment is associated with externalizing symptoms, not all individuals with these experiences develop externalizing behaviors and some exhibit positive adjustment. To address this multifinality, we used latent growth curve modeling to identify trajectories of (a) externalizing symptoms and (b) subjective wellbeing from late adolescence through young adulthood, determine whether types of childhood maltreatment and domains of executive functioning (EF) are associated with initial levels and growth (slopes) of externalizing symptoms or subjective wellbeing, and investigate whether EF moderates these relations. Participants were youth recruited at ages 10–12 (N = 775; 69% male, 31% female; 76% White, 21% Black/African American, 3% multiracial). We examined EF at ages 10–12, childhood maltreatment reported retrospectively at age 25, and externalizing symptoms and subjective wellbeing at multiple points between ages 16 and 28. Experience of childhood maltreatment and certain EF domains were associated with externalizing symptoms and subjective wellbeing at age 16. EF domains were associated with rate of change in externalizing problems, though not in expected directions. EF variables moderated the relation between maltreatment and initial levels of both outcomes and change in externalizing symptoms. Findings have implications for intervention efforts to mitigate externalizing problems and bolster positive adjustment.
Let us start with Sartre, whose creative appropriation of Being and Time’s phenomenology of death came to prominence first – in 1946’s Being and Nothingness – and probably remains the most widely known in its own right. If Sartre’s vision of existential death is rarely recognized as his alternative to Heidegger’s account, that is both because what Being and Time means by death is not widely understood and because Sartre’s alternative represents the furthest departure from Heidegger’s own view. In general, Sartre’s adoption of a subject/object dualism leads him to pervasively re-Cartesianize Being and Time, as if he were completely oblivious to Heidegger’s overarching efforts to undermine Cartesian dualism. (This obliviousness is already clear from Sartre’s oft-quoted but nonetheless false claim that the “existentialism” he shares with Heidegger can be defined by their shared insistence “that subjectivity must be the starting point.”) Sartre’s phenomenology of the objectifying “look of the other” transforms Heidegger’s phenomenology of existential death so dramatically that Sartre can easily appear to be describing a different phenomenon altogether. Read carefully, however, it becomes clear that Sartre’s account of the “the look” allows him to articulate his own version of an existential phenomenon in which I experience “the death of my possibilities” – even though “I am my possibilities” – and yet I live through that experience to tell the tale phenomenologically.
Despite the added value of multisystem (relative to traditional single-system) approaches for characterizing biological processes linked to risk for psychopathology (e.g., neuroendocrine stress responsivity; Buss et al., 2019; Quas et al., 2014), no study to date has evaluated whether multisystem processes may serve as viable biological targets of intervention. Utilizing a multiple-levels-of-analysis approach (Cicchetti & Dawson, 2002), this person-centered study examined whether stress-adapted patterns of hypothalamus–pituitary–adrenal (HPA) axis and sympathetic-adrenomedullary (SAM) system co-activation were amenable to change following the Building a Strong Identity and Coping Skills intervention (BaSICS; Wadsworth et al., 2022). Preadolescents exposed to concentrated poverty (n = 112, Mage = 11.78 years, 57.1% female, 54% assigned to intervention; 40% Hispanic, 63% Black, 20% White) completed questionnaires and the Trier Social Stress Test at both pre- and posttest. Multitrajectory modeling of cortisol and alpha-amylase levels identified four pretest and posttest HPA-SAM co-activation profiles. At pretest, youth exhibiting Asymmetric Nos. 1 & 2 HPA-SAM co-activation reported greater maladjustment relative to youth with Symmetric Nos. 1 & 2 co-activation. Youth exhibiting Asymmetric No. 1 co-activation at pretest were more likely to exhibit Symmetric No. 1 co-activation following BaSICS relative to control. Findings highlight the potential of BaSICS to restore neuroendocrine stress response function in impoverished youth, pointing to HPA–SAM co-activation as a potential biological target of preventive intervention in this population.
Childhood sexual abuse (CSA) and emotional maltreatment are salient risk factors for the development of major depressive disorder (MDD) in women. However, the type- and timing-specific effects of emotional maltreatment experienced during adolescence on future depressive symptomatology in women with CSA have not been explored. The goal of this study was to fill this gap.
Methods
In total, 203 women (ages 20–32) with current depressive symptoms and CSA (MDD/CSA), remitted depressive symptoms and CSA (rMDD/CSA), and current depressive symptoms without CSA (MDD/no CSA) were recruited from the community and completed self-report measures. Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II) and a detailed maltreatment history was collected using the Maltreatment and Abuse Chronology of Exposure (MACE). Differences in maltreatment exposure characteristics, including multiplicity and severity of maltreatment, as well as the chronologies of emotional maltreatment subtypes were compared among groups. A random forest machine-learning algorithm was utilized to assess the impact of exposure to emotional maltreatment subtypes at specific ages on current depressive symptoms.
Results
MDD/CSA women reported greater prevalence and severity of emotional maltreatment relative to rMDD/CSA and MDD/no CSA women [F(2,196) = 9.33, p < 0.001], specifically from ages 12 to 18. The strongest predictor of current depressive symptoms was parental verbal abuse at age 18 for both MDD/CSA women (variable importance [VI] = 1.08, p = 0.006) and MDD/no CSA women (VI = 0.68, p = 0.004).
Conclusions
Targeting emotional maltreatment during late adolescence might prove beneficial for future intervention efforts for MDD following CSA.
A large increase in the rate of hospitalizations for adolescents and children with anorexia nervosa (AN) was observed during the coronavirus disease (COVID-19) pandemic. It is still not clear whether this was a temporary effect or whether the increased admission rates persist.
Methods
Data were retrieved from the largest health insurance in Germany comprising 2.5 million children between 9 and 19 y. All patients of this age group with a discharge diagnosis of typical (AN) and atypical AN (AAN) according to the International Classification of Diseases, Tenth Revision (ICD-10), were included. Admission rates per 10,000 person-years were computed separately by sex, age and type of AN for entire years from 2019 to 2022 and the first half of 2023 in relation to the entire number of insured persons of the same sex and age per year.
Results
Two years after the final lockdown admission rates were still significantly higher in adolescent and childhood AN than in the pre-COVID-19 time. While admission rates declined for adolescents in 2023, those for children remained high, with an increase for girls of more than 40% compared with the rate before the pandemic (1.42 (CI 1.26, 1.60); p < 0.0001). The highest admission risk for AAN relative to the pre-COVID-19 period was observed in adolescents in the first half of 2023 (1.6; CI 1.34; 1.90; p < 0.0001).
Conclusions
Children appear to be especially vulnerable to the pandemic-associated disruptions. Clinicians should try to determine the ongoing effects of the pandemic and support early detection and treatment of AN to prevent its often lifelong consequences.
We have previously demonstrated that calcium plus vitamin D supplementation during adolescent pregnancy reduces the magnitude of transient postpartum bone mass loss. In the present post hoc analysis, we further investigated the effect of calcium plus vitamin D supplementation during pregnancy in hip geometry throughout one year postpartum in Brazilian adolescents with low daily calcium intake (∼600 mg/d). Pregnant adolescents (14–19 years) were randomly assigned to receive calcium (600 mg/d) plus vitamin D3 (200 μg/d) or a placebo from 26 weeks of gestation until parturition. Dual-energy X-ray absorptiometry images were obtained at 5 (n 30 and 26 for calcium plus vitamin D and placebo, respectively), 20 (n 26 and 21) and 56 (n 18 and 12) weeks postpartum, and hip geometry parameters were analysed by Advanced Hip Assessment software. The effects of the intervention, time point and their interaction were assessed using repeated-measures mixed-effects models. No significant intervention effects or intervention × time interactions were observed on hip geometry parameters (P > 0·05). Time effects were observed in cross-sectional area, cross-sectional moment of inertia and section modulus parameters with decreases from the 5th to the 20th week postpartum followed by recovery from the 20th to the 56th week (P < 0·05). Our findings indicate that the postpartum period is associated with transient changes in the hip geometry of lactating adolescent mothers, regardless of the low calcium intake and the supplementation offered during pregnancy, suggesting that a physiological adaptation of these adolescents to low calcium intake is at play.
This study aimed to assess feasibility, acceptability and potential for impact of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA), a co-designed intervention for pregnant adolescents in Malawi. We used a mixed-methods interventional pre-post cohort design. We recruited pregnant adolescents from a rural health centre in Zomba district, Malawi, all of whom were offered a five-session psychosocial intervention delivered by community healthcare workers. Quantitative feasibility indicators related to participant enrolment, session attendance and intervention completion. Feasibility of intervention delivery was explored using in-depth semi-structured interviews with healthcare workers. Acceptability was investigated through in-depth semi-structured interviews with intervention participants and a service user satisfaction questionnaire. Intervention outcomes were assessed using standardised measures of common mental disorders, financial distress and poor mental health and perceived social support. 19 adolescents aged 15–19 years (mean=17.21, SD=1.18) started the intervention, with 18 (94.7%) completing the programme. Significant improvements (p<0.05) were reported across all outcome measures, with moderate to high pre-post effect sizes. Intervention participants reported high levels of service satisfaction, although healthcare workers (n = 6) reported that some feasibility challenges emerged during recruitment and delivery. The FOR MAMA intervention proved to be an acceptable and feasible psychosocial intervention for pregnant adolescents in Malawi.
Early life adversity (ELA) and youth chronic health conditions have been examined as separate contributors to psychopathology. However, little work has specifically examined early life health adversity (ELHA) and its association with risk for internalizing disorders. This study seeks to examine the relationship between ELHA and internalizing disorders across adolescence. A sample of 705 Australian mother–youth dyads participated in a prospective longitudinal study. Mothers reported child health indicators at youth ages three-to-four days, six months, and five years and completed a psychiatric interview at 15 years. Youth completed a psychiatric interview, as well as measures of current health status, at age 20. ELHA was positively associated with both youth anxiety and depressive disorders from ages 15 to 20. When independently accounting for the role of (a) current health status and (b) exposure to traditionally conceptualized forms of ELA, these findings remained statistically significant for anxiety but not depressive disorders. ELHA interacted with maternal depression, such that ELHA was only associated with youth depressive disorders in cases where mothers themselves had experienced depression. Routine mental health screenings may be warranted for youth who experience ELHA and their mothers. Pediatric primary care may be an ideal setting for implementing prevention and intervention efforts.
This study applies a comprehensive bioecological perspective to address a significant gap in the childhood adversity literature by employing latent profile analysis to examine the impact of diverse combinations of early childhood adversities and protective factors on adolescent psychosocial and behavioral outcomes. Drawing from the United Kingdom’s Millennium Cohort Study (N = 19,444), we identified eight unique profiles of early childhood adversity and protective factors. These profiles provide a nuanced understanding of adversity combinations and allow for differentiation between groups with similar profiles. Latent profile membership was a significant predictor of all adolescent outcome variables, indicating that profiles differed significantly from one another on psychosocial and behavioral outcomes (Wald values ranged from 10.10–623.22; p < .001). Some findings support the cumulative risk model, indicating that exposure to multiple early adversities increases the likelihood of adverse outcomes. However, we also found that specific adversities, such as parental psychopathology, parental alcohol use, and neighborhood deprivation, uniquely impact adolescent outcomes. This study highlights the necessity for tailored interventions and policies to support children with distinct early life experiences, emphasizing the importance of addressing both cumulative and specific adversities at multiple levels to prevent psychosocial and behavioral problems in adolescence.
Suicide and suicidal behaviour strongly contribute to overall male youth mortality. An understanding of worldwide data contextualises suicide and suicidal behaviour in young men within any given country.
Method:
Members and colleagues of the World Federation of Societies of Biological Psychiatry’s Task Force on Men’s Mental Health review the relevant data from several regions of the world. The review identifies notable findings across regions of relevance to researchers, policymakers, and clinicians.
Results:
Male suicide and suicidal behaviour in adolescence and emerging adulthood within North America, Latin America and the Caribbean, Europe, the Mediterranean and the Middle East, Continental Africa, South Asia, East Asia, China, and Oceania share similarities as well as significant points of divergence.
Conclusions:
International data provide an opportunity to obtain a superior understanding of suicide and suicidal behaviour amongst young men.