BMC psychologySergio De Filippis, Giada Trovini, Giuseppe Albanesi, Ginevra Lombardozzi, Alessandro Vento, Giorgio Reggiardo, Anna Pugliese, Elio Serra, Georgios D Kotzalidis
BACKGROUND: The "MI VEDETE?" ("Do You See Me?") project explores adolescent mental health, identifying emotional distress and preventing mental health disorders through co-designing the solutions with upper secondary school students, families, and educators within the school environment. The survey assesses multiple domains of adolescent mental distress across emotional, cognitive, behavioural, physical, sleep-related, and risk-related dimensions. METHODS: The project was conducted between 2024 and 2025 in three Italian regions (Lombardy, Lazio, and Puglia). A mixed-methods approach was adopted, including six school-based "Awareness Day" events facilitated by psychiatrists, 96 semi-structured interviews ("anthropological conversations") with students, parents, and teachers, six co-design workshops involving teachers, psychologists, sociologists, and local experts, and a large-scale survey that collected 2,139 responses across different groups. This study focuses on the analysis of the survey data. RESULTS: The findings reveal significant differences among students, parents, and teachers in the perception of adolescent mental health. Students reported high levels of anxiety, emotional exhaustion, isolation, and distress, while both types of informants frequently perceived inferior prevalence rates and differently attributed the causes of these conditions. CONCLUSIONS: The findings highlight marked differences between adolescents' self-reported emotional distress and adults' perceptions of adolescent mental health. The results underscore the need for educational initiatives specifically designed to improve parents' and teachers' ability to recognise early signs of psychological distress in young people. Enhancing adults' capacity to observe and understand adolescents' emotional needs should enable timely intervention, activating targeted support pathways and preventing mental health deterioration.
Irish medical journalO Deighan, A MacManus, J Hayden, F McNicholas
AIM: The Long-Term Illness Scheme (LTI), funded by Ireland's Health Service Executive (HSE), provides free prescriptions at the primary care level for sixteen specified physical and mental health conditions. This survey aimed to assess Child and Adolescent Psychiatrists' knowledge of the scheme, its usage, and the perceived barriers or enablers to its utilization. METHODS: A cross-sectional survey was conducted among Consultants and Higher Specialist Trainees in Child and Adolescent Psychiatry in Ireland (59) on an anonymous, opt-in basis. RESULTS: The findings revealed low levels of knowledge and utilization of this scheme. Majority of Psychiatrists, 35 of 57 (61%,) were not aware of the age criteria, medications reimbursable or that initiation of medication under the LTI scheme is restricted to Consultant Psychiatrists. Content analysis highlighted significant barriers, lack of knowledge and education on this scheme, restrictive inclusion criteria, clinician burnout and administrative burden in clinical practice. DISCUSSION: These results underline the need for national awareness campaign on the LTI scheme, a review of medication included along with improved streamlined administrative processes. Addressing these gaps could reduce barriers for clinicians and improve access to psychotropic medications for children and adolescents with mental illness. Such measures are crucial to enhancing equitable care for mental illness.
BACKGROUND: Evidence on electroconvulsive therapy (ECT) in adolescents is largely retrospective and rarely reports psychiatric outcomes together with anesthetic and procedural characteristics. We characterized modified ECT courses in a tertiary child and adolescent psychiatry service. METHODS: This retrospective cohort included adolescents aged 13-18 years treated with modified ECT from 2010 to 2025; the ECT course was the unit of analysis. Illness severity was rated with the Clinical Global Impression-Severity (CGI-S) scale at admission and discharge. The primary outcome was a composite of any documented hemodynamic event, prolonged seizure, or recovery/behavioral event; short or absent seizures were analyzed separately as a technical seizure-adequacy outcome. Logistic models used standard errors clustered by patient. RESULTS: Among 156 ECT courses in 150 adolescents (1,465 sessions), diagnoses were schizophrenia spectrum (46.2%), bipolar spectrum (23.1%), neurodevelopmental (18.6%), and depressive disorders (12.2%). Median CGI-S decreased from 5.0 at admission to 3.0 at discharge, with a study-defined decrease of at least 2 points in 152 courses (97.4%) and a discharge CGI-S of 2 or less in 60 (38.5%). The primary composite event occurred in 63 courses (40.4%), involving one event domain in 49 (31.4%) and two or more in 14 (9.0%). Short or absent seizures occurred in 42 courses (26.9%); theophylline use was associated with higher odds of this outcome, most plausibly reflecting confounding by indication. Estimates for age, bipolar spectrum disorder, and succinylcholine dose were imprecise and hypothesis-generating. CONCLUSIONS: In this severe tertiary cohort, ECT-centered inpatient care was associated with substantial within-course global improvement, and acute course-level events were common but usually confined to a single domain. Acute anesthesia- or procedure-related events and technical seizure adequacy should be reported separately, and exploratory dose or medication associations should not be interpreted causally.
JMIR formative researchIra-Katharina Petras, Sarah Wüllner, Katharin Hermenau, Kathleen Meerkamp, Michael Siniatchkin
BACKGROUND: Digital media literacy (DML) may help adolescents to handle online risks, misinformation, digital violence, and problematic media use more reflectively. However, structured interventions for adolescents in child and adolescent psychiatry (CAP), particularly in inpatient and day-treatment settings, remain scarce. OBJECTIVE: This study evaluated the feasibility, acceptability, and perceived usefulness of a manualized DML group for adolescents in CAP and explored preliminary changes in digital self-efficacy and critical media literacy (CML). METHODS: A prospective single-arm feasibility study with an embedded pretest-posttest and session-level process evaluation was conducted across 3 CAP clinics in Germany. The intervention comprised 6 weekly 60-minute, manualized modules covering data protection, social media use, and digital violence. Sessions were delivered in an open-group format by trained clinical staff. Recruitment was embedded in routine care, and clinical group participation was independent of study evaluation. Adolescents and facilitators completed paper-and-pencil questionnaires at baseline (T1), after each session, and post intervention or discharge (T2). Analyses were primarily descriptive; exploratory pre-post analyses used paired t tests. RESULTS: The analytic feasibility sample comprised 121 adolescents who attended at least 1 module. T1 data were available for n=60 and T2 data for n=38. Overall, adolescents attended a median of 2 modules (IQR 1-3; mean 2.46, SD 1.65, range 1-6), and 45 attended at least 3 modules. Session-level ratings indicated moderate to high acceptability. Facilitator-rated manual fidelity was moderate to high. Retrospective T2 ratings indicated moderate to high helpfulness (n=38; mean 3.55, SD 1.18; median 4.0, IQR 3.0-4.0) and satisfaction (n=38; mean 3.79, SD 1.07; median 4.0, IQR 3.0-5.0), with no significant differences between completers and noncompleters for helpfulness (U=125.00; P=.60) or satisfaction (U=122.00; P=.53). Among completers (≥3 modules and T2 data; n=28), didactic method acceptability was moderate (mean 2.85, SD 0.60), and perceived learning was moderate to high (mean 3.33, SD 0.95). Exploratory pre-post analyses indicated an increase in perceived self-efficacy for recognizing misinformation (n=21; T1 mean 2.94, SD 0.59; T2 mean 3.38, SD 0.63; t20=2.58; Hedges g=0.56, 95% CI 0.09-1.02; P=.02). Overall CML increased descriptively (P=.07), whereas digital media self-efficacy did not change significantly (P=.27). CONCLUSIONS: Our manualized DML group was feasible and acceptable in routine CAP. Open-group delivery and variable treatment stays limited intervention exposure and data completeness. Findings suggest that brief DML groups may address safety- and knowledge-oriented competencies, but controlled mixed methods studies with systematic recruitment and missing-data documentation are needed.
Current psychiatry reportsTomoya Hirota, Anthony Guerrero, Bennett Leventhal, Daniel Fung, Norman Sartorius, Takashi Okada, Phyllis Chan, Chawanun Charnsi, Keun-Ah Cheon, Oyunsuren Dava…
PURPOSE OF REVIEW: The Far East is highly vulnerable to natural disasters and mass trauma, underscoring the critical need for child and adolescent psychiatrists (CAPs) equipped to deliver disaster mental health care. To understand regional capacity and preparedness, we conducted the third wave of a 12-year longitudinal survey tracking CAP postgraduate training systems and workforce trends in the Far East. RECENT FINDINGS: In 2024, representatives from 16 of 17 countries and functionally self-governing areas completed a standardized online questionnaire. Data regarding CAP training structures, specialty recognition, and workforce size were descriptively compared with previous survey waves (2012 and 2017). The CAP workforce has steadily increased, with new specialists emerging in Cambodia, Mongolia, and Myanmar. By 2024, 75% (12/16) of regions offered postgraduate CAP training-up from 59% in 2017-and recognition of CAP as a distinct specialty increased to 75%. Curricula have diversified, frequently integrating school consultation (83%) and forensic psychiatry (58%). However, national guidelines, board certification (44%), and institutional support remain highly uneven across the region. While CAP training in the Far East has significantly expanded, persistent workforce disparities limit the region's ability to deploy skilled specialists during humanitarian emergencies. Strengthening CAP training systems is an essential public health measure to fortify regional resilience and address child and family disaster psychiatry needs.
Child and adolescent psychiatric clinics of North AmericaDebra E Koss, Falisha Gilman
Despite advances in scientific research, adolescents with substance use disorders continue to experience challenges accessing evidence-based treatment, including stigma, cost, and workforce shortages. As child and adolescent psychiatrists (CAPs), we use our clinical expertise to address these barriers in direct clinical encounters. Throughout this article, you will gain an understanding of how CAPs can improve access to care for the pediatric population and learn the necessary skills to advocate for policy solutions. Emphasis will be placed on the necessity of advocacy education and mentorship at every stage of professional development to support CAPs in translating clinical expertise to advocacy skills.
Swiss medical weeklyDaniel Graf, Silvano Sele, Corinna Reichl, Sarah Oberli, Katharina Blankart, Daniel Ammann, Michael Kaess
STUDY AIMS: Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland. METHODS: Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs. RESULTS: The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds. CONCLUSIONS: In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).
Current psychiatry reportsStephen Cheng, Elizabeth Kim, Rina Bhalodi, Tevin Um, Dustin Wong, Eunice Y Yuen
PURPOSE OF REVIEW: This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. RECENT FINDINGS: Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI's limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
Tijdschrift voor psychiatrieE D'hoore, E Van Raes, N Vliegen
BACKGROUND: The therapeutic relationship is an important predictor of the effectiveness of psychotherapy. Within this relationship, the balance between distance and closeness plays a crucial role. However, within child psychiatry, little is known about the conceptual scope and clinical interpretation of these concepts. AIM: To investigate how child and adolescent psychiatrists, in their contact with minors, give meaning to distance and closeness in the therapeutic relationship and what considerations they make in clinical practice. METHOD: In this qualitative study, semi-structured interviews with ten child psychiatrists explored various perspectives that describe the experience of distance and closeness in clinical practice. Thematic analysis identified meaningful patterns and themes from the interviews. RESULTS: The following themes emerge: 1. Space, time and availability as regulators of distance and closeness; 2. Physical contact: the tension between providing good care and maintaining professional boundaries; 3. Emotional involvement as a source of professional tension; 4. Personal and professional identity in the therapeutic relationship; 5. The doctor as a human being; 6. Professional role and clinical assignment as a framework for establishing distance and closeness. CONCLUSION: Distance and closeness take shape in various ways in the therapeutic relationship with children and adolescents. Child psychiatrists seek an appropriate balance in their own way. This article offers an initial thematic framework to support further dialogue and research.