Effect of 25-hydroxyvitamin D levels on the internalising dimension as a transdiagnostic risk factor: Mendelian randomisation study.

BACKGROUND: Observational studies indicate a relationship between vitamin D (25-hydroxyvitamin D; 25OHD) deficiency and the development of internalising disorders, especially depression. However, causal inference approaches (e.g. Mendelian randomisation) did not confirm this relationship. Findings from biobehavioural research suggests that new insights are revealed when focusing on psychopathological dimensions rather than on clinical diagnoses. This study provides further evidence on the relationship between 25OHD and the internalising dimension. AIMS: This investigation aimed at examining the causality between 25OHD and internalising disorders including a common internalising factor. METHOD: We performed a two-sample Mendelian randomisation using genome-wide association study (GWAS) summary data for 25OHD (417 580 participants), major depressive disorder (45 591 cases; 97 674 controls), anxiety (5580 cases; 11 730 controls), post-traumatic stress disorder (12 080 cases; 33 446 controls), panic disorder (2248 cases; 7992 controls), obsessive-compulsive disorder (2688 cases; 7037 controls) and anorexia nervosa (16 992 cases; 55 525 controls). GWAS results of the internalising phenotypes were combined to a common factor representing the internalising dimension. We performed several complementary analyses to reduce the risk of pleiotropy and used a second 25OHD GWAS for replication. RESULTS: We found no causal relationship between 25OHD and any of the internalising phenotypes studied, nor with the common internalising factor. Several pleiotropy-robust methods corroborated the null association. CONCLUSIONS: Following current transdiagnostic approaches to investigate mental disorders, our results focused on the shared genetic basis between different internalising phenotypes and provide no evidence for an effect of 25OHD on the internalising dimension.

"Just something that happened?": Mental health impact of disclosure and framing of sexual violence in older victims.

INTRODUCTION: Despite the important impact of sexual violence (SV) on mental health, few victims disclose their experiences. Although research in adult victims suggests that SV disclosure could protect against long-term mental health problems, studies in older adults are lacking. OBJECTIVES: To establish the prevalence of depression, anxiety, posttraumatic stress disorder (PTSD), suicide attempts, and self-harm, their association with SV disclosure, and the moderating effect of sociodemographic characteristics and SV framing in the relation between SV disclosure and the different mental health outcomes in older SV victims. METHODS: Data on sexual victimisation, mental health, SV framing, and disclosure were collected through structured face-to-face interviews with 171 randomly selected sexually victimised adults of 70 years and older living in Belgium. SV was measured using behaviourally specific questions based on a broad definition. Mental health outcomes were measured using validated scales. RESULTS: Depression, anxiety and PTSD were reported by 34%, 33% and 9% of participants respectively, 5% had attempted suicide and 1% reported self-harm during lifetime. SV framing was associated with the kind of help victims consulted. SV disclosure was not linked with depression and anxiety, but was associated with an increase of PTSD symptoms in older victims with care dependency (p = 0.004) or a chronic illness and/or disability (p = 0.025). CONCLUSIONS: SV disclosure in itself does not protect against adverse mental health outcomes in old age. Capacity building of professionals trough training and development of clinical guidelines and care procedures may increase appropriate response to SV disclosure by older victims.

Comorbidity Between Internalising and Externalising Disorders Among Adolescents: Symptom Connectivity Features and Psychosocial Outcome.

Internalising disorders are highly prevalent conditions in adolescence and tend to co-occur with externalising disorders. The present study used a symptom network approach to examine the interplay between symptoms of internalising disorders among adolescents with comorbid internalising and externalising disorders. Data comes from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of adolescents aged 13 to 18 years. The most central symptoms across the disorders in the network were poor self-esteem and worry. The comorbidity between anxiety and depression increases the probability of having comorbid externalising disorders. Adolescents with both internalising and externalising disorders had the highest rate of health service utilisation. Comorbidity group, lifestyle factors, deficits in cognitive and academic competence and coping skills were significant covariates of the mental health outcomes. Understanding comorbidity profile of internalising and externalising disorders and central symptoms that bridge these disorders could have important clinical implications.

Effectiveness and long-term stability of outpatient cognitive behavioural therapy (CBT) for children and adolescents with anxiety and depressive disorders under routine care conditions.

BACKGROUND: Randomised controlled trials (RCTs) have provided considerable evidence for the short-term efficacy of cognitive behavioural therapy (CBT) in children and adolescents with depressive and anxiety disorders. However, the effectiveness and long-term stability of treatment effects under routine care conditions remain unproven. AIMS: This observational study investigates the effectiveness and stability of CBT under routine care conditions within a large sample of clinically referred youth with depressive and anxiety disorders. METHOD: Two hundred and twenty former patients (age 6-18 years at start of treatment) underwent a follow-up assessment (follow-up interval: M=5.3 years, SD=2.47). Parent and self-ratings of behavioural and emotional problems were obtained at the beginning and end of treatment and at follow-up. Additionally, at follow-up, a telephone interview and questionnaires exploring other mental symptoms and life satisfaction were administered. RESULTS: A repeated measures ANOVA yielded statistically significant, medium to large pre- post symptom reductions (ηp2=.15 to ηp²=.47) and small to medium post-follow-up symptom reductions (ηp²=.03 to ηp²=.19). At follow-up, between 57 and 70% of the sample reported a decrease in different emotional symptoms since the end of treatment, and 80% reported improved life satisfaction. CONCLUSIONS: These findings provide evidence for the effectiveness and stability of treatment effects of CBT in youth with depressive and anxiety disorders under routine care conditions. Due to the lack of a direct control condition and a substantial proportion of missing data, the results must be interpreted with caution.

Short-term outcomes of the Therapist-assisted Online Parenting Strategies intervention for parents of adolescents treated for anxiety and/or depression: A single-arm double-baseline trial.

OBJECTIVE: This study aimed to evaluate whether the Therapist-assisted Online Parenting Strategies programme increased parenting behaviours known to be supportive of adolescents experiencing anxiety and/or depression. Secondary parenting outcomes of parental self-efficacy, parental accommodation, carer burden, parent-adolescent attachment, family functioning and parent distress were also examined, along with adolescent outcomes of anxiety and depression symptoms, suicidal ideation and sleep. METHOD: Seventy-one parents (94.4% females) and their adolescents (73.2% females) aged 12-18 years (Mean = 15.02, SD = 1.56) being treated for depression and/or anxiety in Australia were recruited into a single-arm double-baseline open-label trial. Parents received Therapist-assisted Online Parenting Strategies, which comprised up to nine web-based modules each supplemented with coaching sessions via videoconferencing. Outcomes were analysed using latent growth curve modelling to determine if changes to outcomes at post-intervention (4 month post-second baseline) exceeded changes between two baselines measured 1 month apart. RESULTS: Sixty-five parents (91.6%) completed at least one module of the online parenting intervention and on average received nine coaching sessions (SD = 2). Parenting behaviours targeted by Therapist-assisted Online Parenting Strategies improved at post-intervention (Cohen's d = 1.16, 95% confidence interval [0.78, 1.51]). Parent-reported parental self-efficacy and parent-adolescent attachment increased (Cohen's d = 1.44 [1.05, 1.82] and 0.39 [0.05, 0.74], respectively), while impairments to family functioning and parent distress decreased (Cohen's d = -0.51 [-0.86, -0.16] and -0.84 [-1.23, -0.44], respectively). Changes to adolescent anxiety, depression and sleep were not significant. CONCLUSION: The Therapist-assisted Online Parenting Strategies intervention improved self-reported parenting behaviours, parental self-efficacy, parent levels of distress, parent-adolescent attachment, and family functioning in parents with adolescents being treated for anxiety and/or depression. However, significant changes in adolescent mental health and sleep outcomes at post-intervention were not observed. The usefulness of a therapist-supported online parenting programme in addressing a service gap for parents seeking professional help is indicated. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000290291, prospectively registered on 26 February 2018; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368031.

Investigating the psychometric properties of the revised child anxiety and depression scale (RCADS) in a non-clinical sample of Irish adolescents.

Background: The psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS) have been established cross-culturally, yet psychometric evidence is lacking for an English-speaking European population. Aim: This research sought to further cross-validate the measure in a non-clinical Irish adolescent sample, and to test for gender and age-based differential item functioning in depression and anxiety. Method: Participants were Irish second-level school students (N = 345; 164 male; 12-18 years, M =14.97, SD = 1.44). Confirmatory factor analysis for categorical data (confirmatory item factor analysis) and multiple-indicator multiple-cause (MIMIC) modelling to identify items displaying possible metric invariance were conducted. Results: A six-factor model fit the data well in both gender samples and both school cycles, as a proxy for age samples. Gender-based metric invariance for 5 of 47 items and age-based metric invariance for three items were identified. However, the magnitudes were small. Internal consistency and validity were also established. Conclusions: While, a number of items demonstrated minor metric invariance, there was no evidence that they influenced overall scores meaningfully. The RCADS can reasonably be used without adjustment in male and female, younger and older, adolescent samples. Findings have implications for the use of the RCADS in an English-speaking European population.

Distinct trajectories of separation anxiety in the preschool years: persistence at school entry and early-life associated factors.

BACKGROUND: Little is known about how children differ in the onset and evolution of separation anxiety (SA) symptoms during the preschool years, and how SA develops into separation anxiety disorder. In a large, representative population-based sample, we investigated the developmental trajectories of SA symptoms from infancy to school entry, their early associated risk factors, and their associations with teachers' ratings of SA in kindergarten. METHODS: Longitudinal assessment of SA trajectories and risk factors in a cohort of 1,933 families between the ages of 1.5 and 6 years. RESULTS: Analyses revealed a best-fitting, 4-trajectory solution, including a prevailing, unaffected Low-Persistent group (60.2%), and three smaller groups of distinct developmental course: a High-Increasing (6.9%), a High-Decreasing (10.8%), and a Low-Increasing group (22.1%). The High-Increasing group remained high throughout the preschool years and was the only trajectory to predict teacher-assessed SA at age 6 years. Except for the High-Increasing, all trajectories showed substantial reduction in symptoms by age 6 years. The High-Increasing and High-Decreasing groups shared several early risk factors, but the former was uniquely associated with higher maternal depression, maternal smoking during pregnancy, and parental unemployment. CONCLUSIONS: Most children with high SA profile at age 1.5 years are expected to progressively recover by age 4-5. High SA at age 1.5 that persists over time deserves special attention, and may predict separation anxiety disorder. A host of child perinatal, parental and family-contextual risk factors were associated with the onset and developmental course of SA across the preschool years.

Adapting a coach-assisted web-based intervention for parents of adolescents who refuse school: qualitative study with users of the Partners in Parenting Plus programme.

BACKGROUND: School refusal is a heterogenous problem which typically emerges in adolescence and co-occurs with internalising disorders. A substantial proportion of adolescents do not respond to existing treatment modalities; thus, novel, effective intervention options are needed. Partners in Parenting Plus (PiP+) is a coach-assisted, web-based intervention designed to empower parents to respond to adolescent internalising disorders. AIMS: To conduct a process evaluation of PiP+ and identify programme adaptations required to meet the needs of parents of adolescents who refuse school. METHOD: Semi-structured interviews were conducted with 14 Australian mothers who had: (a) received the PiP+ programme (not tailored for school refusal) during a prior research trial; and (b) reported that their adolescent was refusing school during their participation in PiP+. Inductive thematic analysis was used to analyse interview transcripts. RESULTS: Participants were 41-53 years old (M = 47.8) and parenting adolescent children aged 14-17 years (M = 14.9). Three themes illustrated how PiP+ features met or could better meet the needs of parents of adolescents who were refusing school: (a) feeling heard, supported and respected; (b) relevance to me and my context; and (c) seeing positive changes. Participants had favourable views of PiP+, especially coached components. Participants requested programme enhancements to better meet the needs of parents of neurodiverse adolescents and discussed the impact of cumulative help-seeking 'failures' on self-efficacy and locus of control. CONCLUSIONS: PiP+ was highly acceptable to the majority of parents navigating the issue of school refusal. This has implications for the enhancement of coach-assisted parenting interventions and the context-specific adaptation of PiP+ for school refusal.

Developmental competencies, temperament, parenting practices and psychosocial adversities in children with internalising disorders - A pilot study.

Research on the aetiology of internalising disorders has focussed on biological and environmental factors, however, the role of developmental competencies that a child acquires has not been explored much. The current report aimed to understand the association among the developmental competencies, temperament, parenting practices and psychosocial adversities in internalising disorders. The sample consisted of 30 children and adolescents with internalising disorders belonging to the age group of six to 18, and one of their parents. All the participants were assessed for functional impairment, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events and family environment using standardised tools. The findings revealed that positive parenting shares a negative relationship with functional impairment(ρ=-0.62; p <.001). On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. In conclusion, the current study indicates that children with internalising disorders differ from control groups in specific developmental competences. These findings have specific implications for intervention and research in the area of internalising disorders in children and adolescents.

"Time Does Not Heal All Wounds": Sexual Victimisation Is Associated with Depression, Anxiety, and PTSD in Old Age.

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalising disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to address SV in later life. Studies researching the mental health impact of lifetime SV, i.e., SV during childhood, adulthood, and old age, are lacking. Between July 2019 and March 2020, 513 older adults living in Belgium participated in structured face-to-face-interviews. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety, and posttraumatic stress syndrome (PTSD) were measured using validated scales. Participants were asked about suicide attempts and self-harm during their lifetime and in the past 12 months. SV was measured using behaviourally specific questions based on a broad SV definition. We found rates for depression, anxiety, and PTSD of 27%, 26%, and 6% respectively, while 2% had attempted suicide, and 1% reported self-harm in the past 12 months. Over 44% experienced lifetime SV and 8% in the past 12 months. Lifetime SV was linked to depression (p = 0.001), anxiety (p = 0.001), and PTSD in participants with a chronic illness/disability (p = 0.002) or no/lower education (p < 0.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12 months. In conclusion, lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are important.

Neural activation of anxiety and depression in children and young people: A systematic meta-analysis of fMRI studies.

Functional magnetic resonance imaging (fMRI) studies consistently demonstrate altered neural activation in youth experiencing anxiety and depression in a way that is distinct from adult-onset disorders. However, there is a paucity of research systematically reviewing this, and no meta-analyses have been conducted using Activation Likelihood Estimation (ALE). The present study conducted a systematic literature search to identify fMRI studies in youth (age 4-18) with depression or anxiety disorders. 48 studies with over 2000 participants were identified that met the inclusion criteria. Significant foci were extracted. Five ALE meta-analyses were conducted: a) activation for both anxiety disorders and depression; b) activation for anxiety disorders only; c) activation for depression only; d) deactivation for both anxiety disorders and depression; e) deactivation for depression. Results indicated significant clusters of increased activation in the bilateral amygdala for youth with internalising disorders, and specifically for those with anxiety disorders. Significant increased activation extended into the dorsal anterior cingulate, entorhinal cortex, the putamen, and the medial and lateral globus pallidus in youth with anxiety disorders. These findings help to detail the nature of anxiety being an amygdala hyperactivity disorder, whilst also defining the distinction between neural activation patterns in anxiety and depression.

Childhood and adolescent television viewing and internalising disorders in adulthood.

Time spent watching television during childhood and adolescence has been linked to socio-emotional and physical health problems in adulthood. It is unclear whether excessive television viewing is a risk factor for internalising mental health disorders such as anxiety and depression. Longitudinal associations between television viewing in childhood and adult diagnoses of anxiety and depression were investigated in a population-based birth cohort from Dunedin, New Zealand. Mean weekday television viewing time was reported by parents and adolescents between ages 5 and 15 years (1977-1987). Diagnoses of any anxiety disorder and major depression were made using standard criteria from symptoms reported for the previous year at ages 18, 21, 26, 32, and 38 years (between 1990 and 2012). Analyses adjusted for sex, parent and teacher reports of worry/fearfulness at age 5, and socioeconomic status during childhood. Diagnoses were counted if present at any of these assessments. Approximately half of all participants met criteria for anxiety disorder or depression during at least one adult assessment. Participants who had watched more television during childhood and adolescence were more likely to have a diagnosis of anxiety in sex-adjusted analyses (OR [95% CI] 1.22 [1.05, 1.41], p = 0.01), although this association weakened after adjustment for early childhood worry/fearfulness and socioeconomic status. There was no association between television viewing and depression in sex- or fully-adjusted analyses. Excessive television viewing during childhood and adolescence may be a risk factor for developing an anxiety disorder in adulthood, but does not appear to influence the long-term risk for major depression.

Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model.

The adolescent developmental stage appears to be a sensitive period for the onset of several particular forms of mental disorder that are characterised by heightened emotionality and social sensitivity and are more common in females than males. We refer to these disorders (social anxiety disorder, generalised anxiety disorder, eating disorders, major depression) collectively as the social-emotional disorders. The aim of this paper is to address an important question in the understanding of social-emotional disorders - why do these disorders commonly begin during adolescence? We present a conceptual model that describes some of the key changes that occur during adolescence and that addresses some hypothesised ways in which these changes might increase risk for the development of social-emotional disorders. An overview of the extant empirical literature and some possible directions for future research are suggested. The model points to interesting links between psycho-social risk factors that should highlight potentially fruitful directions for both psychopathology research and early intervention programs.

A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention.

Recent advances in clinical practice emphasise transdiagnostic interventions as an effective alternative to single disorder approaches. This current systematic review and meta-analysis evaluated the treatment efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) across internalising disorders, as an emotion regulation (ER) based intervention program. Across 15 studies and 1244 participants, large effect size reductions were found across symptoms of anxiety, depression, generalised anxiety disorder, obsessive-compulsive disorder, panic disorder with/without agoraphobia, social anxiety disorder, and borderline personality disorder. In addition, there were moderate effect sizes indicating increased use of adaptive and decreased use of maladaptive ER strategies, highlighting the UP as an effective ER based intervention. Secondary treatment benefits in functional impairment and quality of life were also evident. Implications on future transdiagnostic ER based research are discussed.

[Patterns of psychopathology and psychosocial background of patients at first presentation at the child and adolescent psychiatric outpatient department of the University Clinic Salzburg]. / Verteilungsmuster psychopathologischer Störungen und deren Bezug zum psychosozialen Hintergrund bei Erstvorstellungen an der Terminambulanz für Kinder- und Jugendpsychiatrie an der Universitätsklinik Salzburg.

BACKGROUND: This study examines the prevalence of psychiatric disorders and psychosocial background of outpatients at an Austrian child and adolescent psychiatry department. METHODS: One hundred eighty-three patients were examined using the Mini International Neuropsychiatric Interview for Children and Adolescents and the Multidimensional Clinical Screening Inventory. Pearson's chi-square tests were used to explore the prevalence of psychiatric disorders between gender and age-groups and their relationship with the psychosocial background of patients. RESULTS: Most patients (86.9%) had at least one psychiatric disorder. Almost three quarters (72.4%) of these patients made use of extramural facilities. Boys and girls did not differ in age or presence of a disorder. Internalising disorders were more common among older patients. Externalising disorders were more common among boys and younger patients. 65.2% of patients suffered from at least one co-morbid disorder. Boys and those with at least one externalising disorder showed more problems at school. Girls were victims of sexual assault more often, but boys experienced more extra-familial physical abuse. Girls and those with internalising disorders showed more self-harming and suicidal behaviour. A combination of internalising and externalising disorders correlated with increased drug consumption. Boys spent more time using a computer. CONCLUSIONS: The results show that particular psychopathologies often appear in connection with certain psychosocial burdens. Especially boys show increased vulnerability in relation to school problems. The willingness of patients to make use of extramural points of contact should guide future policies to consider therapeutic options encompassing parents, schools and welfare institutions for children prone to the development of psychiatric symptoms due to psychosocial risk.