Child and Adolescent Psychiatry and Mental Health最新文献

{"title":"More symptoms, less crime: distinguishing clinical severity from violence risk in a national follow-up study of adolescent forensic inpatients.","authors":"Alfred Sarno, Riittakerttu Kaltiala","doi":"10.1186/s13034-026-01135-z","DOIUrl":"https://doi.org/10.1186/s13034-026-01135-z","url":null,"abstract":"<p><strong>Background: </strong>The predictive value of symptom severity on post-discharge criminal offending in forensic psychiatric settings remains unknown, potentially leading to prolonged institutionalization of stabilized patients under the rationale of public safety. Furthermore, outcomes of adolescent forensic psychiatric inpatient care are understudied.</p><p><strong>Aims: </strong>To explore if clinical symptom severity predicts subsequent criminal offending, to investigate the role of severe disorders in future offending, and to quantify offence rates among former adolescent forensic inpatients compared to the general population.</p><p><strong>Methods: </strong>This national register-based study followed 289 youths (under 18 years) consecutively admitted to a forensic psychiatric inpatient unit in Finland between 2003 and 2019 for up to 18 years. Offence rates were analyzed using Cox proportional hazards regression, comparing patients against 1,149 matched general population controls. Predictors included the Brief Psychiatric Rating Scale (BPRS; score range 18-126 points) and Structured Assessment of Violence Risk in Youth (SAVRY), both assigned during a two-month evaluation.</p><p><strong>Results: </strong>Former patients had a significantly higher hazard of offending than controls (HR 6.67, 95% CI 5.10-8.72). However, higher clinical symptom severity (BPRS) independently reduced the risk of future offending by 2% per point (HR = 0.98, 95% CI 0.96-1.00, p = .025); e.g., a 20-point difference corresponds to an approximate 34% reduction in risk. High-risk patients (SAVRY) with severe symptoms offended at rates similar to low-risk patients. Personality disorders were associated with subsequent offending (HR = 1.92, 95% CI 1.01-3.66, p = .047), while schizophrenia spectrum disorders and Length of Stay were not.</p><p><strong>Conclusions: </strong>Severe psychopathology predicts reduced subsequent offending after forensic adolescent inpatient care, possibly due to treatment responsiveness, systemic safety nets and functional impairment. Prolonging hospitalization under the rationale of public safety based on symptom severity may be unnecessary for stabilized patients if continuity of care and outpatient supervision are ensured.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life course, value orientation and self-concept in adolescents with delinquent behavior: a comparative study of delinquent, psychiatric, and healthy youths.","authors":"Helena Gampe, Kornelius Winds, Lucas Rainer, Belinda Plattner","doi":"10.1186/s13034-026-01136-y","DOIUrl":"https://doi.org/10.1186/s13034-026-01136-y","url":null,"abstract":"<p><strong>Background: </strong>Juvenile delinquency is closely linked to complex psychosocial and value-based developmental trajectories. This study compares life-course narratives (childhood and school experiences, daily life structure), value orientation, self-concept, and standardized self-reports of emotions among adolescents with delinquent behavior, adolescents with psychiatric disorders, and healthy peers.</p><p><strong>Methods: </strong>Using a mixed-methods design, narrative interviews were conducted with all three groups (N = 48). Participants were asked to describe their feelings in relation to these domains in order to assess emotional processing, measured by the Positive and Negative Affect Schedule (PANAS).</p><p><strong>Results: </strong>Compared with their healthy peers, narratives from adolescents with delinquent behavior were characterized by greater strain across their developmental course. These descriptions were marked by housing and caregiving instability, insecure bonding experiences with primary caregivers, difficulties in forming coherent and socially oriented value systems, and a tendency toward self-concepts marked by overcompensation. Regarding emotional experience, PANAS results indicate that both the delinquent and psychiatric groups reported higher levels of negative affect than healthy adolescents. Although adolescents with psychiatric disorders also reported adversity, their narratives tended to reflect greater variability in protective factors and more opportunities to benefit from therapeutic and relational support.</p><p><strong>Conclusion: </strong>The findings suggest that delinquent behavior may arise from the cumulative interplay of early adversity, environmental instability, disrupted relational experiences, and challenges in developing individualized values and stable, non-compensatory self-concepts. These results highlight the importance of interventions that address potential moral injury, strengthen reliable relational contexts, and promote socially integrated value orientations. Qualitative approaches provide important insights into these mechanisms and should complement quantitative assessments when working with high-risk youth.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital media balance and mental health: effects of a school-based program.","authors":"Mona Guath, Sissela B Nutley, Lisa B Thorell","doi":"10.1186/s13034-026-01131-3","DOIUrl":"10.1186/s13034-026-01131-3","url":null,"abstract":"<p><strong>Background: </strong>Adolescent mental health problems are rising globally, with problematic digital media use identified as an important risk factor. Universal school-based interventions that integrate Social and Emotional Learning (SEL) with digital balance strategies may promote resilience and reduce risk. This study evaluated On the Inside, a classroom-based SEL and digital balance program.</p><p><strong>Methods: </strong>A total of 750 students aged 13-15 years from eight schools (two control schools) participated. Surveys were completed at baseline (T1), post-intervention (T2), and, for a subsample, one year later (T3). The program comprised five video-based sessions delivered by teachers. Outcomes included psychological distress (PHQ-4), problematic social media use (GSMQ-9), and adaptive behaviors. Data were analyzed using multilevel mixed models to account for clustering by school.</p><p><strong>Results: </strong>Relative to controls (n = 193), students in the intervention group (n = 557) reported reductions in psychological distress, problematic social media use, multitasking, and avoidance, alongside increased use of adaptive strategies such as distancing phones during study and challenging negative thoughts. Several effects, including reduced distress and avoidance, and sustained strategy use, remained at one-year follow-up. No significant effects were observed for sleep, help-seeking, or breathing strategies.</p><p><strong>Conclusions: </strong>This universal, teacher-delivered program integrating SEL and digital balance was feasible and produced small but clinically meaningful improvements in adolescent distress and related behaviors, with some effects sustained after one year. These findings support the potential of school-based interventions to address digital media-related risks and promote mental health at a population level. Further research should refine program components, particularly for sleep and screen time, and examine cost-effectiveness to inform broader implementation.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up effects of mindfulness-based interventions on anxiety in adolescents: a systematic review and meta-analysis of randomized controlled trials.","authors":"Hongbo Zhao, Hongxin Huang","doi":"10.1186/s13034-026-01134-0","DOIUrl":"https://doi.org/10.1186/s13034-026-01134-0","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is one of the most prevalent mental health problems in adolescence, and its onset often coincides with the secondary school years. Mindfulness-based interventions (MBIs) have shown short-term benefits for reducing anxiety in young people, but the durability of these benefits after treatment remains uncertain. To inform clinical and school-based practice, a quantitative synthesis focused specifically on follow-up effects is needed.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating MBIs in adolescents aged 10-19 years and reporting anxiety outcomes at follow-up assessments conducted at least 3 months after the intervention. The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251234254). Major databases (PubMed, Embase, Web of Science, Cochrane Library, Scopus and CNKI) were searched from inception to November 2025. Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Standardized mean differences (SMDs; Hedges' g) with 95% confidence intervals (CIs) were calculated under a random-effects model. Pre-specified subgroup analyses were conducted by age group (10-14 vs. 15-19 years), intervention type (MBSR/MBCT vs. mindfulness-based stress prevention, MBSP), and follow-up interval (3-6 vs. ≥6 months). Univariable meta-regression explored the impact of mean age and total intervention duration on effect sizes. Certainty of evidence for key outcomes was rated using GRADE.</p><p><strong>Results: </strong>Eleven randomized controlled trials (n = 9,856 adolescents) were included. Overall, MBIs were associated with a modest reduction in anxiety symptoms at follow-up assessments ≥ 3 months after treatment (SMD = - 0.30, 95% CI - 0.44 to - 0.16; I² = 79%). Subgroup analyses indicated a moderate effect at 3-6 months (SMD = - 0.40, 95% CI - 0.56 to - 0.25; I² = 52%) but a very small effect at ≥ 6 months (SMD = - 0.09, 95% CI - 0.14 to - 0.05; I² = 0%), with a significant difference between subgroups (p < 0.001).</p><p><strong>Conclusions: </strong>MBIs may confer a modest follow-up benefit on adolescent anxiety, driven mainly by outcomes measured at 3-6 months. Evidence at ≥ 6 months is limited and of low certainty, and does not support a firm conclusion regarding maintenance of effects. Future trials should test whether maintenance-focused components, such as booster sessions or ongoing practice support, improve durability.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of restrictive practices in child and adolescent mental health inpatient care: an integrative review.","authors":"S U Larsen, M L Pedersen, J Baker, J P Hansen, S Lemcke, F A Gildberg","doi":"10.1186/s13034-026-01119-z","DOIUrl":"https://doi.org/10.1186/s13034-026-01119-z","url":null,"abstract":"<p><p>Children and adolescents admitted to psychiatric inpatient units may be subjected to restrictive practices. Such practices can have significant psychological and physical consequences for the young inpatients, as well as for their relatives and the staff involved. Despite this, experiences of restrictive practices remain underreported particularly regarding the mechanisms that sustain their continued use, even in the face of international and national regulations aimed at reducing restrictiveness. A deeper understanding of these mechanisms can help nuance clinical decision-making and illuminate the complex relationships between staff, children, and relatives. This integrative review aims to provide such insights through a systematic literature search that includes both peer-reviewed and grey literature across quantitative and qualitative studies. The included papers were assessed using JBI and GRADE-CERQual and findings were analyzed using Systematic Text Condensation showing that restrictive practices persist not only due to acute crises but through intertwined mechanisms: their ethical justification in care, their institutional and legal normalization, and their embeddedness in everyday ward culture. Children and adolescents, relatives, and staff each shape how safety and responsibility are understood, reinforcing restrictive practices in different ways. These findings point to the need for strategies extending beyond regulation toward cultural and relational approaches that promote emotional safety, agency, and recovery-even when restrictive practices remain necessary. The review was preregistered at PROSPERO (CRD420251032437).</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood adversity moderates the association between serum cortisol and earlier-onset posttraumatic stress disorder.","authors":"Jae-Min Kim, Hee-Ju Kang, Ju-Wan Kim, Ju-Yeon Lee, Hyunseok Jang, Jung-Chul Kim, Sung-Wan Kim, Il-Seon Shin","doi":"10.1186/s13034-026-01129-x","DOIUrl":"https://doi.org/10.1186/s13034-026-01129-x","url":null,"abstract":"<p><strong>Background: </strong>The role of cortisol in Posttraumatic stress disorder (PTSD) remains controversial due to inconsistent findings. Childhood adversity may recalibrate the hypothalamic-pituitary-adrenal (HPA) axis, altering the prognostic value of cortisol. Furthermore, the biological mechanisms underlying earlier- versus delayed-onset PTSD trajectories may differ.</p><p><strong>Methods: </strong>A total of 895 patients hospitalized for physical injuries were prospectively followed for 2 years. Baseline serum cortisol levels and childhood adversity were assessed within one month of injury. PTSD diagnoses and onset timing were determined at 3, 6, 12, and 24 months using the Clinician-Administered PTSD Scale for DSM-5. Logistic regression models evaluated individual and interactive effects of cortisol and childhood adversity on PTSD onset, adjusting for relevant covariates.</p><p><strong>Results: </strong>Neither baseline serum cortisol levels nor childhood adversity independently predicted PTSD onset. However, a significant interaction was observed for earlier-onset PTSD, such that lower cortisol levels were associated with increased risk only among individuals without childhood adversity. This interaction was not observed for delayed-onset PTSD. Cortisol levels were not correlated with childhood adversity.</p><p><strong>Conclusion: </strong>Baseline cortisol predicts earlier-onset PTSD only in the absence of childhood adversity, suggesting that developmental context modifies the prognostic significance of cortisol. Biological risk stratification for PTSD must consider developmental history and symptom onset timing.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and effectiveness of the web‑based skills training START NOW in adolescents in residential youth care: a cluster randomized controlled trial.","authors":"Donja Brunner, Valentine Savary, David Bürgin, Linda Kersten, Janine Alfano, Nikki Rommers, Lelia Lanz, Chiara Chillà, Andreas Papageorgiou, Noortje Vriends, Christina Stadler","doi":"10.1186/s13034-026-01127-z","DOIUrl":"https://doi.org/10.1186/s13034-026-01127-z","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults in residential youth care (RYC) face cumulated adversity and high emotional and behavioral problems yet face structural barriers that limit access to evidence-based mental health care. While digital tools promise scalability and flexibility, real-world implementation and effectiveness in vulnerable youth in institutional care remain understudied.</p><p><strong>Objective: </strong>This study aimed to evaluate the implementation and effectiveness of a newly developed web-based self-help or group-facilitated version of the START NOW intervention in a three-arm cluster-randomized control trial for youth in RYC in Switzerland.</p><p><strong>Methods: </strong>164 adolescents and young adults (M = 16.6 years, SD = 1.5; 43.8% female) from 27 RYC institutions were enrolled in a 9-week self-help or group-facilitated START NOW intervention tested against treatment-as-usual (TAU). Psychological inflexibility was the primary outcome; secondary outcomes included trait resilience, well-being, self-efficacy, functional impairment, and distress. Surveys were administered at baseline, post-intervention, 3-, and 6-month follow-up. Primary analyses employed linear mixed models in an intention-to-treat approach imputing missing data to estimate treatment effects at 3-month follow up. The trial was registered: ClinicalTrials.gov Identifier: NCT05313581; 6th April 2022.</p><p><strong>Results: </strong>The group-facilitated condition showed higher intervention compliance than the self-help help condition, over 50% of youth in the self-help group did not conduct a single session. Longitudinal follow‑up completion rates declined substantially, with only 37.8% providing data at T3 with the self-help group displaying the lowest levels (TAU 47.8%, 20.7% self-help, 48.3% facilitated group). No significant differences in psychological inflexibility or any secondary outcomes were found between study arms.</p><p><strong>Conclusions: </strong>In contrast to prior evidence from group-based START NOW interventions with more intensive facilitator support, the web-based START NOW adaptation evaluated in this found no evidence for additional benefits over TAU in RYC settings. Findings highlight critical implementation barriers to high attrition and missing data. Successful adoption of digital interventions in RYC require tailored, blended approaches with active facilitation and adaptive support structures.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticipated discrimination and suicidal behaviors among Black gay and bisexual male adolescents: the moderating role of developmental assets.","authors":"Donte T Boyd, Arielle H Sheftall","doi":"10.1186/s13034-026-01128-y","DOIUrl":"10.1186/s13034-026-01128-y","url":null,"abstract":"<p><strong>Background: </strong>Black gay and bisexual male adolescents (BGBMA) face disproportionately high rates of suicidal behaviors, shaped by intersecting racial and sexual minority stressors. Anticipated discrimination-a future-oriented minority stressor-may be an important yet understudied correlate of suicidality in this population. Guided by the Developmental Assets Framework, this study examined whether internal developmental assets (positive identity, positive values, social competencies) mitigate the association between anticipated discrimination and suicidal behaviors among BGBMA.</p><p><strong>Methods: </strong>Data were drawn from 384 BGBMA aged 14-17 years residing in three Midwestern U.S. cities who completed an anonymous online Qualtrics survey between December 2023 and January 2024. Suicidal behaviors were assessed using a self-report adaptation of the Columbia-Suicide Severity Rating Scale (C-SSRS). Anticipated discrimination was measured with a nine-item subscale of the Intersectional Discrimination Index, and internal developmental assets were assessed with validated scales of positive identity, positive values, and social competencies. Linear regression models tested main effects of anticipated discrimination and internal assets on suicidal behaviors, followed by moderation analyses examining interaction terms between anticipated discrimination and each asset.</p><p><strong>Results: </strong>Higher anticipated discrimination was significantly associated with greater suicidal behaviors (b = 0.46, p = 0.001). Positive identity (b = - 0.56, p < 0.001) and social competencies (b = - 0.78, p < 0.001) were each associated with lower suicidal behaviors. Two significant moderation effects emerged. Positive identity buffered the association between anticipated discrimination and suicidal behaviors (interaction b = - 0.23, p = 0.011); at high levels of positive identity, anticipated discrimination was no longer significantly associated with suicidal behaviors. In contrast, social competencies amplified the discrimination-suicidality association (interaction b = 0.49, p = 0.015), such that anticipated discrimination was most strongly related to suicidal behaviors at high levels of social competencies.</p><p><strong>Conclusions: </strong>Anticipated discrimination is a robust correlate of suicidal behaviors among BGBMA. Internal developmental assets do not function uniformly: positive identity appears protective, whereas higher social competencies may confer vulnerability under conditions of anticipated discrimination. Findings underscore the need for developmentally and culturally grounded suicide prevention strategies that both strengthen identity-related assets and address discrimination-related stress in Black gay and bisexual male adolescents.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicidal behaviour and resilience-related factors among adolescents in Poland and war-affected Western Ukraine.","authors":"Krzysztof Ostaszewski, Agnieszka Bielawska, Anna Borucka, Jakub Greń, Inna Haletska, Halyna Herasym, Larysa Klymanska, Milena Markiewicz, Iryna Mirchuk, Agnieszka Pisarska, Viktor Savka, Oksana Zelena, Maryna Klimanska","doi":"10.1186/s13034-026-01126-0","DOIUrl":"https://doi.org/10.1186/s13034-026-01126-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The purpose of the research was to verify compensatory and protective models of resilience [14, 27] , among adolescents from Poland and war-affected Ukraine. Guided by the socio-ecological model of resilience theory, we examined the relationship between several psychosocial risk and protective factors and suicidal behaviour among adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Data were collected via online self-report questionnaires in Autumn 2024 from 14 to 15 year olds in Western Ukraine (N = 2179) and Warsaw, the capital of Poland (N = 1154). The response rate achieved was 75% in Lviv, 73% in Drohobych and 70% in Warsaw. Suicidal behaviour was measured by a 3-item Suicidal Thoughts and Behaviours scale adapted from the MINI Kid (Sheehan et al. 2010) (α = 0.87 - 0.90). Four groups of risk factors were examined: 1/ exposure to traumatic experiences, with a 9-item index, and victimization measured by two single questions; 2/ mental health problems (symptoms of depression measured by the shortened 4-item CES-D scale, non-suicidal self-injuries measured by a single question, problems of conduct measured with a 12-item index, problematic internet use measured with the Internet Disorder Scale - Short Form (IDS9-SF); 3/ substance use (alcohol, drug, cigarette and tranquiliser use, all measured with single questions); and 4/ personality characteristics that increase vulnerability (impulsiveness, measured by the Barratt Impulsiveness Scale-Brief (BIS-Brief), sensation seeking measured by a 6-item scale). Three groups of protective factors were also measured: 1/ parental/ familial (parental management, family relationships measured using the Brief Family Relationship Scale); 2/ school (school bonding measured with a 6-item scale, sense of safety at school measured by a single question); and 3/ individual (religiosity, measured by two single questions, individual physical activity measured by a single question, positive perception of the future, and five key aspects of positive youth development (connection, confidence, character, caring, competences), measured with the Positive Youth Development (PYD-VSF) scale. Hierarchical linear regression was conducted to test models of resilience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Descriptive analyses showed that significantly more teenagers in Warsaw (Poland) than in Lviv and Drohobych (Ukraine) had suicidal thoughts in the past 12 months (33.6% vs. 14.7%), had at some time planned suicide (35.5% vs. 16.9%), and had at some time attempted suicide (17% vs. 7.2%). In both countries, suicidal behaviours were significantly more prevalent among girls than boys. Further analyses also showed that adolescents in Warsaw were more exposed to significant risk factors than their peers in Lviv and Drohobych and, conversely, that youth in Lviv and Drohobych were more strongly protected against these risks than those in Warsaw. Regression analysis indicated that traumatic experiences, victimization, dep","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality among adolescent and young adults in specialized substance use treatment: a Swedish register study.","authors":"Patrik Karlsson, Mats Ekendahl, Philip Lindner","doi":"10.1186/s13034-026-01125-1","DOIUrl":"10.1186/s13034-026-01125-1","url":null,"abstract":"<p><strong>Background: </strong>Individuals with substance use problems have higher mortality risks than the general population. This study aimed to assess all-cause and specific-cause mortality among adolescents and young adults in specialized substance use treatment in Sweden, a largely overlooked group in the literature.</p><p><strong>Methods: </strong>A registry cohort was compiled of patients (13-25 years) who between 2011 and 2021 were in contact with Sweden's largest healthcare provider of adolescent substance use treatment, with mortality data covering the same period. Sex, migrant background, parental education, convictions and treatment variables were compiled from registries and included as predictors. We calculated crude mortality rates (CMRs) and estimated Cox regression models to explore the associations between the predictors and mortality. This also included testing for interactions between convictions and treatment variables.</p><p><strong>Results: </strong>Among 23,709 patients, 229 deaths were recorded, meaning that slightly less than 1% died during the follow-up window. The overall CMR was 1.68 deaths per 1000 person years (95% CI = 1.47-1.91), with differences across some predictors. In the fully adjusted Cox regression, significantly elevated mortality risks were observed among males (HR = 1.69, 95%CI = 1.23-2.32), those who had received inpatient treatment (HR = 1.89, 95% CI = 1.42-2.52), and those who had been convicted (HR = 2.64, 95%CI = 1.92-3.63). No significant difference in mortality risk was observed for migrant status, parental education, or number of outpatient visits in the fully adjusted models. Among convicted patients, more outpatient visits were related to a lower mortality risk (HR = 0.98, 95%CI = 0.98-0.99), whereas inpatient treatment was associated with a higher mortality risk (HR = 2.14, 95%CI = 1.13-4.05).</p><p><strong>Conclusions: </strong>Almost one out of hundred patients died during the follow-up period, greatly exceeding the mortality rate in adolescents and young adults in the general Swedish population. The mortality risk varied according to sex, treatment experiences, and convictions, but not according to migrant background or parental education. In sum, we report a complex relation between convictions, treatment, and excess mortality among adolescents and young adults enrolled in specialized substance use treatment, signaling profound unmet clinical and social work needs.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}