Unmet need for mental health care among adolescents in Asia and Europe.

The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13-15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1-2% of those in middle-income countries and 6-25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries.

Navigating young minds: reliability and validity of the Greek version of kiddie - schedule for affective disorders and schizophrenia - present and lifetime DSM-5 version (K-SADS-PL-GR-5).

BACKGROUND: The Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) is one of the most popular semi-structured psychiatric interviews for children and adolescents. Its latest DSM-5 version (K-SADS-PL DSM-5) has only recently been adapted and validated in various languages. In the present study, we aimed to investigate the reliability and validity of the Greek version of the K-SADS-PL DSM-5. METHODS: A total of 137 patients consecutively referred for admission, aged 7-17, were included. The K-SADS-PL DSM-IV was translated and adapted to correspond to DSM-5 categories. Convergent and divergent validity were assessed against two self-report rating scales, Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Emotional Disorders (SCARED). Inter-rater reliability was calculated exclusively for instances where a diagnosis involved three or more patients. RESULTS: Our findings revealed good to excellent inter-rater reliability and good to excellent consensual validity across most psychiatric diagnoses, except for panic disorder. Diagnostic efficiency, measured by sensitivity, specificity, positive and negative predictive values, consistently showed high specificity and negative predictive validity across all diagnostic categories. CONCLUSIONS: These findings support the applicability of the Greek version of the K-SADS-PL DSM-5 as a reliable and valid diagnostic tool in Greek-speaking populations.

[The model of co-production in mental health services].

Service users' right to be involved in decisions concerning their health and quality of life is not only an ethical issue, but also a key aspect for the efficiency and effectiveness of services in modern health systems. Through co-production, service users have an equal partner position in a comprehensive process that includes services design, provision and evaluation. The co-production model is not a new concept but an emerging idea for health services and in particular mental health services. This model is governed by basic principles and values, such as recognizing individuals as active and equal participants with valuable experiences, taking advantage of existing opportunities, sharing and mutual understanding, peer support, tackling discrimination, and facilitation instead of just services provision. Τhe benefits are many and important, both for users (i.e. enhancing trust in services, reducing stigma), and for health professionals and settings (i.e., extroversion and dissemination, increasing needs understanding, changing professionals' attitudes, more efficient use of resources). However, there are limitations which should be considered when co-production is implemented. Regarding co-production, the literature is relatively limited; while there is a plethora of publications on the concepts related to co-production and its principles (e.g., empowerment, advocacy, recovery, etc.). The adoption of the co-production approach in Greece could benefit significantly the mental health services, within the psychiatric reform by establishing an equal relationship between professionals and service users.

Specificity of phonological representations in school-age high-functioning ASD children.

PURPOSE: Well-specified phonological representations are important for the development of spoken and written language. This study investigates the types of speech errors and the quality of phonological representations in Greek-speaking school-age children with high-functioning autism spectrum disorder (HF-ASD), as well as the relationship between stored phonological representations and speech output in this sample, according to Stackhouse and Wells' (1997) model. METHOD: All participants completed a phonological and a naming test, and a non-word repetition task. A receptive phonological task was administered to a subgroup of HF-ASD and typically developing (TD) participants. According to performance in the phonological test, the HF-ASD children were categorised as ASD with Speech Sound Disorder (SSD) or ASD without SSD. RESULT: The HF-ASD children made significantly more speech errors and showed significant difficulties in the repetition of non-words and the stored phonological representations compared to the TD group but had the same naming abilities with their TD peers. The ASD children with SSD and without SSD performed alike in the receptive task, indicating that both groups had unspecified phonological representations. CONCLUSION: These results support the hypothesis of distinct phonological representations for speech input and output and highlight the need of using receptive tasks to evaluate underlying phonological knowledge, a process which could allow clinicians to identify the level of speech breakdown.

[The profile of reading and cognitive skills of children with a history of specific developmental language disorder].

The present study aimed to investigate the profile of reading and cognitive skills of primary school' students with a history of specific developmental language disorder during preschool years. The sample comprised 247 children referred for assessment of their reading difficulties to the University Child Psychiatry Department, at the "Aghia Sophia" Children's Hospital, Athens, Greece. The study was retrospective utilizing medical records from where the following information was drawn: demographic data, presence of a diagnosis of a specific developmental language disorder, results of Reading Test-A and WISC-III. Among the 247 children with normal intelligence IQ>80 (mean age: 10.5 years, 61.5% boys) included in the study, 226 (92.5%) were identified as having significant reading difficulties in at least one of the four subtests of the Reading-A Test (≤ 30 percentile); 72% performed poorly in reading fluency, 67.1% in decoding familiar and pseudowords, 52.8% in reading comprehension and 49.8% in morphosyntax subtest. When comparing children with severe reading difficulties (≤ 10 percentile on the Reading Test A) with a history of specific developmental language disorder (N=110) and no relevant history (N=116), the findings indicated that a significantly higher proportion of children with a history of specific language disorder had severe difficulty in morphosyntax (χ2=21.94, p<0.001) and reading comprehension subtests (χ2=8.89, p <0,001) than those with no history. In terms of the cognitive profile of children with severe reading difficulties, the results showed that a significantly higher proportion of children with a history of developmental language disorder than those with no history had low performance (<7TB) on all WISC-III subtests, however the difference between the two groups was found to be statistically significant on three subtests: "Vocabulary" (p=0.014), Arithmetic (p=0.006), and "Information" (p=0.005). Multiple linear stepwise regression analysis showed that lower levels of the verbal IQ (ß=-0.121, p=0.042) and positive history of developmental language disorder during preschool years (ß=0.537, p<0.001) were independently related to the severity of reading disability. In conclusion, the findings of the present study highlight the importance of early detection of language deficits during the preschool years and timely speech and language therapy intervention.

Feeling Unsafe at School Among Adolescents in 13 Asian and European Countries: Occurrence and Associated Factors.

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic. Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals. Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries. Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.

Coping Strategies in mothers of children with autism spectrum disorder and their relation to maternal stress and depression.

Having a child with autism may have a strong impact on the family, especially on mothers, who are usually the primary caregivers of children with autism. Parents of children with autism report more mental health problems compared to parents of children with typical development or other developmental disabilities. Parental copying strategies may play a significant role when parents have to overcome stressful situations during the child development. The present study aimed to investigate the coping strategies used by mothers of children with autism spectrum disorder (ASD), and their relation to maternal stress and depression. One hundred and forty-three (143) mothers (mean age 42.7 years) of children with ASD (6-17years), who attended the ASD Outpatient Clinic of the Department of Child Psychiatry, at a Children's Hospital, participated in the current study. Mothers completed a series of questionnaires: a demographic characteristics questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), the Family Crisis Oriented Personal Scales (F-COPES), and the Parenting Stress Index Short-Form (PSI-SF). Mothers with higher educational level scored significantly lower in total F-COPES and its subscale "reframing". Increased daily hours related to child care and the child's medication were additional factors significantly associated with lower scores on "reframing". Reframing subscale was also negatively correlated with "parental distress", whereas "passive appraisal" was positively correlated with depressive symptoms. Lower scores on "mobilizing family to acquire" and "accept help" were associated with family life being more seriously affected. Coping strategies of mothers of children with ASD are associated with a number of factors related to personal characteristics of caregivers, child treatment and family characteristics. Mental health professionals should examine factors that may strengthen coping strategies that handle the challenges of having a child with ASD.

Parenting Children with Autism Spectrum Disorder during Crises: Differential Responses between the Financial and the COVID-19 Pandemic Crisis.

Parenting a child with autism can be particularly stressful and challenging, especially during periods of crises. This study focuses on parenting children with autism during the COVID-19 pandemic in comparison to the economic crisis, six years ago. We administered the same set of questionnaires (CES-D, F-COPES, PSI-SF, and WHOQoL-BREF), along with a demographic characteristic and a COVID-19-related questionnaire to the same group of parents of children with autism as we did six years ago. Results indicated that during the COVID-19 crisis, the level of parenting stress and the distress due to personal factors related to demands of parenting, were significantly lower compared to the economic crisis, while the environment facet of quality of life was significantly higher. The depressive symptomatology was elevated during both periods. Finally, when addressing the pandemic crisis, parents were more likely to passively accept problematic issues, less able to obtain social support, and less able to acquire and accept help from others. In our sample, findings differentiate the genre of crises through the parents' responses regarding the sense of competence in their parental role, their quality of life, and the coping strategies they implemented. The study implies that each crisis must be confronted with particular responses to particular needs.

The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?

Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child's experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

Perceptions, emotional reactions and needs of adolescent psychiatric inpatients during the COVID-19 pandemic: a qualitative analysis of in-depth interviews.

BACKGROUND: The new coronavirus pandemic (COVID-19) has been accompanied by severe psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness. AIMS: To explore adolescent psychiatric inpatients' perceptions, emotional reactions and needs during the first wave of the COVID-19 pandemic. METHODS: Individual in-depth interviews were conducted with nine psychiatric inpatients aged 12-17 years. Through open-ended questions, interviewers initiated five themes: (a) knowledge about coronavirus pandemic, (b) changes in everyday routine due to the pandemic, (c) adolescents' feelings about the pandemic, (d) adolescents' positive thoughts and behaviors, and (e) how the social environment can help adolescents deal with the pandemic-related situation. A thematic analysis was conducted using line-by-line open coding. RESULTS: Regarding their knowledge of the impact of the current pandemic, almost all adolescents focused on information about the nature of coronavirus and on existing crisis management practices. Almost all patients identified predominantly negative changes due to the quarantine state, including restrictions on both social life and personal freedom as well as excessive contact with family members during home isolation. As far as their emotions were concerned, adolescents did acknowledge anxiety about self-harm and harming their loved ones as well as mood swings within the family nucleus; anxiety was also manifested about the unknown and the management of the pandemic in other countries. Avoidance of thought rumination about the coronavirus and its consequences, positive thinking and looking towards the future were reported as constructive strategies for coping with challenging emotions. Additionally, a sense of belongingness seems to have been playing a pivotal role in the adolescents coping strategies. Trust in the authorities and the community was another quite noteworthy point that emerged during the interviews. Lastly, our findings indicated adolescents' benefit from receiving balanced health messaging coupled with balanced thinking within their social and family environment. CONCLUSIONS: Enhanced comprehension of possible mediating psychological pathways is needed to help clinicians, researchers, and decision-makers to avert the deterioration of mental disorders and overall functioning, as well as additional stress-related disorders.

Sleep problems in children and adolescents following traumatic life events.

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial.

BACKGROUND: The transgenerational transmission of affective disorders calls for integrating promotion of child development in the services offered to families with parental depression. The main objective of the present research was to examine the effectiveness and differences in the impact of two relevant interventions in Greece. METHODS: Thirty families of depressed patients were randomly assigned to the six-to-eight session Family Talk Intervention group and 32 families were included in the lower intensity parent-only two-to-three session Let's Talk about the Children group. Depressed parents and the eldest of their children were assessed prior to the interventions and 4, 10, and 18 months following baseline assessment. RESULTS: In both groups there were significant improvements in parent's depression, anxiety, perceived social support, parenting and family functioning, as well as improvements in child's depression, anxiety, and child emotional/behavioral problems. Child's prosocial behavior, perceived social support, and health-related quality of life were significantly improved in both groups. All positive effects were evident four months following baseline assessment and could be still documented at 1.5-year follow-up. Mixed linear models showed that family functioning and parenting to a lesser extent were associated with the greatest changes in children's psychosocial outcomes in both interventions.. LIMITATIONS: The lack of data regarding parents that refused to receive the interventions may limit generalizability of results. A further limitation is the lack of a no-intervention control group. CONCLUSIONS: The study offers a preliminary evidence base for integrating preventive interventions for child mental health in routine clinical practice with adult depressed patients.

Child and Parent Mental Health Problems in Pediatric Celiac Disease: A Prospective Study.

OBJECTIVES: The aim of our study was to estimate the levels of mental health problems in children with celiac disease (CD) along with their parents' mental health status, to compare these levels with those of healthy controls and to investigate how these problems are affected by a gluten-free diet (GFD). METHODS: Our study constituted 50 patients with CD at diagnosis before the initiation of a GFD (age 8.6 ±â€Š3.7 years, group A), 39 patients with CD on a GFD for at least 12 months (age 10.4 ±â€Š3.4 years, group B) and 38 healthy controls (age 7.7 ±â€Š3.8 years, group C), as well as their parents. One of the parents of each child completed the Child Behaviour Checklist (CBCL) and the Symptom Checklist 90 (SCL-90-R) to evaluate the children's and parents' mental health problems, respectively. Twenty patients in group A were reevaluated at least 12 months after initiation of a GFD (group D). RESULTS: At diagnosis, CD patients had higher scores in the CBCL for internalizing problems than healthy controls (55.7 ±â€Š10.3 vs 47.9 ±â€Š15.4, P = 0.007) and their parents demonstrated increased severity of mental health problems, including anxiety and depression, than the parents of healthy controls (0.72 ±â€Š0.49 vs 0.54 ±â€Š0.58, P = 0.013). CONCLUSIONS: CD patients at diagnosis and their parents, had more mental health problems, including anxiety and depression, than healthy controls.

Views of Teachers on Anxiety Symptoms in Students with Autism Spectrum Disorder.

People with autism spectrum disorder (ASD) exhibit comorbidity with anxiety. The aim of this study was the investigation of the perception of teachers on anxiety in school children with ASD. The Scale Teacher Response (SAS-TR) questionnaire was completed by 291 special education and 118 general education teachers, providing data on students in their classes with ASD and of typical development (TD), respectively. According to the total scores on SAS-TR, 46.8% of the children with ASD presented levels of anxiety within the clinical spectrum compared with 15.3% of the children of TD. Gender and age were not associated with the anxiety scores, but in the children with ASD, higher intelligence quotient (IQ) was weakly, and better verbal skills more strongly correlated with a higher anxiety level. Teachers' awareness of anxiety symptoms in children with ASD may contribute to their social inclusion.

Review of interventions for the management of anxiety symptoms in children with ASD.

BACKGROUND: Anxiety is a common accompanying symptom in people with Autism Spectrum Disorder (ASD). OBJECTIVES: To investigate interventions available for the management of anxietyin children with ASD internationally. METHODS: Review was made of relevant studies found through PubMed, the National Institute of Health (NIH) publications and resources in the libraries of the University of Macedoniaand the Greek NationalResearch Foundation. RESULTS: Of the 372 studies retrieved dealing withinterventionsfor children with ASD who have anxiety disorders published from the 1980s to 2017, 137 were included in this review.Interventions includepharmacological intervention, cognitive behavioral therapy(CBT),socialrecreational (SR)programs,other psychosocial therapies, teaching social skillsand combinations of educational, psychological and medical treatment. CONCLUSIONS: Various methods for coping with anxiety in children with ASD have been applied, including pharmacotherapy, psychosocial andCBT interventions, parent education and school-based programs. A combination of approachesshould be selected, based onassessment of each child's particular characteristics.

Early life stress and trauma: developmental neuroendocrine aspects of prolonged stress system dysregulation.

Experience of early life stress (ELS) and trauma is highly prevalent in the general population and has a high public health impact, as it can trigger a health-related risk cascade and lead to impaired homeostatic balance and elevated cacostatic load even decades later. The prolonged neuropsychobiological impact of ELS can, thus, be conceptualized as a common developmental risk factor for disease associated with increased physical and mental morbidity in later life. ELS during critical periods of brain development with elevated neuroplasticity could exert a programming effect on particular neuronal networks related to the stress response and lead to enduring neuroendocrine alterations, i.e., hyper- or hypoactivation of the stress system, associated with adult hypothalamic-pituitary-adrenal axis and glucocorticoid signaling dysregulation. This paper reviews the pathophysiology of the human stress response and provides evidence from human research on the most acknowledged stress axis-related neuroendocrine pathways exerting the enduring adverse effects of ELS and mediating the cumulative long-term risk of disease vulnerability in adulthood.

Psychological vulnerability to stress in carriers of congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

OBJECTIVE: Carriers of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) demonstrate increased secretion of cortisol precursors following ACTH stimulation, suggestive of impaired cortisol production and compensatory increases in hypothalamic corticotropin-releasing hormone (CRH) secretion. Both cortisol and CRH have behavioral effects, and hypothalamic CRH hypersecretion has been associated with chronic states of anxiety and depression. We performed an endocrinologic and psychological evaluation in carriers of 21-OHD and matched control subjects. DESIGN: We recruited 29 parents of children with classic CAH (14 males, 15 females; age (mean±SD): 41.8±5.7 yr), and hence 21-OHD carriers, and 13 normal subjects (5 males, 8 females; age: 43.8±6.1 yr). All subjects underwent a formal ovine (o) CRH stimulation test with measurement of ACTH, cortisol, 17-hydroxyprogesterone (17-OHP) and androstenedione concentrations, which was preceded by determination of 24-hour urinary free cortisol (UFC) excretion. Psychometric assessment was performed by administering the State-Anxiety (STAI 1) and Trait-Anxiety (STAI 2) Inventory, Beck Depression Inventory, Symptom Checklist-90R and Temperament and Character Inventory. RESULTS: Carriers of 21-OHD had significantly higher 17-OHP concentrations following oCRH stimulation and higher STAI 1 (47.6±5.6 vs. 43.3±5.4, P=0.023) scores than control subjects. Mean 24-hour UFC concentrations were positively correlated with paranoid ideation (r=0.435; P=0.023) and psychoticism (r=0.454; P=0.017). Stepwise multiple linear regression analysis revealed that the single independent predictor of STAI 1 was peak stimulated 17-OHP concentrations (ß: 0.055, SE: 0.023, R2: 0.290, P=0.031). CONCLUSIONS: Carriers of 21-OHD may be predisposed to the development of anxiety disorders.