Shared Reading and Risk of Social-Emotional Problems.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics recommends literacy promotion as well as routine developmental surveillance during well-child visits to improve academic, relational, and health outcomes. In this study, we examined the possible association between shared reading and social-emotional problems among young children. METHODS: We conducted a retrospective review of longitudinal records for children aged 30 to 66 months presenting for visits to an academic pediatric primary care center between July 1, 2013, and February 1, 2019. The outcome was evidence of social-emotional problems, defined by an Ages and Stages: Social Emotional Questionnaire (ASQ:SE) score above the established cutoff. The predictor was caregiver-reported frequency of shared reading (most = 5-7 days per week, some = 2-4 days per week, rarely = 0-1 days per week) at a previous visit. Generalized linear models with generalized estimating equations were used to assess the association between the longitudinal outcome and predictor, adjusting for child demographics and needs reported on routine social history questionnaires. RESULTS: Analyses included 5693 children who completed at least 1 ASQ:SE (total of 7302 assessments) and had shared reading frequency documented before each ASQ:SE assessment. Children were predominantly Black (75%) and publicly insured (80%). Sixteen percent of ASQ:SE scores were suggestive of social-emotional concerns; 6% of caregivers reported sharing reading rarely. Children with rare shared reading had a higher risk of an ASQ:SE above cutoff compared with those with shared reading on most days (adjusted risk ratio, 1.62; 95% confidence interval, 1.35-1.92). CONCLUSIONS: Less-frequent caregiver-reported shared reading was associated with higher risk of social-emotional problems in young children presenting for primary care. This highlights potential relational and social-emotional benefits of shared reading.

Socioeconomic status and race are correlated with affective symptoms in multiple sclerosis.

OBJECTIVE: Investigate the relationship between socioeconomic status (SES) and race with self-reported fatigue, depression, and anxiety levels in multiple sclerosis (MS). METHODS: Cross-sectional review of the MS Partners Advancing Technology and Health Solutions (MS PATHS) database for adults with MS in the United States. We evaluated race and socioeconomic status (available markers: insurance, employment status, or level of education) as predictors of fatigue, depression, and anxiety sub-scores of the Neuro-QoL (Quality of life in neurological disorders), with particular interest between Caucasians/whites (CA) and African Americans/blacks (AA). Multivariate linear regression models included as covariates age, sex, disability status, smoking status, body mass index, and disease-modifying therapy. RESULTS: 7,430 individuals were included; compared to CA, AA tended to be younger, more female-predominant, and had a higher level of disability. AA had completed slightly less education, had a higher level of Medicaid coverage or uninsured status, and had higher rates of unemployed or disabled status. In the univariate model, markers of lower SES, by whichever definition we used, correlated with worse affective symptoms. In the multivariate model stratified by race, CA showed similar trends. In contrast, in AA, only lower SES by employment status was correlated with worse affective symptoms. In both CA and AA, moderate and severe level of disability correlated with worse affective symptoms. CONCLUSION: SES and race may influence affective symptoms reported by individuals with MS. The reasons for the correlation are likely multifactorial. Longitudinal studies should strive to identify factors associated with risk of affective symptoms in MS that may be modifiable.

Emotion regulation as a transdiagnostic factor in Afghan refugees.

OBJECTIVE: In response to the high rates of comorbidity as well as the severe social impairment among refugees, the examination of transdiagnostic factors such as emotion regulation appears particularly promising in this group. This study investigates the contribution of difficulties in emotion regulation to the self-reported symptom levels of posttraumatic stress disorder (PTSD), depression, and anxiety/insomnia, which are highly prevalent symptoms among refugees. In addition, the link between emotion regulation and social impairment is examined. METHOD: Participants were 74 male Afghan refugees exposed to trauma. They completed measures of trauma exposure, difficulties in emotion regulation (Difficulties in Emotion Regulation Scale), PTSD (PTSD Checklist for DSM-5), depression, anxiety/insomnia, and social impairment (General Health Questionnaire-28). RESULTS: Higher symptom severities of PTSD, depression, and anxiety/insomnia were related to the Difficulties in Emotion Regulation Scale subscales nonacceptance, goals, impulse, strategies, and clarity, but none of our outcomes was related to lack of emotional awareness. Difficulties in emotion regulation accounted for significant variance in PTSD, depression, and anxiety/insomnia beyond demographics and trauma exposure. When predicting social impairment, difficulties in emotion regulation accounted for significant variance beyond PTSD and anxiety/insomnia but not beyond depression. CONCLUSION: The findings indicate that emotion regulation may be a transdiagnostic key factor contributing to symptoms of different mental disorders as well as social impairment in trauma-exposed refugees. It highlights the need and potential directions for transdiagnostic interventions that target these difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

"Something Born of the Heart": Culturally Affiliated Illnesses of Older Adults in Oaxaca.

This qualitative research identifies and analyzes emotions and interventions linked to affective experiences and cultural aspects of health/illness/care processes in 219 older adults of eight Indigenous groups in Oaxaca, Mexico. Life stories are examined from perspectives of cultural gerontology, anthropology of emotions and critical medical anthropology with a gender perspective. Significance and healing of two illnesses of cultural affiliation: tiricia (sadness of the soul) and envidia (rancor against the successful) are examined. Conditions other than diabetes and hypertension are healed by traditional remedies or spiritual cleansings. Examining tiricia and envidia permit improved knowledge and understanding of the emotional culture and the community.

The relationship between trait mindfulness and affective symptoms: A meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ).

Trait mindfulness appears to be related to lower levels of negative affective symptoms, but it remains uncertain which facets of mindfulness are most important in this relationship. Accordingly, the present meta-analysis examined studies reporting correlations between affective symptoms and trait mindfulness as assessed by the Five Facet Mindfulness Questionnaire. A comprehensive search yielded 148 eligible studies, comprising 157 distinct samples and 44,075 participants. The weighted mean correlation for affective symptoms and overall trait mindfulness was r = -0.53. Among mindfulness facets, Nonjudge (r = -0.48) and Act with Awareness (r = -0.47) demonstrated the largest correlations, followed by Nonreact (r = -0.33) and Describe (r = -0.29). Observe was not significantly correlated with affective symptoms. No significant differences in the strength of correlations were found between anxiety, depression and posttraumatic stress disorder (PTSD) symptoms, though symptoms of generalized anxiety disorder exhibited a weaker negative relationship with the Describe facet compared to PTSD symptoms. Describe also showed a stronger relationship with affective symptoms in Eastern samples compared to Western samples, whereas Western samples had a stronger relationship with Nonjudge. These results provide insight into the nature of the association between trait mindfulness and negative affect.

Inattention, emotion dysregulation and impairment among urban, diverse adults seeking psychological treatment.

Emotion dysregulation is commonly reported among adults with Attention-Deficit/Hyperactivity Disorder. This study examined whether inattention and/or hyperactivity/impulsivity directly affect functional impairment, or whether they do so indirectly by decreasing emotion regulation capabilities. An ethnically, racially and socioeconomically diverse sample of clients seeking treatment at a low-fee outpatient mental health clinic were recruited [N = 177, male n = 59, 33.3%, mean (SD) age = 28.54 (8.41) years]. Participants completed measures of inattention, hyperactivity/impulsivity, emotion regulation and impairment at intake. Inattention was more strongly related to emotion regulation and impairment than hyperactivity/impulsivity. Hayes' PROCESS was used to test for significant indirect effects. More severe inattention was associated with less emotional clarity, which in turn was associated with worse Interpersonal Relationship difficulties; more severe inattention was associated with less access to emotion regulation strategies and poorer emotional clarity, which in turn were associated with greater Symptom Distress; and inattention was directly associated with impairment at school and work. In addition to treating inattention, clinicians should focus on emotion regulation deficits. Specifically, working with individuals to improve identification and labeling of emotions, develop strategies to reduce the intensity of their negative emotions, and feel more confident that they have these tools at their disposable may help to reduce impairment.

CR-19-0950: Event-related responses to alcohol-related stimuli in Mexican-American young adults: Relation to age, gender, comorbidity and "dark side" symptoms.

BACKGROUND: Electrophysiological variables may represent sensitive biomarkers of vulnerability to or endophenotypes for alcohol use disorders (AUD). METHODS: Young adults (age 18-30 yrs, n = 580) of Mexican American heritage were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism and event-related oscillations (EROs) generated in response to a task that used pictures of objects, food, and alcohol-related and non-alcohol-related drinks as stimuli. RESULTS: Decreases in energy in the alpha and beta frequencies and higher phase synchrony within cortical brain areas were seen in response to the alcohol-related as compared to the non-alcohol-related stimuli. Differences in ERO energy and synchrony responses to alcohol-related stimuli were also found as a function of age, sex, AUD status and comorbidity. Age-related decreases in energy and increases in synchrony were found. Females had significantly higher energy and lower synchrony values than males. Participants with AUD had higher synchrony values specifically in the beta frequencies, whereas those with a lifetime diagnosis of conduct disorder and/or antisocial personality disorder had lower alpha power and synchrony, and those with any affective disorder had lower ERO energy in the beta frequencies. Those with substance-associated affective "dark-side" symptoms had slower reaction times to the task, lower energy in the beta frequencies, lower local synchrony in the theta frequencies, and higher long-range synchrony in the delta and beta frequencies. CONCLUSIONS: These findings suggest that EROs recorded to alcohol-related stimuli may be biomarkers of comorbid risk factors, symptoms and disorders associated with AUD that also can differentiate those with "dark-side symptoms".

A systematic review of the psychosocial impact of emotional numbing in US combat veterans.

CONTEXT: Previous studies have linked posttraumatic emotional numbing symptoms in US combat veterans with an adverse impact in multiple important life domains. OBJECTIVES: We updated and evaluated the evidence examining the psychosocial impact of combat-related emotional numbing, including ethnoracial and gender differences. METHOD: We reviewed 1,209 articles published betwen January 2012 and 2018 and selected 24 studies for inclusion. We assessed the overall study quality as fair using a national quality assessment tool. RESULTS: Studies found emotional numbing to wield adverse effects in the areas of symptom nonimprovement, mental health difficulties, increased service utilization, poor relationship functioning, reduced quality of life, substance use disorders, suicidality, and aggression/violence. We also found evidence of ethnoracial and gender differences in veterans' posttraumatic stress disorder-related emotional numbing symptoms. CONCLUSION: Clinicians should incorporate findings on emotional numbing into assessment, treatment planning, and monitoring, to improve treatment retention and psychosocial outcomes. Implications for ethnoracial and gender differences require further exploration.

Influence of socio-cultural factors on the emotional problems among college going young-adult children of parents with alcoholism: A study from South India.

Young-adult children of parents with alcoholism are vulnerable to anxiety and depression. We studied the prevalence of emotional psychopathology and examined the mediating role of environmental factors (family support, community support and participation in religious rituals) in relation to psychopathology. College students (N = 1555), aged 18-24 years, from urban and rural domicile were screened on Children of Alcoholics Screening Test (CAST) and those who were positive were assessed for emotional psychopathology on Depression, Anxiety and Stress Scale (DASS-21). Young-adult children of alcoholics with emotional psychopathology were compared with those without emotional psychopathology on demographic characteristics, quality of life, and a questionnaire which measured the role of socio-cultural factors. 33% (N = 512) of 1555 participants screened were found to be Young-adult children of alcoholics. Among them, 35% (N = 181) reported experiencing emotional psychopathology. Participants with high emotional psychopathology reported receiving less support from the family (8.44 ± 1.19 vs 9.57 ± 1.26, p = 0.003), community (6.97 ± 1.08 vs 8.88 ± 1.19, p = 0.001); they participated less in religious rituals (5 ± 0.18 vs 6.56 ± 0.41, p = 0.008) compared to those without psychopathology. Quality of life was significantly lower among Young-adult children of alcoholics with emotional psychopathology. A considerable proportion of Young-adult children of alcoholics reported emotional psychopathology and their quality of life was poor. The modifiable socio-cultural factors such as family, community support and participation in religious rituals were associated with emotional psychopathology. A better utilization of these factors may mitigate the burden of emotional psychopathology and improve quality of life in this vulnerable group.

Acculturative stress, emotion regulation, and affective symptomology among Latino/a college students.

Although recent work has highlighted the relation of acculturative stress with depression and anxiety symptoms specifically among Latino/a university students, the potential mechanisms underlying these associations remain relatively unknown. The present study aims to examine difficulties in emotion regulation as an explanatory factor in the relation of acculturative stress with symptoms of depression, suicidality, social anxiety, and anxious arousal. A sample of 448 Latino/a college students (Mage = 20.67 years, SD = 1.96; 78.3% female) were recruited from a southwestern public university through an online, self-report survey. Indirect effects of acculturative stress via difficulties in emotion regulation on all outcomes were observed among males and females. Follow-up analyses showed the indirect effect on all dependent variables among Latino men occurred exclusively through lack of access to emotion regulation strategies, whereas the indirect effects among Latina women occurred through a different subfactor of difficulties in emotion regulation for each dependent variable. These findings suggest the potential clinical utility of assessing and targeting acculturative stress and difficulties in emotion regulation in the treatment of depression and anxiety problems among Latino/a college students. (PsycINFO Database Record

Measurement Invariance of the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) between the United States of America, India and the United Kingdom.

The Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) has been extensively used worldwide to assess Internet Gaming Disorder (IGD) behaviors. Therefore, investigating cultural limitations and implications in its applicability is necessary. The cross-cultural feasibility of a test can be psychometrically evaluated with measurement invariance analyses. Thus, the present study used Multigroup Confirmatory Factor Analysis (MGCFA) to examine the IGDS9-SF measurement invariance across gamers from the United States of America (USA), India, and the United Kingdom (UK). A total of 1013 gamers from the USA (n = 405), India (n = 336), and the UK (n = 272) were recruited. Although the one-factor structure of the IGD construct was supported, cross-country variations were demonstrated considering the way that this was reflected on items assessing preoccupation/salience, tolerance, deception, gaming escapism/mood modification, as well as daily activities' impairment related to gaming. Furthermore, the same scores on items assessing withdrawal symptoms, tolerance, lack of control over gaming engagement, escapism/mood modification and daily activities impairment associated to gaming, have been found to reflect various levels of IGD severity across the three groups. The implications of these results are further discussed in the context of existing evidence regarding the assessment of IGD.

Emotion dysregulation as a mechanism linking anxiety and hazardous drinking among Latinos in primary care.

BACKGROUND AND OBJECTIVES: Research suggests that Latinos experience significantly more mental health and alcohol use problems than non-Latino whites. However, relatively little is known about the mechanisms underlying alcohol use in this population. One factor associated with excessive alcohol use in Latinos is anxiety. A potential explanatory mechanism for this relationship is emotion dysregulation, as emotion dysregulation in the context of anxiety may lead to alcohol use problems/disorders. The aim of the current study was to examine the indirect effect of anxiety, through emotion dysregulation, on drinking severity and probable hazardous drinking in Latinos. METHODS: Latino adults (N = 264) were recruited from a primary care health clinic as part of a larger ongoing study examining mental health among Latinos in primary care. Participants were interviewed using the MINI and then completed various self-report assessments (in Spanish). Structural equation modeling was used to evaluate model fit. RESULTS: Structural models fit the data well. Additionally, there were statistically significant indirect effects of anxiety via emotion dysregulation on drinking severity and probable screen for hazardous drinking. DISCUSSION AND CONCLUSIONS: Anxiety may contribute to alcohol use problems due to an overall tendency to engage in maladaptive attempts to regulate emotions. SCIENTIFIC SIGNIFICANCE: Targeting emotion dysregulation in the context of anxiety and hazardous alcohol use among Latinos may be one therapeutic strategy to reduce severity of alcohol use (and hazardous drinking). (Am J Addict 2017;26:615-622).

Development and validation of brief scales to measure emotional and behavioural problems among Chinese adolescents.

OBJECTIVES: To develop and validate brief scales to measure common emotional and behavioural problems among adolescents in the examination-oriented education system and collectivistic culture of China. SETTING: Middle schools in Hunan province. PARTICIPANTS: 5442 middle school students aged 11-19 years were sampled. 4727 valid questionnaires were collected and used for validation of the scales. The final sample included 2408 boys and 2319 girls. PRIMARY AND SECONDARY OUTCOME MEASURES: The tools were assessed by the item response theory, classical test theory (reliability and construct validity) and differential item functioning. RESULTS: Four scales to measure anxiety, depression, study problem and sociality problem were established. Exploratory factor analysis showed that each scale had two solutions. Confirmatory factor analysis showed acceptable to good model fit for each scale. Internal consistency and test-retest reliability of all scales were above 0.7. Item response theory showed that all items had acceptable discrimination parameters and most items had appropriate difficulty parameters. 10 items demonstrated differential item functioning with respect to gender. CONCLUSIONS: Four brief scales were developed and validated among adolescents in middle schools of China. The scales have good psychometric properties with minor differential item functioning. They can be used in middle school settings, and will help school officials to assess the students' emotional/behavioural problems.

The moderation effect of personality on healthcare utilization in Chinese people living with HIV.

There is evidence that Type D personality can predict impaired quality of life and health status in various chronic conditions. The evidence is conflicting as to whether Type D is associated with increased healthcare services, and no study has reported on the healthcare utilization of people living with HIV (PLWH) who have a Type D personality. This study investigated the impact of Type D personality on healthcare utilization in a sample of Chinese PLWH and examined physical and emotional symptoms as possible mechanisms of healthcare utilization. This was a cross-sectional study of 199 PLWH in rural China. Participants completed a survey on physical symptoms, emotional symptoms, healthcare utilization, and Type D personality. Those PLWH with a Type D personality reported more physical and emotional symptoms and healthcare utilization than patients without this personality. Among PLWH who had a Type D personality, physical symptoms had a direct effect on healthcare utilization, and emotional symptoms did not significantly mediate this association. However, among PLWH without a Type D personality, emotional symptoms significantly mediated the effects of physical symptoms on healthcare utilization. PLWH with a Type D personality reported more healthcare utilization, which was attributed to their high physical symptoms rather than their emotional symptoms. These findings suggest that PLWH with a Type D personality might be bothered by intensified emotional symptoms, which might be too severe to be associated with physical symptoms and healthcare utilization. New prospective studies should focus on the pattern of healthcare utilization among patients with a Type D personality and their intensified physical and emotional symptoms.

Dating violence in teenage girls: parental emotion regulation and racial differences.

BACKGROUND: Teen dating violence (TDV) is a common phenomenon of great public concern. TDV may lead to severe long-term consequences for victims and offenders, and even more so for females than for males. AIM: The aim of this paper is to investigate possible underlying factors for involvement in TDV either as a perpetrator or a victim. Social learning theory is commonly used to explain internalisation of parents' behaviour on children's behavioural expressions, but less so on parents' emotion regulation as a direct link to later TDV. METHOD: We used longitudinal data from the Pittsburgh Girls Study (N = 2450) to investigate if and how parents' positive and negative emotion regulation is related to TDV, controlling for early aggression and race. RESULTS: Results show a moderately strong association between parents' negative emotion regulation and their daughters' involvement in serious dating violence. We also found that many more African American girls were involved in TDV compared to Caucasian girls, both as a perpetrator and victim. CONCLUSIONS AND PRACTICAL IMPLICATIONS: We discuss directions for future research focusing on emotion regulation and dating violence. Copyright © 2016 John Wiley & Sons, Ltd.

Pain severity and emotion dysregulation among Latinos in a community health care setting: relations to mental health.

BACKGROUND: Although pain severity is often related to poorer mental health and is one of the most common presenting complaints in community health care settings, there is little understanding of the pain experience in relation to anxiety/depressive symptoms and disorders among Latino populations in medical contexts. METHOD: To address this gap, the current study explored an interactive model of pain severity and emotion dysregulation in relation to anxiety/depressive symptoms and psychopathology among 274 Latinos who attended a community-based primary health care clinic [86.9% female; Mage=39.3 (SD=11.2); 96.0% indicated Spanish as their first language]. RESULTS: Results indicated a statistically significant interaction between pain severity and emotion dysregulation for suicidal symptoms, social anxiety symptoms and number of mood/anxiety disorders, such that more severe pain and greater levels of emotion dysregulation related to poorer mental health. Both pain severity and emotion dysregulation were significant predictors of depressive symptoms, but only pain severity was a significant predictor of anxious arousal symptoms. CONCLUSIONS: These novel findings suggest a clinically significant interplay between pain severity and emotion dysregulation among Latinos in. The results are discussed in relation to the need for new screening and intervention tactics that address interrelations between pain severity and emotional dysregulation among Latinos seeking treatment in community health-care-based settings.

The utility of the bifactor model in understanding unique components of anxiety sensitivity in a South Korean sample.

The present study was the first to examine the applicability of the bifactor structure underlying the Anxiety Sensitivity Index-3 (ASI-3) in an East Asian (South Korean) sample and to determine which factors in the bifactor model were significantly associated with anxiety, depression, and negative affect. Using a sample of 289 South Korean university students, we compared (a) the original 3-factor AS model, (b) a 3-group bifactor AS model, and (c) a 2-group bifactor AS model (with only the physical and social concern group factors present). Results revealed that the 2-group bifactor AS model fit the ASI-3 data the best. Relatedly, although all ASI-3 items loaded on the general AS factor, the Cognitive Concern group factor was not defined in the bifactor model and may therefore need to be omitted in order to accurately model AS when conducting factor analysis and structural equation modeling (SEM) in cross cultural contexts. SEM results also revealed that the general AS factor was the only factor from the 2-group bifactor model that significantly predicted anxiety, depression, and negative affect. Implications and importance of this new bifactor structure of Anxiety Sensitivity in East Asian samples are discussed.

Mental Health Effects of Premigration Trauma and Postmigration Discrimination on Refugee Youth in Canada.

This report examines the role of pre- and post-migration trauma in explaining differences in refugee and immigrant mental health. Data were derived from mother-youth refugee and immigrant dyads from six countries of origin who were living in Canada at the time of the study. Youth reports of emotional problems (EP) and aggressive behavior (AB) were the mental health outcomes. EP and AB were regressed on predictor blocks: a) status (refugee versus immigrant), visible minority, and gender; b) premigration trauma and postmigration discrimination; c) parent and youth human and social capital; d) poverty, neighborhood, and schools. Refugees suffered higher levels of EP and AB, premigration traumas, and discrimination. Postmigration perception of discrimination predicted both EP and AB and explained immigrant versus refugee differences in EP. Antirefugee discrimination net of discrimination based on immigrant or visible minority status has deleterious mental health consequences.

Emotional and Behavioral Disorders in 1.5th Generation, 2nd Generation Immigrant Children, and Foreign Adoptees.

Existing theories (e.g., acculturative stress theory) cannot adequately explain why mental disorders in immigrants are less prevalent than in non-immigrants. In this paper, the culture-gene co-evolutionary theory of mental disorders was utilized to generate a novel hypothesis that connection to heritage culture reduces the risk for mental disorders in immigrant children. Four groups of children aged 2-17 years were identified from the 2007 United States National Survey of Children's Health: 1.5th generation immigrant children (n = 1378), 2nd generation immigrant children (n = 4194), foreign adoptees (n = 270), and non-immigrant children (n = 54,877). The 1.5th generation immigrant children's connection to their heritage culture is stronger than or similar to the 2nd generation immigrants, while the foreign adoptees have little connection to their birth culture. Controlling for age, sex, family type and SES, the odds for having ADD/ADHD, Conduct Disorder, Anxiety Disorder, and Depression diagnosis were the lowest for the 1.5th generation immigrant children, followed by the 2nd generation immigrant children and the foreign adoptees. The foreign adoptees and non-adopted children were similar in the odds of having these disorders. Connection to heritage culture might be the underlying mechanism that explained recent immigrants' lower rates of mental disorders.

The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data.

Adults from black and minority ethnic (BAME) backgrounds are less likely to access mental health services through voluntary care pathways and are more likely to access through compulsory ones. The aim of the present research was to explore the association between ethnicity and care pathway through child and adolescent mental health services (CAMHS), in terms of reason for referral and case closure, in children presenting with emotional problems. A sample of N = 11,592 children from 26 CAMHS was taken from a national routinely collected dataset (56 % female; 7 % aged 0-5 years, 40 % 6-12 years, 53 % 13-18 years, and <1 % 19-25 years). Multinomial logistic regressions showed that BAME children were consistently more likely to be referred to CAMHS through education, social, and other services than primary care, compared to White British children (odds ratio (OR) = 1.52-9.96, p < .001) and they were less likely to end treatment due to child and family non-attendance (OR = 0.59-0.79, p < .05). Similar to adults, children from BAME groups may be more likely to access CAMHS through compulsory than voluntary care pathways.