Understanding the Perspective of Youths on Undergoing Metabolic Monitoring While on Second-Generation Antipsychotics: Challenges, Insight, and Implications.

Introduction: Prescription of second-generation antipsychotics (SGAs) in youths is rapidly increasing globally, despite the potential for significant adverse effects and long-term health consequences. A known adverse reaction resulting from SGAs is metabolic syndrome (MS). Youths exposed to antipsychotics are at higher risk than adults for adverse drug reactions, including adverse events such as MS (with weight gain as the most significant adverse outcome) and other long-term endocrinological abnormalities. This study aimed to explore the experiences of young patients on factors impacting barriers to metabolic monitoring of SGAs and the strategies to address those barriers thereby providing further guidance on policy and service delivery. Methods: Semi-structured interviews were conducted with patients (youths who were prescribed SGAs) who attended Child and Youth Mental Health Services. The interviews focused on barriers to monitoring and strategies to enhance rates of monitoring that could be customized across study sites. Results: Young patients revealed that none of them had any concerns or objections to receiving anthropometric metabolic measurements. However, they seemed concerned to undergo blood tests as part of the metabolic monitoring process. Specifically, youths cited their fear of the needles as barrier to undergo the required blood tests. Youths have also reported that their dislike to healthy foods and exercise being the most common challenge they face while trying to engage in a healthy lifestyle to manage the SGAs resulted weight gain. Conclusion: Prescribers are recommended to actively engage young patients about the expected SGAs-induced adverse effects, the importance of conducting metabolic monitoring, and how to prevent and minimize the expected adverse effects from the start of initiating SGAs. This could be a vital step toward a successful treatment as the insight of youths into the details of the chosen treatment can play a significant role into treatment adherence and recovery.

The impact of COVID-19 on children and adolescents attending Child and Youth Mental Health Services in Queensland, Australia.

OBJECTIVE: This explorative study aims to provide insight into impacts of the COVID-19 pandemic and associated restrictions, on mental health of children and adolescents treated at Child and Youth Mental Health Services, and their parents. METHOD: The COVID-19 Mental Health Survey was disseminated to parents of children and adolescents under treatment at community Child and Youth Mental Health Services (Brisbane, Australia) between July-November 2020 throughout different stages of COVID-19 related restrictions. Parents of 110 children participated. RESULTS: Most reported child's symptoms were sadness (46%), anxiety (60%), lack of focus (61%), lack of joy in their usual activities (38%) and reduction in sleep (42%). Parental emotions were significantly correlated with their child's emotions. Parent's lack of enjoyment of usual activities had the overall strongest average correlation (0.27) but this was no longer significant once other variables were controlled for. Children who attended school remotely for some of the days had a significantly (p < .05) higher risk of having more reported symptoms. Interestingly, in later stages of the lockdown with further easing of restrictions, symptoms also tended to be more severe. CONCLUSION: Cross-sectional data on children and adolescents in Queensland, Australia with pre-existing mental health issues suggests mental health continued to deteriorate through the pandemic even as restrictions eased. Changes in schooling seem to be an especially important risk factor.

Specialist care of children with complex needs: Insights from comparison of child development and child mental health clinics.

AIM: Paediatricians and child psychiatrists review children with complex comorbidity, noting similarities between tertiary Child Development Service (CDS) and Child and Youth Mental Health Service (CYMHS) cohorts. Mental health comorbidity is common in developmental services. Developmental comorbidity in mental health cohorts is uncharacterised. The study aimed to describe CDS and CYMHS cohorts using measures of child development, mental health, physical health and psychosocial risk. METHODS: A questionnaire was completed by parents of CDS and CYMHS new clients aged 4-11. It included measures of mental health symptoms, child development, physical health, stressful life events, family functioning, parent mental health and socio-economic variables. Sample rates were compared to population norms. CDS and CYMHS cohorts were compared. RESULTS: The study population had elevated rates of psychosocial risk, family dysfunction, physical illness, developmental risk and mental health symptoms. CDS had higher levels of developmental risk and family dysfunction. Most CDS clients (81%) had mental health difficulties. CYMHS clients were older, and had more mental health symptoms, stressful life events and child safety contact; 81% of CYMHS clients demonstrated developmental risk. CDS and CYMHS had similar socio-demographic profiles and parent mental health difficulties, and similarly high rates of physical health problems. CONCLUSIONS: Consideration should be given to mental health screening and support in CDS, and to developmental screening in CYMHS. Both services support at-risk children with complex developmental, mental health and physical co-morbidity necessitating shared approaches to clinical and population health, including care integration, and collaborative cross-disciplinary models of service provision and training, and advocacy.

Practitioners' Perspective on Metabolic Monitoring of Second-Generation Antipsychotics: Existing Gaps in Knowledge, Barriers to Monitoring, and Strategies.

Introduction: Prescription of second-generation antipsychotics (SGAs) in youth is rapidly increasing globally and in Australia. Lack of timely metabolic monitoring for potential adverse effects puts youth at greater risk for lifelong adverse health impact. Metabolic monitoring is recommended as best practice to prevent and/or manage SGA-induced weight gain/metabolic syndrome. The adherence to clinical guidelines remains suboptimal. It is crucial to gauge insight to challenges and strategies from the perspective of prescribers and to recommend strategies in promoting quality use of SGAs and adherence to pharmacovigilance standards. Methods: Psychiatrists participated through semistructured interviews within the community mental health clinics in the Queensland State of Australia. The interviews focused on barriers to monitoring and strategies to enhance rate of monitoring with key focus on practical strategies for future implications in community setting. Results: Ten participants completed the interviews. Barriers were specified such as lack of adequate resources to conduct monitoring, carers' disengagement in their youth's treatments, and patients' refusal to undergo blood tests. Strategies to enhance metabolic monitoring heavily relied on organizational support, provision of training, and education opportunities. Conclusions: Clinical recommendations require mental health providers to facilitate conduction of metabolic monitoring among youth prescribed SGA/s. However, they are not provided with enough support and there are challenges that prevent such care. It is crucial to understand the challenges in managing a complex and vulnerable patient cohort. This research has thrown light on these key aspects of existing gap between best practice standards and clinical practice in youth prescribed SGAs.

Transition to Parenthood: Antenatal Education Promotes Perinatal Mental Health When Collaboratively Delivered by Midwives, Mental Health Peer Workers and Perinatal and Infant Mental Health Professionals.

Transition to Parenthood is a two-session (antenatal and postnatal) module for inclusion in a birth and parenting education course, designed to proactively support perinatal and infant mental health. In this pilot study, 299 mothers and 241 fathers/partners participated in the whole module, with 35 mothers completing pre- and post-program measures of depression, anxiety, stress, and parenting confidence. Statistically significant improvements were found on all four measures with high effect sizes. Participant ratings of learning and satisfaction were high and persisted over time. These results provide support for the usefulness of group-based birth and parenting education that focuses on perinatal and infant mental health, with mental health peer workers co-delivering the program.

Characteristics and treatment outcomes of children and adolescents accessing treatment in Child and Youth Mental Health Services.

AIM: To provide insight into the characteristics and treatment outcomes of children and adolescents accessing outpatient Child and Youth Mental Health Services (CYMHS), and to explore whether outcomes differ by age, sex, and ancestry background. This information can guide how to optimize the treatment delivered at these services. METHODS: An observational retrospective study was performed based on data from 3098 children and adolescents between age 5 and 18 who received treatment at Brisbane, Australia, community CYMHS between 2013-2018. Patient characteristics, service use, and clinician and parent rated Routine Outcome Measures (ROM) were extracted from electronic health records. RESULTS: Anxiety and mood disorders were the most common mental disorders (37% and 19%). In 1315 children and adolescents (42%), two or more disorders were diagnosed, and the far majority (88%) had experienced at least one psychosocial stressor. The ROM scores improved between start and end of treatment with Cohen's d effect sizes of around 0.9. However, ~50% of the children still scored in the clinical range at the end of treatment. Outcomes did not differ over gender and Indigenous status. CONCLUSIONS: Children and adolescents accessing CYMHS have severe and complex mental disorders as reflected by high rates of comorbidity, exposure to adverse circumstances and high symptom scores at the start of treatment. Despite the clinically relevant and substantial improvement, end ROM scores indicated the presence of residual symptoms. As this increases the risk for relapse, services should explore ways to improve treatment to further reduce mental health symptoms.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age. METHODS: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes. RESULTS: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD. CONCLUSIONS: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia.

Perinatal mental illness is a known risk to maternal-infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes "Together in Mind," a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6-week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016-18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post-program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p < .000); Depression, Anxiety and Stress Scale (DASS-21) (d = 0.5; p < .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p < .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p < .000), Ages and Stages Questionnaire: Social-Emotional (6 months) (d = 0.83; p < .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal-infant relationship within the context of complex maternal mental health issues.

Con frecuencia se excluye a las madres perinatales con asuntos de salud mental severos y complejos de programas de apoyo a la crianza, lo cual presenta un riesgo para la relación materno-infantil y el desarrollo saludable del infante. El Centro de Queensland para la Salud Perinatal y la Salud Mental del Infante puso a prueba 'Juntos en la Mente,' un programa perinatal y de salud mental infantil de un día con énfasis en madres con salud mental entre moderada y severa e infantes de menos de 12 meses. La colaborativa intervención la llevaron a cabo 3 servicios públicos de salud mental y de salud infantil a lo largo de 7 lugares de Servicio de Hospital y Salud en Queensland, Australia, durante 2016-18. En el período de 2 años, se trabajó con 24 grupos de 6 semanas de duración y con 84 madres que completaron las medidas cuantitativas de pre- y post- intervención, así como encuestas posteriores al programa para reportar la experiencia de las participantes. Se dieron mejorías estadísticamente significativas en todas las medidas cuantitativas, lo cual muestra un efecto de tamaño entre grande y mediano: La Escala de Resultados de Salud de la Nación (HoNOS) (d = 0.82; p <.001); Escala de Depresión, Ansiedad y Estrés (DASS-21) (d = 0.5; p <.001); Escala Karitane de Confianza en la Crianza (KPCS) (d = 0.63; p <.001); Escala de Afectividad Materna Postnatal (MPAS) (d = 0.49; p<.001), Cuestionario de Edades y Estados: Socio-Emocional (6 meses) (d = 0.83; p <.001). Los resultados sindican intervenciones tempranas colaborativas refuerzan el naciente desarrollo de la relación materno-infantil dentro del contexto de los complejos asuntos de salud maternos.

Les mères périnatales avec des problèmes graves et complexes de santé mentale sont fréquemment exlues de programmes de soutien au parentage posant ainsi un risque à la relation maternelle-nourrisson et au développement sain de l'enfant. Le Centre de Queensland (en Australie) pour la Santé Mentale du Nourrisson a mis en place un programme 'Together in Mind', un programme de santé mentale périnatale et du nourrisson de jour ciblant les mères ayant des maladies mentales modérées à sévères avec des nourrissons de moins de 12 mois. L'intervention collaborative a été offerte par trois services publics de santé et de santé mentale de l'enfant au travers de 7 hôpitaux et sites de service de santé à Queensland en Australie entre 2016 et 2018. Durant cette période de deux ans 24 groupes de durée de 6 mois ont été formés avec 84 mères remplissant des mesures qualitatives pré-intervention et post-intervention et des questionnaires à la fin du programme, relatant l'expérience de la participante. Nous avons trouvé des améliorations statistiquement importantes dans toutes les mesures quantitatives, montrant une taille d'effet de grande à moyenne: Echelle de Résultat de Santé de la Nation (HoNOS) (d = 0,82; p <,001); Echelle de Dépression, Anxiété et Stress (DASS-21) (d = 0,5; p <,001); Echelle Karitane de Confiance de Parentage (KPCS) (d = 0,63; p <,001); Echelle d'Attachement Maternel Postnatal (MPAS) (d = 0,49; p <,001), le Questionnaire Âges et Étapes Socio-Émotionnel (6 mois) (d = 0,83; p <,001). Les résultats indiquent que l'intervention précoce collaborative renforce le développement qui pointe de la relation maternelle-nourrisson dans le contexte de problèmes de santé mentale complexe.

Bereavement is different: A multinational bereavement symptom model validation.

Clinicians need to rule out an appropriate grief reaction when diagnosing major depression. This study identifies symptom differences by bereavement status and validates a symptom model of bereavement. Symptom features from six national cross-sectional epidemiological samples were analyzed and estimates pooled. Crying often, thinking of death, appetite loss, waking up early, trouble sleeping, and depending on others were significantly more likely in the bereaved. Symptoms of thinking of or attempting suicide, feeling one would be better off dead or wanting to die, worthlessness, social conflict, worthlessness with difficulty making decisions, being discouraged, feeling less than others, being troubled, not coping, feeling hopeless, sleeping more, being upset and history of an anxiety disorder were all significantly less likely among the bereaved. Moderate to good model discrimination effect sizes were found. Good model performance was found when narrowly defined complicated bereavement cases were excluded. On the whole the bereaved are more likely to report symptoms consistent with a normal grief reaction. As depression screening becomes the norm in primary care, normal grief that meets Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) symptom criteria for a MDE likely has a high risk of being diagnosed inappropriately as pathological depression.

Poverty over the early life course and young adult cardio-metabolic risk.

OBJECTIVES: There is little known about whether exposure to family poverty at specific periods of the early life course independently contributes to coronary heart disease risk beyond the contribution of concurrent poverty. METHODS: Children were recruited in early pregnancy and additional survey data obtained during the pregnancy and at the 5-, 14- and 30-year follow-ups. Fasting blood samples were also obtained at the 30-year follow-up. Analyses are multinominal logistic regressions stratified by gender and with adjustments for confounding. RESULTS: For male offspring, family poverty at different stages of the early life course was not associated with measures of cardio-metabolic risk. For females early life course, poverty predicted obesity, homeostatic model assessment of insulin resistance (HOMA-IR) and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), as well as concurrent family poverty associated with obesity, HOMA-IR, TC/HDL-C, HDL-C and increased systolic and diastolic blood pressure. CONCLUSIONS: Family poverty in the early life course independently predicts increased levels of cardio-metabolic risk of females. The primary finding, however, is that concurrent poverty is independently and strongly associated with increased cardio-metabolic risk levels in young adulthood.

Illicit drug use by mothers and their daughters in Australia: A comparison of two generations.

BACKGROUND: While recent decades have witnessed an increase in the use of illicit drugs in Australia, the extent to which the types of drugs used has changed over a generation of young women has not been documented. METHODS: Data are from a prospective birth cohort study. Mothers were recruited in early pregnancy (1981-83) and then they and their child were followed up, with mothers interviewed 27 years (2008-2011), and daughters 30 years (2010-14), after the birth. At these most recent interviews both mothers and daughters were administered the Composite International Diagnostic Interview (CIDI III). Comparisons are for mothers and daughters separated by a 25 year period. For this study, we compare levels of lifetime use of a range of illicit drugs and drug use disorders reported by mothers and their daughters (N = 998 mother/daughter pairs) with adjustment for family income, marital status, education and occupation. RESULTS: There has been a generational increase in the use of illicit substances and prevalence of substance use disorders experienced by Australian women. Mothers' use of illicit drugs was generally restricted to cannabis. By contrast the majority of daughters report lifetime use of an illicit drug with cannabis, club drugs and stimulants the most common. Compared to the mothers, daughters used club drugs 50 times, cocaine 19 times and inhalants 20 times more often. Daughters report experiencing 12 times the rate of cocaine use disorders, 9 times the rate of stimulant disorders and 7 times the rate of cannabis use disorders compared to their mothers. CONCLUSIONS: Mothers of the current generation of 30 year old Australian women rarely used illicit drugs and few experienced a drug use disorder. The current generation of young women report commonly using one or more illicit drugs with a substantial minority experiencing a drug use disorder. It is unlikely that the use of illicit drugs by young women in Australia will be reversed in the foreseeable future. Government policies and treatment practices need to be calibrated to the reality of the much greater contact with illicit drugs being exhibited by younger women.

Current pharmacotherapy options for conduct disorders in adolescents and children.

INTRODUCTION: Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD). AREAS COVERED: The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children. EXPERT OPINION: Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.

The inter- and intra- generational transmission of family poverty and hardship (adversity): A prospective 30 year study.

BACKGROUND: Children exposed to family poverty have been found to have higher morbidity and mortality rates, poorer mental health and cognitive outcomes and reduced life chances across a wide range of life domains. There is, however, very little known about the extent to which poverty is experienced by children over their early life course, particularly in community samples. This study tracks changes in family poverty and the main factors that predict family poverty (adverse life experiences) over a 30-year period since the birth of the study child. METHODS: Data are from a prospective, longitudinal, birth cohort study conducted in Brisbane, Australia. Consecutive families were recruited at the mothers' first obstetrical visit at one of two major obstetrical hospitals in Brisbane. Data are available for 2087 families with complete data at the 30-year follow-up. Poverty was measured using family income at each time point (adjusted for inflation). FINDINGS: Poverty affects about 20% of families at any time point. It is common for families to move in and out of poverty, as their circumstances are affected by such adversities as unemployment and marital breakdown. Over the period of the study about half the families in the study experienced poverty on at least one occasion. Only a very small minority of families experienced persistent poverty over the 30-year duration of the study. Logistic regressions with time lag show that family poverty predicts subsequent adversities and adverse events predict subsequent poverty. CONCLUSIONS: Experiences of poverty and adversity are common and may vary greatly over the child's early life course. In assessing the health consequences of poverty, it is important to distinguish the timing and chronicity of early life course experiences of poverty and adversity.

Pharmacotherapy of conduct disorder: Challenges, options and future directions.

UNLABELLED: There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. STUDIES INCLUDED: antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.

Age at first tobacco use and risk of subsequent psychosis-related outcomes: A birth cohort study.

OBJECTIVE: Compared to the substantial body of research examining links between cannabis use and psychosis, there has been relatively little attention to the role of tobacco as a potential risk factor for psychosis. This study explored the association between age at first tobacco use and psychosis-related outcomes in a birth cohort. METHOD: This study is based on a large birth cohort (the Mater-University Study of Pregnancy). At approximately 21 years of age, cohort members (N = 3752) were assessed for three psychosis-related outcomes (International Classification of Diseases non-affective psychosis, the presence of any hallucination and total count of delusional-like experiences) with the Composite International Diagnostic Interview and the Peters Delusional Inventory. Associations between age at first tobacco use and psychosis-related outcomes were examined using logistic regression in a model (a) adjusted for sex and age and (b) in a second model excluding all respondents who had a history of past problematic and current cannabis use. RESULTS: When adjusted for age and sex, those who commenced tobacco at 15 years of age or younger were significantly more likely to (a) have non-affective psychosis, (b) be in the highest quartile of total score of the Peters Delusional Inventory and (c) report hallucinations. After excluding all those with a history of a cannabis use disorder, or who were current (last month) cannabis users, a significant association between age at first tobacco use and the presence of hallucinations persisted. CONCLUSION: There is an association between age at first tobacco use and subsequent psychosis-related outcomes in young adults. While the findings cannot be used to deduce causality, it adds weight to the hypothesis that early tobacco use may contribute to the risk of developing psychosis-related outcomes.

Cohort Profile Update: The Mater-University of Queensland Study of Pregnancy (MUSP).

The Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes began in 1981 with data collected on 7223 pregnant woman-child pairs (6753 mothers, of whom 520 had 2 study children, less 50 who had multiple births). These women, and their children, were initially followed for up to 21 years. Since then there have been additional follow-ups of the mothers (27 years) and their children (30 years). There has also been a substantial increase in the breadth of topics addressed, with the collection of biological samples, the administration of structured clinical assessments of mental health and cognitive capacity, and markers of physical health such as lung function and blood pressure. MUSP was originally developed as a birth cohort study. It has become a longitudinal study of growth, development and ageing with an emphasis on the generational transmission of a wide range of factors impacting on adult health outcomes. We welcome interest in our study; for study background and publications visit [www.socialscience.uq.edu.au/musp] or contact [j.najman@uq.edu.au].

Improving collaboration: a qualitative assessment of inter-agency collaboration between a pilot Multisystemic Therapy Child Abuse and Neglect (MST-CAN) program and a child protection team.

OBJECTIVE: Child protection inter-agency collaboration is characterized by strengths and problems. Some literature notes positive attitudes and high trust between teams. However, difficulties with communication, confidentiality, roles, boundaries and divergent paradigms reconciling child protection and parent mental health needs have been documented. This study investigated whether a pilot model of intensive family intervention for maltreated children and associated intensive inter-agency cooperation delivered an effective collaboration. METHOD: At the completion of the pilot program, a child protection team was interviewed. A qualitative assessment by semi-structured group interview format of inter-agency collaboration was undertaken and evaluated by a thematic analysis. RESULTS: The analysis identified: strong endorsement of the collaborative model; no changes in perception of referred patients; changes in treatment approaches. No perceived conflict between child protection and parent mental health needs were noted. CONCLUSIONS: The changes noted may be due to the unique structure and functioning of the pilot Multisystemic Therapy Child Abuse and Neglect program, which encouraged high levels of team communication, strong client engagement, availability and intensive treatment of child and parent mental health problems. The implications for future collaborations are discussed as well as limitations of the study.

Are child and adolescent mental health problems increasing in the 21st century? A systematic review.

OBJECTIVE: Up to one in five children experience mental health problems. Social and cultural factors may influence emergence of mental health problems. The 21st century has led to changes in many of these factors, but it is unclear whether rates of internalizing and externalizing problems have also changed in recent cohorts of young people. METHODS: A comprehensive literature search was undertaken to locate cohort or population studies that examined changes in mental health of children over time, where participants were aged 18 years and under, and the time frame for change was at least 10 years, with data for at least one time point in the 21st century being statistically compared to at least one time point in the 20th century. Studies were reviewed for quality and outcome. RESULTS: Nineteen studies met criteria for review. These included studies of toddlers, children, and adolescents. Seventeen studies examined internalizing problems, and 11 studies examined externalizing problems. For both children and toddlers, recent cohorts did not exhibit worsening of mental health symptoms. In adolescents, the burden of externalizing problems appear to be stable. However, the majority of studies report an increase in internalizing problems in adolescent girls. The findings for internalizing problems in boys were mixed. CONCLUSIONS: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts. Approaches for prevention and early intervention should be explored.

A randomized, controlled, crossover trial of fish oil treatment for impulsive aggression in children and adolescents with disruptive behavior disorders.

OBJECTIVE: Epidemiological research links aggression to low serum concentrations of omega-3 fatty acids, such as those found in fish oil. However, no studies have specifically examined whether fish oil supplementation can reduce the frequency and severity of impulsive aggression in children with disruptive behavior disorders. METHODS: Children presenting with impulsive aggression and meeting research criteria for diagnosis of disruptive behavior disorders were randomized to receive either: 1) Fish oil capsules (4 g daily) for 6 weeks followed by placebo (identical-looking capsules) for 6 weeks; or 2) placebo for 6 weeks, followed by fish oil for 6 weeks, in a double-blind, crossover design. Primary outcomes were the Children's Aggression Scale and the Modified Overt Aggression Scale. Secondary outcomes included emotional and behavioral functioning (Strengths and Difficulties Questionnaire [SDQ]), hyperactivity symptoms (Attention-Deficit/Hyperactivity Disorder [ADHD] Rating Scale), family functioning (Family Assessment Device), and cognitive functioning (Stop Signal Task, Trail-Making Task, and Eriksen Flanker Task). Serum concentrations of omega-3 and omega-6 fatty acids were measured at baseline, and at 6 and 12 weeks. RESULTS: Twenty-one children participated (81% male; mean age 10.3±2.2 years; range 7-14). Fish oil treatment increased serum concentrations of eicosapentanoic acid (F=14.76, p<0.05) and total omega-3s (F=20.56, p<0.05), but did not influence primary ratings of aggression. In fact, a trend suggested that fish oil worsened a secondary measure of aggression (SDQ Conduct Subscale, F=4.34, p=0.06). Fish oil treatment was associated with an improvement in one rating of hyperactivity (SDQ Hyperactivity Subscale, F=2.22, p<0.05), but did not influence any other outcome measures. CONCLUSIONS: These findings suggest that fish oil treatment does not improve aggression in children with disruptive behavior disorders.