The mood disorder spectrum vs. schizophrenia decision tree: EDIPHAS research into the childhood and adolescence of 205 patients.

BACKGROUND: The early detection of patients at risk of developing schizophrenia and bipolar disorder, and more broadly mood spectrum disorder, is a public health concern. The phenotypical overlap between the prodromes in these disorders calls for a simultaneous investigation into both illness trajectories. METHOD: This is an epidemiological, retrospective, multicentre, descriptive study conducted in the Grand-Est region of France in order to describe and compare early symptoms in 205 patients: 123 of which were diagnosed with schizophrenia and 82 with bipolar disorder or mood spectrum disorder. Data corresponding to the pre-morbid and prodromal phases, including a timeline of their onset, were studied in child and adolescent psychiatric records via a data grid based on the literature review conducted from birth to 17 years of age. RESULTS: Two distinct trajectories were highlighted. Patients with schizophrenia tended to present more difficulties at each developmental stage, with the emergence of negative and positive behavioural symptoms during adolescence. Patients with mood spectrum disorder, however, were more likely to exhibit anxiety and then mood-related symptoms. Overall, our results corroborate current literature findings and are consistent with the neurodevelopmental process. We succeeded in extracting a decision tree with good predictability based on variables relating to one diagnosis: 77.6% of patients received a well-indexed diagnosis. An atypical profile was observed in future mood spectrum disorder patients as some exhibited numerous positive symptoms alongside more conventional mood-related symptoms. CONCLUSION: The combination of all these data could help promote the early identification of high-risk patients thereby facilitating early prevention and appropriate intervention in order to improve outcomes.

Associations between school difficulties and family type and the role of socioeconomic, behavior and health-related difficulties in early adolescents: a population-based study.

OBJECTIVES: Nowadays many early adolescents are living in non-intact families (parents divorced/separated, reconstructed families or single parents) and have many school difficulties (learning difficulty, skipping school, school absence due to family problems, grade repetition, low school performance, and school dropout ideation). This study assessed the associations between school difficulties and family type which remain little addressed and the confounding role of socioeconomic adversities and behavior, social support and health-related difficulties (BSSHDs). METHODS: The study population included 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed at the end of school-year a questionnaire gathering socioeconomic adversities, school difficulties and BSSHDs (being obese, substances use, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt; cumulated number noted BSSHDCM). Data was analyzed using logistic regression models. RESULTS: The adolescents with parents divorced/separated, reconstructed families or single parents had a much higher risk for various school difficulties than those in intact families (sex-age-adjusted odds ratios 1.60-4.70, mostly with p < 0.001). These risks were robust and remained significant (often with p < 0.01/0.001) after adjustment for socioeconomic adversities and BSSHDCM. The contributions of socioeconomic adversities plus BSSHDCM to the risks were mostly elevated (>40%, reaching 65%) while those of socioeconomic adversities alone were mostly moderate (<30%, but reaching 52%). CONCLUSIONS: Family type plays a strong role in school difficulties among early adolescents, mainly due to socioeconomic adversities and BSSHDCM. Our results may help primary care providers identify at-risk adolescents and their problems and establish timely prevention and care.HighlightsLearning difficulty, school absence, grade repetition, low academic performance, and school dropout ideation are common in early adolescents.The adolescents with parents divorced/separated, reconstructed families or single parents have up to 4.7-time higher risk for these school difficulties than those in intact families.These risks are robust after adjustment for socioeconomic, behavior and health-related difficulties which explain up to 65% of the risks.School-difficulty prevention should consider family features and include early monitoring behavior and health-related difficulties in adolescents.

Accompagnement à la parentalité en Protection maternelle et infantile : co-construction de la logique d'intervention PERL.

INTRODUCTION: In the Greater Eastern region of France, a primary prevention intervention in perinatal care has shown promising results on child development. In order to make this intervention transferable and sustainable outside a research context, it was adapted into a universal family health program. The PERL (Petite Enfance Recherche-action en Lorraine: early childhood research-action in Lorraine) research-action aimed to evaluate the effects of this new intervention. METHOD: The objective of the article was to present the intervention logic of the PERL program, based on the evaluation of processes and mechanisms (2018-2019). The method was based on 18 semi-structured interviews with actors involved in the construction and implementation of PERL, and a consultation process. RESULTS: Supported by the Maternal and Child Protection services (PMI), PERL is a program based on home visits by nurses, analysis of practices and supervision. In contrast to a standardized or an injunctive perspective, the approach recognizes and supports the parent as an expert of his or her own child. The importance of supervision in facilitating the adoption of an unconditional benevolent posture and the professional development of nurses confronted with complex situations is one of the cornerstones of the system. CONCLUSIONS: PERL is a structured and non-standardized parenting support program, based on strong health promotion concepts. This evaluation underlines the importance and challenges of having a shared vision of the intervention logic. In the perspective of the deployment and transfer of PERL, it will be necessary to adapt the system to the contexts and territories. In this perspective, an implementation guide has been produced.

Variations in perceived primary healthcare access across family structures and their predictors in adolescents.

Families have greatly changed over time and little is known about primary care access barriers for adolescents associated with family type. We assessed family disparities in lack of listening and treatment explanations (LLTE) by general practitioners (GP), lack of treatment adherence (LTA) and GP change and the confounding roles of socioeconomic factors, school, behaviour and health difficulties among 1559 middle-school-aged (9.9-18.8 years old) adolescents who completed a questionnaire on sex, age, socioeconomic characteristics (family structure, nationality, parents' occupation, education and income), school performance, substance use, physical health, psychological health, social relationships, living environment, LLTE by GPs, LTA and GP change. Data were analysed using logistic regression models. LLTE, LTA and GP change affected 22.3, 38.0 and 7.3% of subjects respectively. Compared with the adolescents living in intact families, and controlling for sex and age, those with separated or divorced parents or reconstructed families and those with single parents respectively had 1.58- and 1.96-times higher LLTE risk and 1.48- and 1.72-times higher LTA risk. Adolescents with separated or divorced parents or reconstructed families had 1.92-times higher GP-change risk. Socioeconomic factors explained 16-36% of LLTE or LTA risks, but not GP-change risk. Further considering school, behaviour and health difficulties explained 55-87% of LLTE or LTA risks and 27% of GP-change risk. In conclusion, changes in family situations may have produced more non-intact families and adolescents with greater socioeconomic, school, behaviour and health difficulties. These factors are strong barriers to primary care access and may warrant prevention targets for adolescents, their parents, schools and GP.

MEDIACONNEX: a multicenter randomised trial based on short message service to reduce suicide attempt recurrence in adolescents.

BACKGROUND: Suicide attempt among adolescents is a public health problem around the world. The risk of recurrence is high: about 30 % of adolescents. New ways to prevent suicide attempt recurrence being developed for adult suicide attempters include maintaining contact with them, and results are encouraging. METHODS/DESIGN: The MEDIACONNEX study will be a simple blinded, parallel-group, multicenter randomised controlled trial. It will compare usual care alone to a program based on usual care plus short message service (SMS) provided to adolescents who attempt suicide and who receive treatment in pediatric and adolescent psychiatry units at hospitals in eastern France. Adolescents will be recruited over an 18-month period. The intervention will be based on the SMS, involving personalized and evolving text messages, sent on days 7 to 14 and months 1, 2, 4 and 6 after the SA. The primary endpoint will be the recurrence of an SA, with an assessment during 12 months. Secondary endpoints will be the evolution of 1) social networks, 2) depression and 3) health-related quality of life, with an assessment at inclusion and at 6 months. DISCUSSION: This paper describes the design of MEDIACONNEX, which will assess the effectiveness of an SMS program for adolescent suicide attempters on SA recurrence. This program will be easy to reproduce and inexpensive. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (no. NCT02762734 ) on March 2016.

Recurrence of suicide attempt in adolescents lost to contact early by clinicians: The 10-year REPEATERS cohort of French adolescents.

Losing contact with adult suicide attempters in the year after the suicide attempt (SA) increases the risk of recurrence. The situation with adolescents is unknown. We aimed to determine whether being lost to contact early (LCE) by clinicians is a risk factor of long-term SA recurrence among adolescents and the associated factors. Data were collected 10 years after an index SA and a Cox model was used for analysis. Among the 249 SA patients included, 59 (24%) were LCE, the most important risk factor of SA recurrence up to 10 years (hazard ratio [HR] = 2.8 [95% confidence interval (95% CI) 1.4-5.5]; p = .016). Risk factors of being LCE were female sex (odds ratio [OR] = 2.9 [95% CI 1.1-8.2]; p = .009), a psychiatric comorbidity (OR = 2.2 [1.1-4.3]; p = .023) and no family history of suicide (OR = 2.1 [1.1-4.3]; p = .047). These results support the development of preventive actions early after an SA in an adolescent to maintain contact and care.

[From nursing to changing social representations: the study of health literacy in psychiatry]. / Des sciences infirmières à la modification des représentations sociales : l'étude littératie en santé en psychiatrie.

The Litterapsy study focuses on the assessment of health literacy in patients with psychiatric disorders, a field that has been little studied in France. It is based on the observations of an advanced practice nurse specializing in psychosocial rehabilitation. Its aim is to provide objective data to better understand how these patients understand medical information and navigate the healthcare system.

Associations between depressive symptoms with suicide behaviors and negative relationships with mother and father in early adolescents: a population-based study.

BACKGROUND: Adolescent-parent negative relationships may favour depressive symptoms only (DSonly) and more strongly those plus suicide ideation (DSSI) or attempt (DSSA) in early adolescents (10-16 years). We assessed their associations which remain poorly addressed. METHODS: This study included 1256 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, academic performance, substance (alcohol, tobacco, cannabis and other substances) use, relationships with father and mother, depressive symptoms, last-12-month suicide ideation, and lifetime suicide attempt. For depressive symptoms and suicide attempt, the time of the first occurrence during adolescent's life course was also gathered. Data were analyzed using multinomial logistic regression models and Kaplan-Meier survival estimates. RESULTS: Many adolescents suffered from DSonly (8.0%), DSSI (2.5%) and DSSA (3.9%) and from negative relationships with father only (NRfather, 11.2%), mother only (NRmother, 6.1%), and both parents (NRboth parents, 10.9%). DSSA was more strongly associated (P<0.001) with NRmother (sex-age-adjusted odds ratio saOR=14.34) and NRboth parents (saOR=12.15) than NRfather (saOR=4.57). Similar results were found for DSSI (saOR 12.90, 12.23 and 2.16, respectively) and DSonly (saOR 4.18, 4.84 and 3.18, respectively). These results remained strong when controlling for socioeconomic features, academic performance and substance use (contribution reaching 62%). The risk early began and then steadily increased over time. CONCLUSIONS: Adolescent-parent negative relationships favor DSonly and more strongly DSSI and DSSA. Mother had a much higher role than father. The role and support of both parents should be considered for prevention and care to reduce adolescents' mental health difficulties.

Diagnostic performance of two teledentistry tools in elderly care facilities: the ONE-1 protocol for a pilot prospective diagnostic study.

INTRODUCTION: Elderly people living in care facilities suffer from difficulties in accessing preventive and curative dental care. This leads to poor oral health, which is an increased risk of systemic diseases, in a fragile and dependent population. All this contributes to a progressive loss of autonomy and a decreased quality of life. The use of information and communication technologies through oral telemedicine could help to overcome these barriers. We described the protocol for evaluating the diagnostic performance of two intraoral cameras against a gold standard clinical examination. METHODS AND ANALYSIS: We conduct a pilot multicentric and prospective diagnostic study (a minimal-risk, minimal-burden interventional research called ONE-1 (for Oral graNd Est step 1)) on two intraoral diagnostic tools (Soprocare camera and consumer camera) compared with a reference intraoral examination. Patients in four elderly care facilities will be included, with randomisation of participant selection and randomisation of the order of the three intraoral examinations performed by a dental surgeon. We will evaluate the diagnostic performance of each device with the asynchronous analysis of videos by two independent dental surgeons against the clinical gold standard examination performed by a single, third dental examiner. The primary outcome is the presence of at least one tooth decay in the dentition of each study participant. Second, we will evaluate the presence of other dental or oral diseases, and the time required to perform each examination. Finally, we will evaluate the organisation of patient follow-up. ETHICS AND DISSEMINATION: The protocol has been approved by the French ethics committee (Protection to Persons Committee, Nord-Ouest IV on 9 June 2021 and on 28 November 2022). Results will be disseminated through conferences' presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05089214.

School difficulties in immigrant adolescent students and roles of socioeconomic factors, unhealthy behaviours, and physical and mental health.

BACKGROUND: School is a multi-cultural setting where students need social, material, physical, and mental resources to attain school achievement. But they are often lacking, especially for immigrant students. In an early adolescence context, this study assessed risk for school difficulties among European and non-European immigrants and the roles of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours. METHODS: This cross-sectional study included 1,559 middle-school adolescents from north-eastern France, who completed a self-administered questionnaire including socioeconomic characteristics (gender, age, family structure, father's occupation, and family income), WHO-Quality of life (measuring the four dimensions physical health, psychological health, social relationships, and living environment), unhealthy behaviours (last-30-day uses of tobacco, alcohol, cannabis, and other illicit drugs and no regular sports/physical activities), grade repetition, low school performance (<10/20), and school dropout ideation at 16 years. Data were analyzed using logistic models. RESULTS: Grade repetition affected 14.8% of students, low school performance 8.2%, and school dropout ideation 3.9%. European immigrants had a higher risk for grade repetition only with a gender-age-adjusted odds ratio (OR) of 2.44, vs. French students. This odds ratio decreased to 1.76 (contribution 47%) with further adjustment for all confounders (family structure, father's occupation, family income, physical health, psychological health, social relationships, living environment, and unhealthy behaviours). Non-European immigrants had a statistically higher risk for all grade repetition, low school performance, and school dropout ideation with ORs of 3.29, 3.02, and 3.42, respectively vs. French students. These odds ratios decreased to 1.76, 1.54, and 1.54, respectively (contributions 66%, 73%, and 78%) with further adjustment for all confounders. CONCLUSIONS: Compared with French students, European immigrant students were more affected only by grade repetition while non-European immigrant students by all grade repetition, low school performance, and school dropout ideation. The contribution of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours was very high and much higher for non-European than for European immigrant students. Public policy should focus on these factors and services to reduce school difficulties.

"Without Them, I Would Never Have Been Able to Carry on" Levers for the Sustained Employment of Patients with Chronic Inflammatory Arthritis: A French Qualitative Study.

BACKGROUND: Chronic inflammatory arthritis (IA) is known to be involved in declining work outcomes and increased risk of experiencing unemployment. The aim of this study is to qualitatively identify the levers for the employment of patients with IA and AI-like conditions. METHODS: To accomplish this task, a multi-centered, exploratory qualitative design involving one-on-one semi-directed interviews and a focus group was performed among 18 IA French patients to deepen our understanding of what enables patients to maintain employment despite the limiting, chronic, and expanding nature of their symptoms. RESULTS: Analysis revealed five clusters of levers for the employment of chronic IA patients: The first cluster of levers was based on a set of verbatim records mentioning an overall improvement in the management of the disease. The second cluster of levers was based on a set of verbatim records mentioning the perceived added value of one's occupation at a personal, familial, or societal scale. The third cluster of levers was based on a set of verbatim records mentioning the perceived interpersonal supportiveness of the professional sphere. The fourth cluster of levers was based on a set of verbatim records mentioning the micro-, meso-, and macro-characteristics of the working environment. The fifth cluster of levers was based on a set of verbatim records mentioning intrapersonal attributes. CONCLUSIONS: This study deepens and updates the current knowledge on what empowers patients dealing with chronic AI. These results provide valuable insights for stakeholders involved in designing or deploying employment initiatives for patients with AI.

Experiences of parents and patients hospitalised in a child psychiatric unit for anorexia nervosa after reorganisation of care imposed by the COVID-19 Pandemic in France: a qualitative study-The QUALICOVID study.

BACKGROUND: Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. METHODS: The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. RESULTS: Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a "normal" life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. CONCLUSION: Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. TRIAL REGISTRATION: ID-RCB 2020-A01101-38-This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.

Anorexia nervosa is a common mental health condition in the adolescent population. A set care protocol is in place and patients presenting this condition experience difficulty in adapting to change. In 2020, the COVID-19 pandemic was escalating in France and a national lockdown was declared by the French government on 16 March. In Nancy, France, we opted for premature discharge where possible and an intensive outpatient care programme in accordance with government recommendations. The purpose of our study was to investigate the experiences of patients and their parents regarding changes in the care strategy following lockdown. We found that patients and parents viewed the reorganisation of care in a positive light, particularly in terms of absence from school and intensive outpatient care. Our research could also benefit adolescents presenting with anorexia nervosa and undergoing restructuring of their care programme.

Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality.

BACKGROUND: Approximately 800 million people, representing 11% of the world's population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. OBJECTIVE: This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale-French (MARS-F). METHODS: Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. RESULTS: The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS - journal de l'humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. CONCLUSIONS: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

Child Development and Early Interaction: PERL Research Protocol, a Preventive Home Visiting Program, Randomized Controlled Trial in France.

Background: Early childhood is a key period for reducing the social inequalities that affect health. Some parenting support and home visitation programs have proven to be effective in assisting parents during this period. France's Protection Maternelle et Infantile (maternal and child welfare) services (PMIs) are at the heart of this primary prevention and may adapt their intervention to improve parenting support. In this manuscript, we describe the protocol of the PERL study, an intervention based on a home visiting program. Method and design: The PERL study is a single-center, randomized, controlled interventional trial. The aim was to assess the impact of a preventive home visiting program on the development of young children and parent-baby interaction. Visits were made by PMI nurses to 64 randomly recruited families from the general population. All families who had a baby born after 37 weeks of pregnancy between September 2018 and December 2019, and who resided in the trial area were eligible. Participants were randomly allocated to the intervention group or the control group. The PMI nurses made 12 home visits in the first year, 6 in the second year, and 4 in the third and fourth years of the child's life. Primary and secondary outcomes were measured when the child was 4 and 24 months old. These measurements recorded (i) the child's developmental milestones, in particular, language and socio emotional skills, (ii) early interaction, maternal sensitivity, and attachment patterns, (iii) maternal psychopathology including depression. Discussion: This study aims to assess the impact of home visits, made by specifically-trained and supervised nurses, on the child's development and parent-child interactions. Such interventions are complementary to other preventive programs addressing the impact of social inequalities on perinatal health. Placing nurses' professional skills at the center of this project may prove an effective and cost-saving intervention compared to existing programs. The study proposes a prevention model that is in keeping with the principle of reducing social inequalities in health by providing support from the earliest age through public service. Clinical Trial Registration: The clinical trial number is NCT03506971, registered on April 24, 2018.

A Quantitative and Qualitative Study of Notes Left by Youth Who Died by Suicide in Quebec from 1895 to 1985.

The study of suicide notes and the evolution of their content could contribute to a better understanding of reasons conducive to suicide mortality and offer further prevention strategies. From 1895 to 1985, 706 coroner's inquests of individuals who died by suicide and were 20 years old or younger were found in the province of Quebec. Quantitative analysis compared those who left notes (n = 47) to those who did not leave notes (n = 659). Furthermore, notes were subjected to inductive thematic analysis. Sociodemographic characteristics of the deceased individuals did not change over time. Qualitative analysis revealed four superordinate themes: (1) last wishes, (2) to those I leave behind, (3) about me and how and why I did it, and (4) self-positioning in the world. Only the last theme evolved over the time period considered. Suicide notes shed light on the psychological state of the majority of young note leavers and suggest the persistent feelings of distress and entrapment before the suicide, which may be important factors for caregivers and family members to monitor.

Health Care Trajectories for Children With ADHD in France: Results From the QUEST Survey.

Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.

Association between Suicide Ideation and Attempts and Being an Immigrant among Adolescents, and the Role of Socioeconomic Factors and School, Behavior, and Health-Related Difficulties.

The risk of suicide behaviors in immigrant adolescents varies across countries and remains partly understood. We conducted a study in France to examine immigrant adolescents' likelihood of experiencing suicide ideation in the last 12 months (SI) and lifetime suicide attempts (SA) compared with their native counterparts, and the contribution of socioeconomic factors and school, behavior, and health-related difficulties. Questionnaires were completed by 1559 middle-school adolescents from north-eastern France including various risk factors, SI, SA, and their first occurrence over adolescent's life course (except SI). Data were analyzed using logistic regression models for SI and Cox regression models for SA (retaining only school, behavior, and health-related difficulties that started before SA). Immigrant adolescents had a two-time higher risk of SI and SA than their native counterparts. Using nested models, the excess SI risk was highly explained by socioeconomic factors (27%) and additional school, behavior, and health-related difficulties (24%) but remained significant. The excess SA risk was more highly explained by these issues (40% and 85%, respectively) and became non-significant. These findings demonstrate the risk patterns of SI and SA and the prominent confounding roles of socioeconomic factors and school, behavior, and health-related difficulties. They may be provided to policy makers, schools, carers, and various organizations interested in immigrant, adolescent, and suicide-behavior problems.

Associations between school difficulties and health-related problems and risky behaviours in early adolescence: A cross-sectional study in middle-school adolescents in France.

Health-related problems and risky behaviours (substance use) are frequent in adolescents, may alter their physical and mental capabilities, and may thus generate school absenteeism, low academic performance, and school dropout ideation. This study assessed their associations and the contribution of socioeconomic factors among 1559 middle-school adolescents (mean age 13.5+1.3) from north-eastern France. They completed a questionnaire including socioeconomic characteristics, health-related problems (poor physical health, psychological health, social relationships, and living environment) assessed with the World Health Organization's quality of life measure (score<25th percentile), risky behaviours, school absences during the present school year, last-trimester academic performance, and school dropout ideation. Data were analysed using logistic regression models. School absenteeism was frequent (12.6% of subjects for 8-14 days, and 6.0% for ≥15 days); 8.2% of subjects had low academic performance (average school-mark <10/20) and 3.9% school dropout ideation. All school difficulties were strongly associated with all health-related problems (gender-age-school-level-adjusted odds ratios gasOR between 1.5 and 4.2), and with risky behaviours (gasOR between 1.4 and 14). Socioeconomic factors differently contributed to these associations (contribution reaching 77%). Policy makers, schools, physicians and parents should be more aware of the problems and help adolescents to reduce health-related problems and risky behaviours and to increase resilience.