Adolescent Psychiatry - Volume 14, Issue 1, 2024

Background: Systemic racism and health inequality for Children and Adolescents of Color (CAoC) and their families need to be acknowledged and addressed in the provision of mental health treatment by child and adolescent psychiatrists. The lack of parity for behavioral health drives the lack of integration of “mental” health with overall health and the lack of funding, policy, planning, and practices to support the social and emotional health of children and their families. Additionally, the unequal treatment faced by Black, Indigenous, and People of Color (BIPOC) children and their families further impacts their overall health and mental health outcomes. Implicit biases, conscious and unconscious, influence clinical judgments, lead to errors in diagnostic and treatment decisions and impair child and adolescent psychiatrists’ ability to fully partner with families to treat, advocate for, and improve the clinical and life trajectories of this diverse group of young people and families that child and adolescent psychiatrists are called to serve. Methods: Using a case vignette, this paper discusses historical examples showing how child and adolescent psychiatrists’ implicit bias may manifest when working with CAoC. Medical training and clinical practice have paid scant attention to the broader impacts of systemic racism and inequities in healthcare until recent years. Discussion: This article provides clinical recommendations for clinicians to navigate these factors through trauma-centered and patient-centered care. Viewing through the lens of intergenerational racial trauma and acknowledging one’s own bias, clinicians can better help and support CAoC as they strive toward a brighter future.

The onset of common mental illnesses, such as mood and anxiety disorders, often begins in adolescence and young adulthood. While traditional clinical care focuses on reducing psychiatric symptoms, it is important to simultaneously promote positive psychological states (i.e., flourishing). In this brief review, we synthesize the published literature on flourishing among adolescents and young adults with mood and anxiety disorders. Using VanderWeele’s flourishing model domains, we developed search terms that we applied to PubMed, PsycINFO, and Google Scholar databases. We identified four articles that met the inclusion criteria for this review. Each study identified in this review used distinct flourishing scales to examine various flourishing domains. Overall, incorporating techniques to promote positive mental health in clinical care decreased psychiatric symptoms and increased flourishing. More research is needed to examine how incorporating flourishing into clinical care can reduce suffering and promote positive mental health in patients.

COVID-19, caused by the SARS-CoV-2 virus, began in late 2019. On March 11^th, 2020, the World Health Organization (WHO) declared the virus a pandemic, and by March 13^th, 2020, the United States (US) government declared the pandemic a national emergency and, subsequently, a global pandemic. Since then, the world has experienced an upheaval affecting every age group in almost every aspect of life. This was particularly true for young people. Globally, a number of studies indicated that the COVID-19 pandemic has had a significant impact on youth mental health measures. In the US, the Centers for Disease Control and Prevention (CDC) 2022 report showed that more than a third of high school students reported that they experienced poor mental health during the pandemic, and 44 percent reported feeling persistently sad or hopeless in the last 12 months. More than half (55 percent) reported experiencing emotional abuse by a parent or other adult at home, and 11 percent reported experiencing physical abuse. In addition, more than a quarter (29 percent) reported that a parent or other adult in the home lost their job. The pandemic upended not only daily life but also healthcare delivery throughout the world. Its vast impact on the healthcare system has disproportionately affected transitional age youth (TAY) between 15 to 25 years old. While the pandemic caused unprecedented changes and challenges, it was also a learning experience that deepened our understanding of our system of care, its strengths and vulnerabilities. This paper will discuss many challenges and opportunities associated with the delivery of psychiatric services for TAY in college mental health, emergency departments, and inpatient and outpatient settings, as well as in specialized programs, such as those for early psychotic disorders.

Objective: The existing literature on the contribution of substance use and psychosocial risk factors in the development of suicidal ideation in the Turkish youth provides limited information. This study aims to compare the relative association of substance use and psychosocial risk factors with suicidal ideation in a sample of high school students in Istanbul. Methods: High school students were administered a survey of 66 questions in the school setting. The total number of students surveyed was 31,604 by the Istanbul Department of Education, and the primary questions and their sub-questions generated dependent and independent variables that were used in this study. The relationship between substance use, psychosocial factors, and suicidal ideation was explored in this study. Logistic regression was used with independent variables, such as substance use, light users, and heavy users and dependent variable as suicidal ideation. The variation explained by this model was compared to the variation explained by the psychosocial factors (age, gender, school type, immigration status, perceived family affluence, parental education, school grades, self-esteem scale, faith scale, anomie scale, anxiety scale, depression scale, irritability scale, antisocial personality scale, time with peers, time with family, parental involvement, family substance use, and peer influence) while exploring the strength of the associations for each factor. Results: Psychosocial factors explained 33.8 % variance in the dependent variable, i.e., suicidal ideation, whereas substance use among those participants explained only 2.2 % variance in predicting suicidal ideation. Restricting analyses to heavy drug users found a consistently low explained variance of about 1.5 % of suicidal ideation in this population. Conclusion: The psychosocial factors are stronger predictors of suicidal ideation as compared to the substance use risk factors in a sample of Turkish youth.

Background: At present, there is little data on the factor structure of ADHD symptoms in adolescents, especially as they are organized in the International Classification of Diseases-10 (ICD-10) or the recently proposed ADHD S-1 bifactor model. This study aimed to analyze how mother and adolescent self-ratings of ADHD symptoms align with these models. Methods: This study utilized confirmatory factor analysis (CFA) on a group of 300 adolescents (ages ranging from 11 to 17 years) to examine the factor structure in terms of mother ratings and adolescent self-ratings of ADHD symptoms (inattention [IA], hyperactivity [HY], and impulsivity [IM]) presented in the Disruptive Behavior Rating Scale (DBRS). Based on existing theory, the study examined five structural ADHD models: (1) DSM-5/ICD-10 one-factor model (with all symptoms loading on a single factor); (2) DSM-5 two-factor model (with IA and HY/IM factors); (3) ICD- 10 three-factor model (with IA, HY, and IM factors); (4) DSM-5 bifactor S – 1 model (with HY/IM as the reference indicators for the general factor); and (5) ICD-10 bifactor S – 1 model (with IM as the reference indicators for the general factor). Additionally, mothers and adolescents completed the five-item hyperactivity scale in the Strengths and Difficulties Questionnaire (SDQ). Results: The results showed the most support for the ICD-10 three-factor model, with all three factors in this model showing adequate discriminant validity, good omega coefficient reliability values, and significant and positive association with SDQ hyperactivity. Furthermore, it is speculated that the ADHD structure in adolescents might involve a general ADHD factor alongside an IA-specific factor, omitting an HY component. Since the general factor was marked by the IM symptoms, this suggests that ADHD at a latent level could be typified by IA and IM symptoms, excluding HY symptoms. Conclusion: The theoretical implications of the findings are discussed.