[Coronavirus Pandemic - #STAYHOME: How Are You Holding Up? Questions And Tips For 11-18-Year-Olds To Make It Better].

PURPOSE: Adolescents have to cope with several challenges and restrictions due to the COVID-19 pandemic, with many of those incongruent with the typical developmental tasks of adolescent age. Some adolescents might be particularly vulnerable in this situation, including those who are deprived of psychological, social or health care services and/or are exposed to abuse or neglect in their home environment. The aims of the current international multicentre follow-up study are to: 1. collect data on the mental health and quality of life of adolescents during and after the pandemic; 2. improve their mental health by providing an online prevention program that addresses their actual needs; 3. accelerate the development of culturally adapted prevention programs by involving an international team, and 4. to contribute to adequate preparation for any potentially occurring, similar situationin the future. METHODS: Participants aged 11-18 years and their parents/caregivers from diff erent parts of Europe and non-European countries are recruited online. Data are collected regularly in a follow-up study by means of structured self-administered online questionnaires on adolescents' mental health, quality of life and current attitudes and needs. The baseline data collection was in March 2020 at first restrictions of the COVID pandemic in Europe. It is followed up several times (at the beginning weekly, later monthly, bi-monthly, three-monthly) to study changes in mental health, quality of life and attitudes of children and adolescents during the coronavirus disease pandemic. Data were collected by means of structured questionnaires (see below). The time frame of the study is set to one year from study start, March 2021. The last data collection was done in December 2020. The prevention program is developed and provided based on continuously analysed incoming data. CONCLUSIONS: Prevention based on the results of the study is expected to contribute to maintaining adolescents' mental health, improve their quality of life, increase their and their environment's cooperation with the necessary restrictions during the pandemic, and to make reintegration easier once the restrictions are over. Furthermore, the study has the potential to inform on the wellbeing of children and adolescents in extreme situations in general, thus contribute to future preventive measures and policymaking. Implications and Contribution: The proposed international online follow-up study is expected to provide scientifi c evidence for 1. possible changes in the mental health and quality of life of adolescents during and after a pandemic situation, 2. the eff ectiveness of a culturally adapted prevention program developed to address challenges associated with these changes.

[When is self-injury nonsuicidal? Reviewing the relationship between suicial and nonsuicidal self-injury].

BACKGROUND: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has included nonsuicidal self-injury (NSSI) as a proposed independent diagnostic category, emphasizing the nonsuicidal nature of the phenomenon. Nevertheless, this terminology and concept have provoked a still ongoing scientific debate among researchers and clinicians. AIMS: By extending a systematic search with a broader focus on the prevalence and psychopathological correlates of NSSI, the aim of the present study is to explore the relationships between NSSI and suicidal behavior. METHODS: A systematic literature search was conducted in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with the search terms "NSSI" and "prevalence" and "mental disorder" or "psychiatric disorder". The results were completed by manual searches. Inclusion criteria were for each publication to be an empirical study in English language that does not focus on a specific population. RESULTS: A total of 25 papers examined the relationship between NSSI and suicidality explicitly. Among these papers, fifteen focused on children/adolescents, five on young adults, four on adults, and one on participants from heteroge - neous age groups. According to the results reviewed, altogether 50-70% of those who engaged in NSSI also reported suicidal thoughts or attempts. Those who did not report suicidal ideation differed from those who reported both NSSI and suicidal ideation in certain intra- and interpersonal traits (e.g., less depressive and borderline personality disor der symptoms, fewer negative life events, more social support) and in some specific characteristics (e.g., higher frequency and higher number methods) of NSSI. DISCUSSION: Based on the publications reviewed, significant suicidal risk is associated with NSSI in both adolescence and adulthood. This risk may be even higher in the presence of certain comorbid disorders and other psychosocial factors as well as in the presence of certain NSSI patterns such as repetitiveness or multiple NSSI methods.

Psychiatric diagnoses in "healthy" control group of a clinical study and its effects on health related quality of life.

BACKGROUND: The measure of health-related quality of life (HRQoL) among children with mental disorders is still in early ages, even though the worldwide-pooled prevalence of psychiatric diagnoses among children and adolescents is around 13%. Several studies confirmed that these children have impaired social and school functioning and low HRQoL. Mental disorders among children often remain undiagnosed or diagnosed too late, in that case additional negative effects could be expected. The aim of the current study was to identify psychiatric disorders in children who participated in a clinical study as a "healthy" control group and measure its effects on HRQoL. METHODS: The inclusion criteria for control participated children were not having ongoing or previous psychiatric or psychological treatment. In the second step control children (n=79, age range 6-15) were divided into two subgroups according to achieved diagnostic criteria. Measures were Mini International Neuropsychiatric Interview Kid and Inventory for the Assessment of the Quality of Life in Children and Adolescents. For data analyzing due to unequal sample sizes robust Welch t-test with omega squared, Spearman's rank correlation coefficients and logistic regression were applied. RESULTS: According to the children and parents control group with diagnoses have lower HRQoL in school, peer relationships and mental health dimensions than control group without diagnoses. Furthermore, by the children's report this difference exists in the domain of time spent alone, by the parent proxy report exist in the somatic health and general dimensions. An increasing number of diagnoses decreased HRQoL in most areas. The presence of psychiatric diagnoses by children increase 8 times more likely to have low HRQoL in the domain of school and 4 times in the domain of time spent alone. CONCLUSIONS: These results draw attention to the relative high ratio of undiagnosed mental disorders in the control group and for the low HRQoL of these children. Screening of psychiatric disorders in schools should be crucial and the earliest recourse of treatment in the identified children. The findings of this study also underline the importance of assessing HRQoL from different perspectives.

[Quality of life of adolescents with conduct disorder: gender differences and comorbidity with oppositional defiant disorder].

BACKGROUND: Quality of life is the individuals' subjective evaluation of their general well-being, including physical and mental health, social relationships and everyday functionality. The aim of our study was to examine conduct disorder in terms of gender differences in prevalence, and relationship to quality of life domains in the presence or absence of comorbid oppositional defiant disorder. METHODS: Altogether 392 adolescents, aged 13-18 years (M=14.5; SD= 1.37), participated in this study. The members of the clinical group were selected from Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary with externalizing symptoms in their case history. The control group was selected from public schools in Budapest, Hungary. Mini International Neuropsychiatric Interview Kid was used to diagnose conduct disorder and oppositional defiant disorder, and parent and adolescent version of the Inventory of Quality of Life in Children and Adolescents (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen) was used to measure the children's quality of life. RESULTS: In this sample 8.5% of adolescents were diagnosed with conduct disorder, of which 52.9% had a comorbid oppositional defiant diagnosis. Conduct disorder diagnosis was only present in the clinical group, 9 of participants with such diagnosis were male and 24 were female. Girls with conduct disorder evaluated their family life domain (p<0.01) and their global quality of life (p<0.05) lower than the boys. Compared to adolescents without comorbid oppositional defiant disorder diagnosis, adolescents with conduct disorder and comorbid oppositional defiant disorder had significantly worse quality of life in the domain of time spent alone (p<0.05). CONCLUSIONS: Conduct disorder is associated with decreased quality of life. The presence of comorbid oppositional defiant disorder correlates with lower quality of life in several domains. These findings are considerable for the clinical management of these externalizing disorders.

Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender.

BACKGROUND: The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology. METHODS: Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13-18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann-Whitney U test, chi-square test and mediator model were used. RESULTS: Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n = 10 (28.60%), girls: n = 25 (71.40%) ((χ2(1) = 10.643 p < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls. CONCLUSIONS: ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.

Self-injury and externalizing pathology: a systematic literature review.

BACKGROUND: During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. METHODS: A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). RESULTS: Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. CONCLUSIONS: Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.

The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders.

Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.

Research group as helpers due to the war in Ukraine: Focus group experiences of women researchers.

Introduction: World Health Organization studies have shown that one in every five people who have experienced war or other conflicts suffers from a mental health disorder, the most vulnerable groups being children and women. According to international guidelines, mental health care should be made available immediately in the event of disaster. With the first influx of Ukrainian refugees to Hungary at the outbreak of the war, the Research Group of Childhood Mental Health at Eötvös Loránd University and Semmelweis University in Budapest immediately decided to help by transforming itself into a support group for refugee families. The members of the support group are all women. The aim of the present study is to explore the motivation behind the transformation of the research group and the help it provided. A further aim was to compare the group's experiences with descriptions in the literature of impacts on helpers who work with refugees. Methods: The current paper reflects on the transformation from researchers to helpers and the effects of that transformation at group and individual level using the focus group method and consensual text analysis. The transformation of the support group necessitated the involvement of students, whose experiences are also examined. Results: We identified five main categories: context; the help recipients' perspective; the personal level; the professional level; and the level between the personal and professional. Discussion: The analysis revealed the way in which the voluntary helping developed, the resulting difficulties, and coping options. Volunteering among Ukrainian refugees has both positive and negative psychological consequences. While stress and trauma threaten the psychological well-being of the helpers, positive aspects, such as flexibility and professional development, are also reported. Due to the strong motivation among group members and their experience in practical work, the all female research group was quickly able to transform itself into a support group.

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents-A Network Approach.

Although earlier research has highlighted that psychiatric disorders significantly impair patients' quality of life (QoL), few studies have examined the relationship between nonsuicidal self-injury (NSSI) and QoL. Our aim was to investigate whether QoL mediates the mental disorder-NSSI relationship, and to study the QoL ratings agreement of self and parents in a clinical population of adolescents. We involved 202 adolescents from Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, aged 13-18 years. All participants completed the Deliberate Self-Harm Inventory, Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, and the Mini International Neuropsychiatric Interview Kid. To map the interrelationship between the NSSI, mental disorders, and QoL dimensions, Mixed Graphical Models were estimated. Adolescents with a history of NSSI rated their QoL to be significantly lower than adolescents without NSSI. Self and parents' QoL ratings are closer in the NSSI sample than in the no-NSSI sample. Among all QoL dimensions, only family problems had a direct significant association with NSSI engagement. Our results highlight that, contrary to our hypothesis, the presence of mental disorders mediates the relationship between most QoL dimensions and the occurrence of NSSI. Our results draw attention to the potential causal effect of environmental factors (e.g., peer problems) on mental disorders that, in turn, result in NSSI. The present paper highlights the importance of network modelling in clinical research.

Nonsuicidal Self-Injury: Its Associations With Pathological Internet Use and Psychopathology Among Adolescents.

BACKGROUND/HYPOTHESES: As risk factors for nonsuicidal self-injury (NSSI), most studies highlight the importance of internalising disorders, while only a few researches show the connection between externalising disorders and NSSI. Although some papers have introduced the idea that increasing prevalence rates of NSSI are connected to the broader use of the internet, associations between NSSI and pathological internet use (PIU) are understudied. According to our hypothesis, there is a connection between PIU and NSSI, but this is mediated by psychopathological factors from both internalising and externalising dimensions. METHODS: In line with the dimensional approach of psychiatric disorders, participants (N = 363) were recruited from both clinical (N = 202 psychiatric inpatient) and nonclinical (N = 161 adolescents from secondary schools) settings. Measurements: Demographic Questionnaire; Strengths and Difficulties Questionnaire (SDQ); Deliberate Self-Harm Inventory (DSHI); Young Diagnostic Questionnaire for Internet Addiction (YDQ), Mini International Neuropsychiatric Interview Kid (M.I.N.I. Kid). RESULTS: There was high NSSI frequency (39.9%-71% of them were girls) in our sample. NSSI was significantly more frequent among those who showed threshold symptoms on SDQ than in the subthreshold group [H(3) = 53.293, p <.001]. In the NSSI frequency, there was also a significant difference between 'normal' internet users and both 'maladaptive' and 'pathological' internet users [H(2) = 10.039, p <.05 p = .007]. According to the mediator models, the relationship between PIU and NSSI is not a direct association; it is mediated by all examined psychopathological factors (M.I.N.I. kid diagnoses) except for obsessive-compulsive disorder (OCD), alcohol abuse and dependence, and adjustment disorder. CONCLUSIONS: We found a high frequency of NSSI. According to our results, PIU in itself is not a risk factor for NSSI but might become a risk factor in the presence of comorbid psychiatric disorders. All of these findings draw the attention of clinicians to the importance of careful screening of comorbid disorders with PIU.

Nonsuicidal Self-Injury and Suicide: The Role of Life Events in Clinical and Non-Clinical Populations of Adolescents.

BACKGROUND: Nonsuicidal self-injury (NSSI) is highly prevalent in clinical and non-clinical populations of adolescents. Several studies have supported both the distinction and the strong association between NSSI and suicidal behavior. Although there is a great deal of data on the role of life events in both suicidal behavior and NSSI, few studies have assessed the role of life events in the NSSI-suicidal behavior relationship. Our aims were to explore the relationship between NSSI and suicidal behavior, and the possible moderating role of stressful life events in a clinical and non-clinical adolescent population. METHOD: A clinical (n = 202) and a nonclinical (n = 161) population of adolescents, aged 13-18 years were assessed. The Mini International Neuropsychiatric Interview Kid, Deliberate Self-Harm Inventory and the Life Events List were used. Group differences related to suicidal behavior, NSSI, and life events were tested with Wilcoxon tests. Two- and three-way interactions were tested with negative binomial regression models including zero-inflation parameter. RESULTS: The prevalence of suicidal behavior (W = 7,306, p < .001), NSSI (W = 9,652, p < .001) and life events (W = 10,410 p < .001) were significantly higher in the clinical than in the non-clinical group. Between number of life events and NSSI, a moderate effect size (.38, 95%CI [.28,.46]) was found. The main effect of NSSI (χ2 (1) = 109.65, p < .001) and group membership (χ2 (1) = 39.13, p < .001) predicted suicidal behavior; the main effect of quantity of life events did not explain suicidal behavior. The interaction between NSSI and number of life events (χ2 (1) = 10.49, p < .01) was associated with suicidal behavior. Among interpersonal, non-interpersonal events and adverse childhood circumstances, only interpersonal events were associated with both suicidal behavior (χ2 (1) = 6.08, p < .05) and had a moderating effect (χ2 (1) = 8.59, p < .01) on the NSSI-suicidal behavior relationship. Patterns of the effects of life events on the NSSI-suicidal behavior relationship did not differ in the two groups. CONCLUSION: Our results confirm the importance of prevention and intervention of NSSI, considering its high prevalence and frequent co-occurrence with suicidal behavior in both clinical and non-clinical adolescent populations. Moreover, to support NSSI and suicide prevention, we would like to highlight the importance of stressful life events, especially those associated with interpersonal conflicts, require special attention.

Suicidal Risk, Psychopathology, and Quality of Life in a Clinical Population of Adolescents.

BACKGROUND: According to literature data, psychopathology is associated with both quality of life (QoL) and suicidal risk in adolescents, but the literature does not fully support a direct association between psychopathology and suicidal thoughts and behaviors. The aim of this study was to investigate the possible mediational role of QoL in the relationship between psychopathology and level of suicidal risk in a clinical sample of adolescents. METHOD: The authors examined a clinical population of 134 adolescents, aged 13-18 years. Suicidal risk-having any current suicidal ideations and/or previous suicide attempt-was assessed by the Mini International Neuropsychiatric Interview. QoL was evaluated by the adolescent self-rated versions of "Das Intervertar zur Erfassung der Lebensqualität Kindern und Jugendlichen" (ILK: Measure of Quality of Life for Children and Adolescents) and psychopathology was measured by adolescent self-rated versions of the Strengths and Difficulties Questionnaire (SDQ). A mediational model, in which QoL mediated the relationship between psychopathology and suicidal risk controlling for gender and age, was tested by means of regression analyses. RESULTS: Gender and age were both associated with suicidal risk. Self-reported QoL significantly mediated the relationships between emotional problems (=1.846; 95% BCa CI: 0.731-2.577), as well as peer problems (=0.883; 95% BCa CI: 0.055-1.561) and suicidal risk: more emotional and peer problems were associated with lower QoL, which in turn was related to higher level of suicidal risk. CONCLUSION: Based on this study, which aims to make further steps in suicidal prevention, our findings suggest that clinicians should routinely screen the QoL of their patients, especially in adolescents with emotional and peer problems. Furthermore, it is important to focus intervention and treatment efforts on improving the QoL of adolescents with emotional and peer problems.