Growing engagement with digital spaces among children and adolescents increases the risk of negative online experiences (NOE). This study examined the prevalence, risk factors, and reporting barriers for NOE among youth with mental health and neurodevelopmental conditions.

A cross-sectional, mixed-methods study between January and July 2023 was conducted using a community-based sample from the Child Mind Institute's Healthy Brain Network. A total of 1,009 youth aged 9 to 15 years (58.4% male; mean age = 11.79 years, SD = 1.71 years) completed a quantitative survey. A subsample (n = 109) participated in a qualitative follow-up involving a 3-day moderated online bulletin board.

Of the 1,009 participants, 26.6% experienced NOE in the previous year, with 68.7% reporting multiple incidents; however, 80% did not report them. Factor analyses identified 3 key reporting barriers: reporting process, reporting policy, and emotional barriers. Social aptitude, mental health symptoms, and parenting style predicted youths' likelihood of encountering NOE and key reporting barriers. Qualitative findings indicated that reporting decisions involved assessing malice, perpetrator intent, and NOE type; ambiguity in these areas contributed to reporting uncertainty.

This study highlights the gap between the high prevalence and low reporting rates of NOE among youth with mental health and neurodevelopmental conditions. Identified demographic, clinical, and family factors were associated with increased risk of experiencing NOE and the 3 reporting barriers. Findings underscore the need for targeted, developmentally appropriate strategies involving policymakers, technology developers, clinicians, and educators to support safer online environments for at-risk youth.

• Educate children and families about online reporting processes using developmentally appropriate, clear, and accessible language.• Encourage parents to adopt consistent, supportive involvement in their children's online activities, as positive parenting was associated with lower risk and reporting barriers.• Address emotional barriers by normalizing help-seeking, validating fears of embarrassment or retaliation, and connecting youth with safe peer or adult support.• Collaborate with schools and digital platforms to advocate for user-friendly reporting tools and resources tailored to younger or more vulnerable users.

Safer supply programs (SSPs) have emerged in Canada in a response to the drug toxicity crisis and to the contaminated illicit drug supply. A form of safer supply, injectable opioid agonist treatment (iOAT) programs, provide individuals with access to regulated opioids that are generally self-administered in supervised settings. The implementation of SSPs has been controversial, and gathering additional data on their impact is necessary to inform their future. An iOAT program in New Brunswick, Canada, was evaluated from the perspectives of individuals accessing the program, to better understand program experiences, impacts, and barriers. Semistructured interviews were completed with iOAT participants (N = 21) who had been in the program for approximately six months. An Interpretive Phenomenological Analysis was used to understand the experiences of participants in the program. Participants reported positive experiences that were associated with the program's low-threshold and nonstigmatizing environment. Impacts such as improvements in mental health, increased financial stability, decreased engagement in criminal activities, and reduced use of substances from the illicit market were reported. Challenges associated with program involvement included inadequacies in the strength of available medications, negative impacts from interruptions to safer supply (e.g., from being arrested or hospitalized), and barriers to access (e.g., transportation and daily attendance). The findings from this study demonstrate the importance of SSPs as a vital option in the care of people who use drugs and identify the need for wraparound health services as well as increased continuity of care from SPPs to services available in healthcare and criminal justice settings.

This study examined temporal trends in mental health diagnoses and treatment patterns among children and adolescents across the COVID-19 pre-pandemic, pandemic, and post-pandemic periods in the United States.

This retrospective cohort study used the TriNetX U.S. Collaborative Network, including 13.3 million children and adolescents aged 3 to 18 years with health care encounters from October 2018 to December 2022. Using 2 complementary approaches-rolling monthly health care-seeking incidence and treatment-engaged cohorts (≥2 encounters per phase)-we assessed psychiatric diagnoses, psychotropic medication initiation, and psychotherapy use across 3 phases: pre-pandemic (October 2018 to February 2020), pandemic (March 2020 to July 2021), and post-pandemic (August 2021 to December 2022). Analyses were stratified by age, sex, race, and ethnicity.

Incidence rates declined sharply during early pandemic lockdowns, rebounded by March 2021, and remained elevated post-pandemic. Compared with pre-pandemic levels, psychiatric diagnoses increased 24%, psychotropic medications 35%, and psychotherapy 26%. Antidepressants had the largest increases (58%-94%), with female children and adolescents showing steeper rises (65%-137%) compared with male children and adolescents (41%-57%). Attention-deficit/hyperactivity disorder (ADHD) medication use also increased, with the greatest rise in preschoolers (147%), whereas male adolescents showed minimal change or decreases. Racial and ethnic disparities persisted. Among treatment-engaged youth, adolescents had higher antidepressant use (32%-36%) and hydroxyzine use (7%-10%), with reduced benzodiazepine use (7%-4%).

Substantial and sustained increases in pediatric behavioral health treatment persisted beyond the acute pandemic period, concentrated among female individuals and driven primarily by antidepressant prescribing. These patterns warrant monitoring and targeted interventions to address sex disparities and persistent racial and ethnic inequities.

To evaluate the feasibility and acceptability of a model of care for paediatric obsessive-compulsive disorder (OCD), by outlining the barriers and enablers experienced by clinicians implementing the model in routine public health settings.

Six child and adolescent public mental health services participated in a Type 2 implementation and effectiveness trial of an OCD model of care. Clinicians were trained in screening, assessment, psychoeducation and group-based exposure with response prevention. Focus group interviews were conducted at the conclusion of the trial with clinicians from each service. Interview responses were guided by a logic model to elucidate enablers and barriers to implementation, considering resources, moderators, mediators and outcomes.

Implementation varied across services. Three key themes emerged. Firstly, existing resources were directly and inversely linked to implementation. Secondly, OCD training and specialised clinical support increased clinicians' knowledge and skills, benefitting both clinicians and clients. Finally, case complexity influenced how and when implementation occurred.

The model of care was feasible and acceptable. Adjuncts to clinical service delivery (e.g. attending training) were easier to implement than changes to existing procedures (e.g. introducing screening). Aligned with the UK NICE guidelines, this model of care may be suitable for public Australian services to improve OCD detection and treatment for young people.

Refugee women face barriers to reproductive health care, including limited English proficiency, transportation challenges, inconsistent insurance coverage, socioeconomic instability, and prevalence of trauma-related mental health conditions. This study describes the characteristics, diagnoses, and health care utilization of refugee women receiving care at the Refugee Women's Health Clinic (RWHC) of Valleywise Health (VH), a safety net health care system in the southwestern United States. Further, it examines the role of an integrated cultural health navigator (CHN) program in addressing access and care barriers for refugee women. Study objectives were to characterize demographics, health diagnoses, reproductive health care utilization, and the scope of CHN service delivery.

We conducted a retrospective cohort study using electronic medical record data from 21,062 refugee-identified patients seen at VH from 2009 to 2024, with a focused descriptive analysis of 7,504 women who received care at the RWHC. Analyses of CHN service delivery were conducted among a subset of 1,581 patients with available CHN flowsheet documentation.

Patients originated from >100 countries, demonstrating extensive racial, linguistic, and religious diversity. Among RWHC patients, 48.1% experienced at least one pregnancy; 93.2% received prenatal care, and 55.3% initiated care in the first trimester. Mental health diagnoses were common, including anxiety (10.0%) and depression (9.8%). Preventive services were widely utilized, including sexually transmitted infection screening (43.1%) and contraceptive counseling (32.2%). CHNs supported approximately 5,000 patient encounters annually, with services focused on appointment adherence, enhanced interpretation and transportation access, and linkage to behavioral health and supportive services.

The RWHC and its integrated CHN program represent a community-based, equity-focused model of reproductive health care delivery for refugee women in a safety-net setting. Embedding CHN programs within clinical settings may mitigate socioeconomic, linguistic, and mental health-related care barriers by strengthening care coordination and access. This model offers a framework for advancing reproductive health equity among resettled refugee women.

The school environment influences adolescent health through both individual experiences, such as one's own engagement with school, and broader school-level factors, such as aggregate student levels of engagement, affecting all students. For mental-health outcomes, existing evidence more consistently supports individual-level influences than school-level effects. In relation to depression, negative student-level educational experiences have been associated with increased symptoms, while evidence for school-level associations remains limited and often methodologically weak. We aimed to address this gap through a secondary analysis of longitudinal data from a trial involving 49 English secondary schools.

Student-reported educational experiences (school belonging, educational commitment, participation at school, relationships with teachers and expectation of university) as well as family affluence were measured at baseline (ages 12-13) and depressive symptoms were assessed at follow-up (ages 15-16). Associations were examined at both the individual student and aggregate school level of educational experiences.

Forty-five schools were retained at endline and 4,601 students comprised our analytical sample. At the student level, greater school belonging (beta coefficient = -0.24; 95% confidence interval = -0.29, -0.19) and educational commitment (beta coefficient = -0.19; 95% confidence interval = -0.29, -0.08) were associated with lower risk of depressive symptoms in fully adjusted models. At the school level, only overall educational commitment was associated with reduced depressive symptoms in a partially but not fully adjusted model (beta coefficient = -1.02; 95% confidence interval = -1.86, -0.18).

These findings suggest that educational experiences influence depressive symptoms primarily through individual-level mechanisms, for example involving students' sense of belonging, engagement, participation and relationships) but the general level of educational commitment within a school may also play a meaningful role. (249 words).

Advantaged socioeconomic circumstances are linked to a higher risk of diagnosed eating disorders (EDs). However, evidence on non-diagnosed cases, that is, individuals reporting ED symptoms without formal diagnosis, remains limited, suggesting detection and treatment-seeking barriers. In this study, we assessed associations between socioeconomic circumstances and clinically diagnosed and non-diagnosed EDs in childhood and adolescence.

This study used data from the Danish National Birth Cohort, linking registry-based diagnosed EDs (participant ages 6-18 years) with self-reported ED symptoms at age 18 years. Data included 523,148 individuals born in Denmark between 1996 and 2003, with 44,552 providing information on self-reported ED symptoms used to classify non-diagnosed EDs. Socioeconomic indicators, including parental education and household income at age 6 years, were analyzed using quasi-Poisson and multinomial logistic regression to estimate incidence rate ratios (IRRs) and relative risk ratios (RRRs).

Diagnosed EDs were more common among individuals with higher parental education, following a stepwise pattern. Compared to short education (∼12 years), long education (∼17-20 years) was associated with higher risk (IRR = 1.35, 95% CI = 1.21-1.52), whereas basic education (∼10 years) was linked to lower risk (IRR = 0.70, 95% CI = 0.59-0.83). The pattern reversed for non-diagnosed EDs, with individuals whose parents had basic education showing a higher risk (RRR = 2.19, 95% CI = 1.83-2.63) compared to individuals whose parents had short education. No clear pattern was observed for household income.

This study highlights socioeconomic disparities in ED diagnosis and treatment. Individuals from educationally advantaged backgrounds were more likely to receive a diagnosis, whereas those from educationally disadvantaged backgrounds had a higher risk of non-diagnosed EDs.

Parental Social Disparity and Adolescent Eating Disorders; https://osf.io/dm24e/.

Relatively few population-based studies have explored the relationship between shift work patterns and anxiety-depression comorbidity among nurses. This study aimed to identify different patterns of nurse shift work and assess their association with anxiety-depression comorbidity.

This study was based on the Nurses' Environmental and Occupational Exposure and Health Nexus (NEON) cohort. A self-designed questionnaire was used to collect general demographic information and shift work details. Anxiety and depressive symptoms were evaluated using the generalized anxiety disorder-7 (GAD-7) and the patient health questionnaire-9 (PHQ-9), respectively. Latent class analysis (LCA) was performed to identify homogeneous groups of shift work. A three-step approach of LCA, involving logistic regression models, was applied to examine associations between various shift patterns and anxiety-depression comorbidity. Sleep quality served as a stratification factor for the subgroups.

Three latent classes were identified among 2791 shift nurses: Class 1: high-frequency, high-seniority group (N = 441, 15.80%); Class 2: low-frequency, low-seniority group (N = 835, 29.92%); Class 3: low-frequency, high-seniority group (N = 1515, 54.28%). Binary logistic regression analysis showed that, compared with Class 2, Class 3 had increased risks of anxiety, depression, and comorbid anxiety and depression by 54.8% (OR = 1.548, 95% CI 1.304-1.838), 30.6% (OR = 1.306, 95% CI 1.096-1.555), and 47.6% (OR = 1.476, 95% CI 1.245-1.749), respectively. Moreover, Class 1 had the highest risk of these conditions in both unadjusted and adjusted models. Sleep quality had no significant modifying effect.

This study identified distinct patterns in nurses' shift work. Different patterns were significantly associated with anxiety-depression comorbidity. Targeted interventions addressing specific shift patterns may improve nurses' mental health and contribute to achieving broader health goals.

Despite growing concerns about mental health in Black adolescents, cultural factors influencing their help-seeking behaviors remain largely understudied. Pathways to formal mental health help-seeking and the influence of religion remain underexplored in Black adolescents. This study investigated the relationship between religious affiliation and formal mental health service utilization in Black adolescents using a mixed-methods sequential explanatory approach. Quantitative analysis (n=285) revealed that religious Black adolescents are more likely to seek mental health services from school-based professionals and less likely to use phone or text lines compared to their nonreligious counterparts. Using inductive thematic analysis, three themes were identified from qualitative interviews (n=6): Cultural and Community Emphasis on Religious Coping, Stigma and Dismissiveness, and Awareness of the Need for Additional Help. Findings underscore the need for culturally responsive mental health interventions and collaborations with community organizations to improve formal service access and utilization for Black teens. Implications for clinicians, educators, and community leaders focus on strategies to promote health equity and address systemic barriers to care in Black communities.

Neuropsychiatric symptoms of Marfan syndrome (MFS) are rarely described, yet accumulating evidence suggests a possible association with psychotic disorders. We report a 17-year-old male with MFS who, two months after medically indicated sternal repair for Marfan-related skeletal dysplasia, developed an acute psychotic episode with catatonia. Catatonic features on admission comprised mutism, rigidity, negativism, posturing, and food refusal (Bush-Francis Catatonia Rating Scale score 31/69). Psychotic features included persecutory delusions, delusions of immortality, and hallucinatory behaviour. Biographical review revealed longstanding limited autonomy, poor social integration, and reactive body image distress following surgery. After exclusion of organic and toxic causes, a diagnosis of brief psychotic disorder comorbid with mild intellectual disability was established. Benzodiazepine treatment was initiated for catatonia; olanzapine was added on day seven for persistent psychotic features, achieving full remission by day 24, with sustained remission off all medication over three years of follow-up. Three pathogenic axes are discussed as hypotheses - a possible shared genetic vulnerability via fibrillin-1/TGF-β dysregulation; Lujan-Fryns syndrome as an unresolved differential; and a stress-diathesis model in which surgery precipitated decompensation on a background of psychosocial burden and cognitive vulnerability. This case supports systematic psychiatric screening in MFS patients, particularly around major surgical events in adolescence.