The months following psychiatric hospitalization are associated with heightened suicide risk among adolescents. Better characterizing predictors of trajectories of suicidal ideation (SI) post-discharge is critical.

We examined trajectories of SI over 18 months post-discharge and emotional processing variables (recognition, reactivity, and regulation) as predictors using a multi-method approach. Participants were 180 adolescents recruited from a pediatric psychiatric inpatient unit, assessed during hospitalization and 3, 6, 12, and 18-months post-discharge. At each time-point, participants reported on SI; at baseline, they completed measures of emotion dysregulation, reactivity, and a behavioral task measuring facial emotion recognition.

A three-group model best fits the data (Chronic SI, Declining SI, and Subthreshold SI groups). The Chronic SI group, compared to the Declining SI group, had greater difficulty identifying children’s sad facial expressions. The Declining SI group compared to the Subthreshold SI group reported greater overall emotion dysregulation and difficulties engaging in goal-directed behavior. No other emotional processing variable was significantly associated with specific SI trajectories.

The findings suggest that difficulties in properly identifying peer emotions may be predictive of resolution of severe SI post-discharge. Furthermore, the results suggest that emotion regulation may be an important target for discharge planning.

Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.

Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.

A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys (P < 0.05).

Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.

Cannabis use is elevated in youth with depression and attention-deficit/hyperactivity disorder (ADHD), but drivers of this increase remain underexplored. The self-medication hypothesis suggests cannabis is used by patients for mood regulation, a common difficulty in ADHD and depression. This study aimed to examine associations between mood instability and cannabis use in a large, representative clinical cohort of adolescents diagnosed with ADHD and/or depression.

Natural language processing (NLP) approaches were utilised to identify references to mood instability and cannabis use in the electronic health records of adolescents (aged 11–18 years) with primary diagnoses of ADHD (n = 7,985) or depression (n = 5,738). Logistic regression was used to examine mood instability as the main exposure for cannabis use in models stratified by ADHD and depression.

Mood instability was associated with a 25% higher probability of cannabis use in adolescents with ADHD compared to those with depression. Following adjustment for available sociodemographic and clinical covariates, mood instability was associated with increased cannabis use in both ADHD (aOR: 1.61 [95% CI: 1.41–1.84]) and depression (aOR: 1.38 [95% CI: 1.21–1.57]) groups.

This was the first study to explore the differential impact of mood instability on adolescent cannabis use across distinct diagnostic profiles. NLP analysis proved an efficient tool for examining large populations of adolescents accessing psychiatric services and provided preliminary evidence of a link between mood instability and cannabis use in ADHD and depression. Longitudinal studies using direct measures or tailored NLP techniques can further establish the directionality of these associations.

To compare the international BMI standard/references of the International Obesity Task Force (IOTF), MULT and the WHO and to analyse the association between changes in BMI growth channelling (BMI-GC) during childhood and the risk of being overweight in early adolescence.

Participant data from the Millennium Cohort Study (MCS), young lives (YL) and Generation XXI (G21) cohorts were obtained at three time points. Lin’s concordance correlation coefficient (CCC) and the weighted Kappa coefficient were used to assess the agreement among the BMI standard/references. The relative risk (RR) of being overweight at 9·5–13·5 years, based on an increase in BMI-GC (amplitude ≥ 0·67) between 3·5–6 years and 6·5–9 years, was calculated, with estimates adjusted for sex, ethnicity and socio-economic status.

Ethiopia, India, Portugal, Vietnam and United Kingdom.

Totally, 12 624 participants from the MCS, YL and G21 studies.

The prevalence of overweight across the three ages groups was higher when using the WHO standard/reference (12·8–25·9 %) compared with the MULT (17·1–22·9 %) and IOTF (13·0–19·3 %) references. However, substantial agreement (0·95 < CCC ≤ 0·99) was found among these standard/references. Children who increased their BMI-GC by ≥ 0·67 and < 0·86 were more likely to be overweight at 9·5–13·5 years (MULT-RR = 2·49, 95 % CI: 2·00, 3·09/ WHO-RR = 2·47, 95 % CI: 1·96, 3·12/ IOTF-RR = 2·31, 95 % CI: 1·82, 2·93), compared with those who have stayed in their BMI-GC.

A change in the BMI-GC among normal-weight children during childhood was associated with a significantly higher risk of being overweight at 9·5–13·5 years. These findings suggest that monitoring BMI-GC in children could be a tool to intervene and to prevent overweight in early adolescence.

Malignant catatonia represents a severe and life-threatening neuropsychiatric syndrome that demands prompt recognition and intervention. This condition poses particular diagnostic and management challenges in adolescents, especially when genetic predispositions and neurodevelopmental vulnerabilities complicate the clinical picture.

This report examines a complex case of malignant catatonia in a 17-year-old female with developmental delay but no prior psychiatric diagnoses, who developed severe cognitive and behavioural deterioration. We explore the diagnostic complexities, therapeutic challenges and potential genetic contributions to her presentation.

We present a comprehensive case analysis documenting clinical progression, treatment responses and genetic findings through whole-exome sequencing. The patient’s journey spans from initial presentation to long-term follow-up, with systematic assessment using standardised catatonia rating scales.

The patient’s condition manifested as severe psychomotor impairment, mutism and autonomic instability, showing minimal response to initial treatment. Electroconvulsive therapy yielded significant but temporary amelioration of symptoms. Genetic analysis revealed a heterozygous mutation in the pogo transposable element derived with zinc finger domain (POGZ) gene – a gene implicated in neurodevelopmental disorders – suggesting this variant contributed to her neurobiological vulnerability. Concurrent features of functional neurological disorder further compounded the diagnostic complexity, illustrating the intricate interplay between genetic susceptibility and clinical presentation.

This case illuminates the challenges clinicians face when diagnosing and treating complex neuropsychiatric presentations in adolescents, particularly when genetic predispositions intersect with functional neurological symptoms. The findings emphasise how comprehensive, multidisciplinary approaches remain essential for optimal patient care. Moreover, this case highlights the selective utility of genetic investigation in elucidating potential underpinnings of complex, treatment-resistant malignant catatonia, whilst demonstrating that genetic variants may confer vulnerability rather than direct causation.

Low neuromuscular fitness is documented in adolescents with CHD and may be associated with clinical and morphological factors, indicating the need to assess strength in this population.

To evaluate neuromuscular fitness with a multifactorial approach and its associations with other clinical and morphological factors in adolescents with CHD.

This is an observational, cross-sectional study with adolescents with CHD, aged between 10 and 18 years. Neuromuscular fitness was calculated by the sum of the z-scores of four strength tests. Clinical factors of CHD were assessed by medical records and questionnaire. The morphological factors assessed were waist-to-height ratio, sum of skinfolds, and upper arm muscle area. Descriptive statistics, analysis of covariance, and linear regressions were performed.

Sixty adolescents with CHD participated, aged 12,7 ± 2,1 years, 55% girls. Maximum isometric strength was inadequate in 33%, jump height (power) in 33%, abdominal muscle strength resistance in 78%, and upper limb muscle strength resistance in 27%. Neuromuscular fitness was inadequate in 89% (n = 53) of adolescents with CHD. In the unadjusted regression, neuromuscular fitness was associated with arm muscle area (β = 0,12; p = 0,02; R2adj = 0,08) and in the unadjusted and adjusted regression it was lower in cyanotic (vs. acyanotic) CHDs (β = −1,76; p = 0,03 R2adj = 0,24).

The findings reveal deficits in different presentations of musculoskeletal strength in a large proportion of adolescents with CHD, reinforcing the need to measure fitness from a broader perspective. Low muscle mass and the presence of cyanotic CHD may imply in reduced neuromuscular fitness in adolescents with CHD.

The impact of CHD on safe driving for adolescents is currently unknown. A prospective, qualitative descriptive study was conducted among adolescents with CHD to describe perceived barriers, facilitators, and impacts of CHD on safe, independent driving among adolescents.

Twenty-eight adolescents aged 15–19 years with CHD participated in virtual, semi-structured interviews in 2023. Adolescent interview data were analysed with conventional content analysis refined by Theoretical Domains Framework in NVivo software.

Mean participant age was 16.4 ± 0.23 years (57% male). Single ventricle physiology (25%) and septal defects (32%) were prevalent diagnoses among the study population. Most participants (92%) did not have driving restrictions.

Driving as a normal rite of passage for adolescents with CHD; and confident—but curious—about the impacts of CHD on driving. Adolescents felt confident that driving is not impacted by CHD. They were curious about the likelihood of cardiovascular emergencies and related symptoms while driving. Perceived barriers and facilitators to safe, independent driving were like what has been described in published literature among adolescents without CHD.

These findings celebrate the normalcy of driving during adolescence and reveal curiosities about the impacts of stress, anxiety, fatigue, and risks of heart attack and stroke on driving. Adolescents may look to CHD healthcare providers to help them learn about driving. These findings may inform the development of tools to facilitate meaningful conversations with adolescents regarding driving safety as part of the transition to adult CHD care.

Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.

A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.

After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].

While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.

Low-income, publicly insured youth face numerous barriers to adequate mental health care, which may be compounded for those with multiple marginalized identities. However, no research has examined how identity and diagnosis may interact to shape the treatment experiences of under-resourced youth with psychiatric conditions. Applying an intersectional lens to treatment disparities is essential for developing targeted interventions to promote equitable care.

Analyses included youth ages 7–18 with eating disorders (EDs; n = 3,311), mood/anxiety disorders (n = 3,219), or psychotic disorders (n = 3,035) enrolled in California Medicaid. Using state billing records, we examined sex- and race and ethnicity-based disparities in receipt of core services – outpatient therapy, outpatient medical care, and inpatient treatment – in the first year after diagnosis and potential differences across diagnostic groups.

Many youth (50.7% across diagnoses) received no outpatient therapy, and youth with EDs were least likely to receive these services. Youth of color received fewer days of outpatient therapy than White youth, and Latinx youth received fewer therapy and medical services across outpatient and inpatient contexts. Sex- and race and ethnicity-based disparities were especially pronounced for youth with EDs, with particularly low levels of service receipt among boys and Latinx youth with EDs.

Results raise concerns for unmet treatment needs among publicly insured youth, which are exacerbated for youth with multiple marginalized identities and those who do not conform to historical stereotypes of affected individuals (e.g., low-income boys of color with EDs). Targeted efforts are needed to ensure equitable care.

To describe the design and psychometric assessment of the Adolescent Home Food Environment Questionnaire (Acronym in Portuguese: QAAD).

This was a cross-sectional study. Data were collected between August 2021 and January 2022 through self-administered questionnaires via a survey management application accessible by computer or smartphone. The instrument was subjected to analysis by a panel of experts and to a pretest that enabled the adjustment of the language and the reformulation of the questions. The psychometric evaluation included the assessment of test–retest reliability (intraclass correlation coefficient), internal consistency (composite reliability), structural validity (exploratory structural equation modelling and confirmatory factor analysis) and construct validity (Mann‒Whitney test; P< 0·05). The following food environment aspects were evaluated: family eating practices, food availability and accessibility, cooking equipment availability and parental feeding style. Moreover, the weekly frequency of fruit, bean and added sugar beverage consumption was assessed.

A public high school in Rio de Janeiro, Brazil.

14-to-19-year-old students (n 34 in the test‒retest reliability study; n 501 in the validation analysis).

The final version of the QAAD included thirty-two questions allowing the assessment of seven dimensions of the home food environment. The QAAD demonstrated satisfactory reliability (ICC ranging from 0·44 to 0·78), adequate internal consistency (composite reliability > 0·70) and satisfactory structural and construct validity.

The careful QAAD design provided a valid, reliable and consistent instrument for characterising adolescents’ home food environments, which may provide information for tailoring and targeting healthy eating promotion actions aimed at adolescents.

There is a need for developmentally tailored intervention approaches that empower parents to respond to adolescent school refusal in the context of internalising disorders. Partners in Parenting Plus-Education (PiP-Ed+) is a manualised coach-assisted online parenting programme that has been co-designed with parents, youth and education-sector experts to fill this gap. It addresses multiple parenting factors associated with adolescent school refusal and internalising disorders.

This study aimed to evaluate the acceptability, feasibility and preliminary indications of efficacy of PiP-Ed+.

An open-label, uncontrolled trial was conducted using a mixed-methods design. Participants were 14 Australian parents of adolescents (12–18 years) who had refused school in the context of internalising disorders.

PiP-Ed+ was viewed as highly acceptable and feasible. Coaching sessions in particular were perceived as valuable and appropriate to the parents’ level of need, although longer-term support was suggested to sustain progress. Between baseline and post-intervention, there were significant increases in parents’ self-efficacy to respond to adolescent school refusal and internalising problems, and concordance with evidence-based parenting strategies to reduce adolescent anxiety and depression. Days of school refused and carer burden did not change.

Findings support the value of proceeding to evaluate the efficacy of PiP-Ed+ in a randomised-controlled trial. Results are interpreted in the context of study limitations.

Adolescent and parental perceptions of the Fontan Udenafil Exercise Longitudinal Assessment Randomised Controlled Trial (FUEL) and its open-label extension were examined, to identify factors affecting future research participation.

A validated survey was administered at two time points to adolescents (12–19 years) and their parents to assess likes/dislikes of study participation, research team, study burden and benefits. A 5-point Likert scale (strongly disagree [−2] to strongly agree [ + 2]) was used, and scores were averaged. Regression models explored potential predictors. Open-ended questions queried the most/least appealing aspects of participation and considerations for future research.

Among 250 FUEL participants at 14 centres, 179 adolescent and 183 parent surveys were completed at T1 (6 months after randomisation). Perceptions of research participation were generally positive: 1.35 ± 0.45 for adolescents; 1.56 ± 0.38 (p < 0.001) for parents. There were no significant differences between females vs. males. Themes from open-ended responses included liking to help others and themselves, liking the study team, and disliking study burden. Adolescents liked the compensation and disliked study-related testing. At T2 (end of open-label extension study), 121 adolescents and 114 parents responded. Perception scores remained high at 1.39 ± 0.51 for adolescents and 1.58 ± 0.37 for parents (p = 0.001). There were no significant gender differences in perceptions between adolescents, but mothers had slightly better perceptions than fathers (p = 0.004).

Perceptions of research were positive and slightly better for parents. Study teams and compensation were key contributors to positive perceptions. Study burden and testing were viewed less favourably. Future studies should consider families’ preferences and potential barriers to participation.