J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
Editorial: Rising Psychotropic Medication Use Among US Youth.
Olfson M
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41759967 · Publisher ↗
Psychotropic medication use among children, adolescents, and young adults in the United States has increased over the past 2 decades, focusing renewed attention on the appropriateness of prescribing, polypharmacy, and po...
Psychotropic medication use among children, adolescents, and young adults in the United States has increased over the past 2 decades, focusing renewed attention on the appropriateness of prescribing, polypharmacy, and potential drug-drug interactions during critical periods of neurodevelopment. In their new study, Meng and colleagues report findings from a repeated cross-sectional analysis of nationally representative data from the US National Health and Nutrition Examination Survey (NHANES) spanning 2001 through March 2020, including 1,625 young people 6 to 24 years of age who reported psychotropic medication use. Psychotropic medication use, defined as self-reported use of stimulants, antidepressants, antipsychotics, or benzodiazepine-related medications in the past month, increased from 5.3% in 2001 to 2004 to 8.3% in 2017 to March 2020. Psychotropic polypharmacy, defined as concurrent use of 2 or more psychotropic medications, nearly doubled over the 2001 to 2020 study period, rising from 1.8% to 3.3%. Increases were most pronounced for children and young adults and were driven largely by stimulant use. Among young people prescribed psychotropic medications, 26.0% received at least one medication combination involving a potential contraindication or major drug-drug interaction. Together, these findings reveal increasing use of medication-based treatments for mental health conditions in US youth, alongside increasing treatment complexity and potential safety risks, highlighting the importance of careful prescribing and ongoing clinical monitoring.
Editorial: Cognitive Development in Offspring of Individuals Living With Bipolar Disorder and Schizophrenia: Opportunities for Early Identification and Support.
Bhatt A, Diehl J
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41759966 · Publisher ↗
In this issue of the Journal, Pedruzo and colleagues advance our understanding of cognitive functioning in children of individuals living with schizophrenia and bipolar disorder. There are known cognitive changes associa...
In this issue of the Journal, Pedruzo and colleagues advance our understanding of cognitive functioning in children of individuals living with schizophrenia and bipolar disorder. There are known cognitive changes associated with schizophrenia and bipolar disorder, notably in working memory, attention, executive functioning, and social cognition. However, there are limited data on cognitive outcomes of offspring of individuals living with these disorders.
The Effects of Psychological Treatment of Maternal Depression on Children and Parental Functioning: A Meta-analysis.
Cuijpers P, Stikkelbroek Y, Holt C … +6 more , Hirschler Y, Miguel C, Harrer M, Karyotaki E, van Straten A, Milgrom J
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41707889 · Publisher ↗
OBJECTIVE: Although it is well established that maternal depression can be treated successfully with psychological treatments, it is not yet clear whether successful treatment has a positive effect on the development and...
OBJECTIVE: Although it is well established that maternal depression can be treated successfully with psychological treatments, it is not yet clear whether successful treatment has a positive effect on the development and mental health of offspring. METHOD: A random-effects meta-analysis was conducted of randomized trials on psychological treatments of depressed pregnant women and mothers; reported outcomes included parental functioning/marital distress, mother-child interaction, child development, child mental health, child length/height, and child weight. RESULTS: The meta-analysis included 47 randomized trials (51 comparisons between treatment and control groups; 7,745 participants). The interventions had a moderate effect on depression in mothers (SMD = 0.57, 95% CI [0.43, 0.70]). Significant effects on parental functioning/marital distress (k = 31, g = 0.23, 95% CI [0.07, 0.39]), mother-child interaction (k = 27, g = 0.34, 95% CI [0.12, 0.56]), and child mental health (k = 10, g = 0.29, 95% CI [0.12, 0.45]) were also found. No significant effect was found for child development, height, and weight, possibly because of low power. Heterogeneity was high in most analyses. Sensitivity analyses resulted in mixed outcomes, with some main results not supported, whereas others resulted in significant outcomes (child development, height, and weight) that were not significant in the main analyses. CONCLUSION: Treatment of depressed mothers probably has small but significant effects on parental functioning/marital distress, mother-child interaction, and child mental health. This substantially increases the importance of making psychological treatments available to pregnant women and mothers with depression. STUDY REGISTRATION INFORMATION: The effects of psychological treatment of maternal depression on children and parental functioning: A meta-analysis; https://osf.io/m5xys/overview.
Correction.
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41707888 · Publisher ↗
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Crucial Conversations: Psychiatric Diagnosis and Shared Decision-Making With Adolescents in the Age of Social Media and Artificial Intelligence.
Pierce JM
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41690544 · Publisher ↗
Do psychiatrists need to talk more? We are taught to listen more than we speak, to invite the patient's narrative, and to observe its unspoken undertones. But are we vocal enough in sharing our formulations with patients...
Do psychiatrists need to talk more? We are taught to listen more than we speak, to invite the patient's narrative, and to observe its unspoken undertones. But are we vocal enough in sharing our formulations with patients and explaining our thought processes as we plan and prescribe treatment? Despite the evidence that providing psychoeducation to patients and families improves mental health outcomes, many providers forgo the opportunity to engage in it, perhaps because of time constraints, lack of reimbursement, or inadequate training and skills development in the practice. We need to talk more, and yet, when we do offer psychoeducation, might we be talking too much? Explaining symptom constellations and relaying the evidence for proposed interventions can easily veer toward a one-sided lecture, bypassing the opportunity for dialogue and collaborative connection with patients.
Editorial: Stratified, Stepped Care for Youth at Risk for Suicidal Behavior.
Brent DA
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41672136 · Publisher ↗
In this issue of JAACAP, Asarnow and colleagues report the results of their innovative, elegantly conducted clinical trial that assessed the added value of stratified, stepped care (SSC) for youth at risk for suicidal be...
In this issue of JAACAP, Asarnow and colleagues report the results of their innovative, elegantly conducted clinical trial that assessed the added value of stratified, stepped care (SSC) for youth at risk for suicidal behavior in a health system that was already implementing a Zero-Suicide Quality Improvement (ZS-QI) program. SSC is designed to match the intensity of intervention with the assessed suicidal risk. Although SSC+ZS-QI did not differ from ZS-QI alone on the study's primary outcome, namely, the 12-month incidence of suicide attempts (SA), it did reduce the rate of all self-harm behavior, primarily driven by a reduction in non-suicidal self-injury (NSSI). This effect was most prominent in those youths who were in the lower and intermediate risk categories. This work advances the field in 2 ways. First, it shows that individuals at increased but intermediate risk for suicidal behavior can benefit from interventions of lower intensity. Second, because the negative results in the primary outcome are due to the much lower than expected rate of SA in the ZS-QI-only arm, this study is consistent with other reports showing that the implementation of ZS-QI can reduce SA in at-risk patients..
The Architecture of Meaning: What Holds Us Together When Words Fall Apart.
Richards MC, Schreiber J
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41672135 · Publisher ↗
In child and adolescent psychiatry, we are often asked to interpret behaviors or narratives that defy easy explanation-moments when young people or their families communicate distress in ways that appear disorganized, op...
In child and adolescent psychiatry, we are often asked to interpret behaviors or narratives that defy easy explanation-moments when young people or their families communicate distress in ways that appear disorganized, oppositional, or opaque. Yet beneath these presentations lies something fundamentally human: an effort to make sense of overwhelming internal states and to reestablish connection with others. This month's Media Forum invites us to consider how our clinical work changes when we approach these expressions not as signs of pathology to be corrected, but as openings into a shared search for meaning.
Correction.
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41655836 · Publisher ↗
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Editorial: A Better Understanding of Suicidal Ideation Through Constructs That Predict Suicidal Behavior.
Vitiello B
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41654011 · Publisher ↗
Efforts to identify the critical elements that sustain suicidal ideation and predict transition to suicidal behavior have been ongoing for decades, mainly in adults, but also in youth. Both the importance of this work fo...
Efforts to identify the critical elements that sustain suicidal ideation and predict transition to suicidal behavior have been ongoing for decades, mainly in adults, but also in youth. Both the importance of this work for suicide prevention and the challenge of capturing into constructs the heterogeneity of the possible paths toward suicide cannot be overemphasized. Underlying these efforts is an assumption of equifinality whereby multiple pathways converge to common patterns of transition from suicidal thinking to behavior. Three prominent theoretically based approaches are Psychache, which sees suicide as an escape from unbearable mental pain; the Interpersonal Theory of Suicide (IPTS), which delineates Perceived Burdensomeness, Thwarted Belongingness, and Acquired Capability for Suicidal Behavior as major contributors to the suicide risk; and the Reasons for Living (RFL), which considers the patient's reasons for living as a protection against suicide..
Testing a Hierarchical Structural Model of Youth Psychopathology Symptoms Over Time and Across Informants, Gender, and Pubertal Status.
Hankin BL, Brandes CM, Young JF
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41651059 · Publisher ↗
OBJECTIVE: Predominant psychopathology classification systems (Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases) exhibit multiple limitations. Alternative, empirically ba...
OBJECTIVE: Predominant psychopathology classification systems (Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases) exhibit multiple limitations. Alternative, empirically based dimensional approaches (eg, the Hierarchical Taxonomy of Psychopathology [HiTOP]) have been examined mostly with adults, with less structural research in youth, and even less incorporating youth personality dysfunction alongside "common" symptoms. Exploratory, descriptive work among youth is needed to organize an empirically based, comprehensive structure of psychopathology that is also generalizable across time, informant, gender, and development. METHOD: Exploratory factor analyses were conducted using data from a general community sample of 588 youth (baseline, mean age = 13.58 years, range = 9.3-17.5 years; 55.5% female) and parent informants on youth psychopathology symptoms. Additional exploratory analyses evaluated hierarchical structure models across time (18 months apart), informant (youth- and parent-report), gender, and pubertal status. RESULTS: Hierarchical factor analyses revealed a structure unfolding from one general psychopathology factor down to 9 interpretable narrowband symptom factors. Intermediate factors replicated 3 broadband spectra found in prior research on child psychopathology structure (internalizing, disinhibited externalizing, and personality dysregulation). This structure was largely consistent at the broadband spectra level across informants. Narrowband symptom structure exhibited some consistencies and nuanced differences across gender and pubertal status for both informants and across time for youth-reports. Parent-report structure was more consistent than child-report across time, gender, and pubertal status. CONCLUSION: Results yield new insights on the empirically based organization of youth mental health symptoms. We discuss (dis)continuities across informants, youth gender, and developmental stage. Findings highlight the importance of considering developmental considerations when planning and evaluating alternative diagnostic models of mental health. STUDY REGISTRATION INFORMATION: Testing a Hierarchical Structural Model of Youth Psychopathology Symptoms Over Time and Across Informants, Gender, and Pubertal Status; https://osf.io/9agvs/.
Efficacy and Safety of Micronutrient Treatment for Irritability in Adolescents: 8-Week Double-Blinded Randomized Placebo-Controlled Trial (BEAM).
Rucklidge JJ, Sherwin AH, Mulder RT … +2 more , Manna L, Boden JM
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41643810 · Publisher ↗
OBJECTIVE: Irritability is a transdiagnostic dimension characterized by affective and behavioral components. The Balancing Emotions of Adolescents with Micronutrients (BEAM) study investigated broad-spectrum micronutrien...
OBJECTIVE: Irritability is a transdiagnostic dimension characterized by affective and behavioral components. The Balancing Emotions of Adolescents with Micronutrients (BEAM) study investigated broad-spectrum micronutrient (vitamins and minerals) efficacy and safety for adolescents with moderate-to-severe irritability symptoms. METHOD: A total of 132 unmedicated adolescents (12-17 years of age) were randomized to micronutrients (n = 67) or active placebo (n = 65) for 8 weeks and monitored remotely with weekly parent/adolescent questionnaires and monthly online meetings with a registered psychologist. Primary outcome measures were the Clinical Global Impression-Improvement (CGI-I), Emotion Dysregulation Inventory (EDI)-Reactivity subscale, and Clinician Affective Reactivity Index (CL-ARI-Total). RESULTS: Both groups were well matched at baseline. Generalized linear mixed-effect regression models showed significant main effects of treatment on the CGI-I (p = .012), EDI (p = .043), but not CL-ARI-Total (p = .276), although the rate of change over time did not significantly differ between treatment groups. Post hoc analyses showed disruptive mood dysregulation disorder (DMDD) and socio-economic status (SES) modified treatment response; those with DMDD and from lower SES families were more likely to respond to micronutrients. For the entire sample, baseline to end-of-RCT between-group effect sizes (ES) were small-to-medium (0.30-0.36) whereas for those with DMDD (n=30), ES were very large (1.06-1.44); 64.3% of DMDD participants were responders on micronutrients compared with 12.5% on placebo (p = .003, relative risk [RR] = 4.053; NNT = 1.9). Secondary outcomes highlighted significant benefits of micronutrients over placebo on CGI-Severity, parent-reported conduct symptoms and prosocial behavior, and adolescent-reported suicidal ideation. Micronutrients also led to faster improvement in clinician-rated irritability, parent-rated dysphoria, and adolescent-rated quality of life, stress, and prosocial behaviors. Only one side effect differed significantly between groups: temporary diarrhea was more common on micronutrients (20.9%) than on placebo (6.2%; p = 0.02, RR = 3.40). A minority of participants (<10%) found swallowing pills a challenge. CONCLUSION: This RCT provides preliminary evidence that micronutrients may be an effective and safe treatment for adolescent irritability, with a reassuring reduction in suicidal ideation and, if findings are replicated, may transform outcomes for adolescents. CLINICAL TRIAL REGISTRATION INFORMATION: BEAM: Balancing Emotions for Adolescents with Micronutrients:ANZCTR - Registration DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Treating Invisible Wounds: The Case for Trauma-Informed Care in Autism.
Merahn S
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41638425 · Publisher ↗
The weathering of marginalized communities-premature biological aging resulting from chronic exposure to systemic stressors-has transformed our understanding of health disparities in populations facing discrimination and...
The weathering of marginalized communities-premature biological aging resulting from chronic exposure to systemic stressors-has transformed our understanding of health disparities in populations facing discrimination and structural barriers. Originally articulated to explain accelerated health decline among Black Americans, the weathering hypothesis and its biological substrate, allostatic load, offer a perspective for understanding another population experiencing persistent adversity: namely, autistic individuals.
Considerations for Sharing of Weight in the Electronic Health Record for Patients With Eating Disorders.
Carlson JL, Derenne JL
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41638424 · Publisher ↗
EHRs have allowed patients access to important health care information in real time, but with this development comes dilemmas and challenges with effectively managing the availability of sensitive data. Providers should...
EHRs have allowed patients access to important health care information in real time, but with this development comes dilemmas and challenges with effectively managing the availability of sensitive data. Providers should be aware of these common, potentially challenging situations. Rather than uniformly blocking weight-related information, providers should consider this an opportunity to engage and to support adolescents and their families in managing their health information in a developmentally appropriate manner.
Editorial: Modeling Environmental Complexity in Psychological Science: Methodological Opportunities and Challenges.
Laky ZE
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41638423 · Publisher ↗
Although no model can fully capture the complexity of the human experience, some simplify it in ways that yield meaningful insight. This adage raises critical questions: How do we decide which modeling approaches to adop...
Although no model can fully capture the complexity of the human experience, some simplify it in ways that yield meaningful insight. This adage raises critical questions: How do we decide which modeling approaches to adopt and evaluate their translational utility? Recent years have seen a surge in the use of sophisticated statistical methods and large datasets to disentangle complex interactions across ecological systems. In this issue, Ramduny et al. elegantly tackle a highly complex nature-by-nurture question with a novel, data-driven Bayesian latent profile analysis (LPA) algorithm applied to subsample of 2,766 youth from the Adolescent Brain Cognitive Development℠ (ABCD) Study. The authors examined longitudinal associations across multiple levels of environmental influence (eg, family conflict, cannabis laws), subcortical gray matter volume, and internalizing and externalizing symptoms. This work advances our understanding of risk for psychopathology in youth, identifies potential intervention targets, and lays important groundwork for ongoing dialogue about future directions for the field.
Protective Factors of the Longitudinal Association Between Discrimination and Mental Health Among Mexican-Origin Youth.
Alegría M, Cruz-Gonzalez M, Yip T … +9 more , Wang L, Fang Y, Park IJK, Xiong M, Fukuda M, Valentino K, Zhen-Duan J, Alvarez K, Shrout PE
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41621613 · Full text
OBJECTIVE: The negative effects of discrimination on mental health are well established. Few longitudinal studies have investigated protective factors that could mitigate these effects for youth of Mexican origin in the...
OBJECTIVE: The negative effects of discrimination on mental health are well established. Few longitudinal studies have investigated protective factors that could mitigate these effects for youth of Mexican origin in the United States. This 3-wave longitudinal study examined individual-, family-, peer-, and neighborhood-level protective factors attenuating the effect of discrimination-related stress on youth depressive and anxiety symptoms. METHOD: A total of surveyed 344 Mexican-origin youths (ages 12-15) from 2 Midwestern counties were surveyed longitudinally over 3 annual waves. Youths completed self-report measures of depression, anxiety, and discrimination as well as 6 potential protective factors: perceived social position, parent-child relationship, peer relationships, perceived social support, school connectedness, and neighborhood collective efficacy. Multilevel models with time-varying variables were used to analyze the effect of the potential protective factors on the association between discrimination and depressive and anxiety symptoms. RESULTS: Perceived social position, parent-child relationship, peer relationships, and perceived social support significantly attenuated the impact of racial discrimination on depressive symptoms at the between-youth level, but not at the within-youth level. No significant protective factors emerged for racial discrimination and anxiety symptoms at either the between-youth or the within-youth level. No cross-moderation effects were observed. CONCLUSION: These results highlight the importance of self-perceived social position and support in combating the effects of discrimination on depressive symptoms in Mexican-origin youth. Most protective factors centered on interpersonal relationships with caregivers and peers. Findings indicate the need for a greater understanding of school connectedness and neighborhood collective efficacy as nonsignificant protective factors, taking into consideration that these perhaps continue to be discriminatory rather than supportive contexts. CLINICAL TRIAL REGISTRATION INFORMATION: Seguimos Avanzando-Latino Youth Coping With Discrimination; https://clinicaltrials.gov/study/NCT04875208. DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
Systematic Review: Child and Adolescent Refugees and Asylum-Seekers' Contact With Specialist Mental Health Services.
Sengun Filiz E, Patel R, Hodes M
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41619964 · Publisher ↗
OBJECTIVE: To investigate the utilization of specialist child and adolescent mental health services (CAMHS) among refugee and asylum-seeking children (<18 years old) globally compared with nonrefugee peers, specifically...
OBJECTIVE: To investigate the utilization of specialist child and adolescent mental health services (CAMHS) among refugee and asylum-seeking children (<18 years old) globally compared with nonrefugee peers, specifically looking at differences in diagnostic and therapeutic profiles, service use referral pathways and barriers to access, and hospitalization. METHOD: A systematic search of MEDLINE, Embase, PsycINFO, and CINAHL was conducted from inception until August 8, 2025. Observational studies with quantitative outcomes comparing CAMHS use between refugee/asylum-seeking and nonrefugee/non-asylum-seeking children were included. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale, and data were presented in a narrative synthesis due to heterogeneity. RESULTS: This review included 25 studies, mainly from high-income settings and of high quality. Refugee/asylum-seeking youth exhibited higher rates of posttraumatic stress disorder, anxiety, and depression, but lower outpatient CAMHS utilization, compared with nonrefugee/non-asylum-seeking peers. Refugees/asylum-seekers received fewer guideline-concordant treatments, particularly for attention-deficit/hyperactivity disorder and mood disorders. Compared with nonrefugees, refugees were more likely to be referred by nonmedical agencies. Barriers included language, stigma, fragmented primary care registration, and crisis-driven entry into services through emergency departments or social services rather than primary care. Findings on inpatient admissions yielded a mixed picture, with unaccompanied minors overrepresented in involuntary care. CONCLUSION: Results imply inequity in CAMHS contact among refugee youth, in the context of high need and despite lack of economic barriers. More timely and culturally sensitive access is needed, as well as effective training for nonmedical agencies and responsive public policies that reduce structural barriers to psychiatric care and address the complex circumstances and needs of displaced youth. STUDY REGISTRATION INFORMATION: Systematic Review: Child and Adolescent Refugees and Asylum-Seekers' Contact With Specialist Mental Health Services; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022310239.
Adolescents' Relationships With Their Parents and Peers as Mediators Between Economic Circumstances and Emotional Symptoms: A Multicountry Longitudinal Analysis.
Steare T, Rose-Clarke K, Araya M … +8 more , Cueto S, Dang HH, Ellanki R, Evans-Lacko S, Hammerton G, Lewis G, Yadete W, Patalay P
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41619963 · Publisher ↗
OBJECTIVE: Adolescents' social relationships might partly explain the increased risk of mental health problems in adolescents living in poorer economic circumstances. There are few studies in low- and middle-income count...
OBJECTIVE: Adolescents' social relationships might partly explain the increased risk of mental health problems in adolescents living in poorer economic circumstances. There are few studies in low- and middle-income countries, where most of the world's adolescents live. This study investigated whether adolescents' relationships with their parents and peers mediated the association between their economic circumstances and emotional symptoms in Ethiopia, India, Peru, and Vietnam. METHOD: Longitudinal data of 3,529 adolescents from the Young Lives study (1,741 female [49.3%]) were analyzed. Household consumption expenditure and adolescents' subjective assessment of household wealth were measured at age 15. The mediators-adolescents' positive relationships with their parents and peers-were measured at age 19. The outcome-emotional symptoms, characterized by low mood and anxiety-was measured at age 22. Mediation was assessed through counterfactual g-computation formula, adjusting for baseline and intermediate confounders. RESULTS: No evidence was found that adolescents' positive relationships with their parents or peers mediated the association between economic circumstances and emotional symptoms in any country. Living in poorer economic circumstances was typically associated with more severe emotional symptoms. CONCLUSION: Adolescents' parent and peer relationships might not mediate the effects of poorer economic circumstances on emotional symptoms in these countries, contrasting with previous studies that highlight an important role of relationships in high-income countries. Further research is needed that addresses limitations of this study and to explore other potential mechanisms, including different aspects of social relationships, that might influence mental health outcomes for adolescents living in poverty across different settings. STUDY REGISTRATION INFORMATION: Socio-Economic Inequality in Adolescent Mental Health: Mediating Roles of Adolescents' Relationships With Their Peers and Parents Across Four Countries; https://osf.io/sb67c/overview.
Defining Entrants Into the Child and Adolescent Psychiatry Workforce in the United States: Match Results From 2009 to 2025.
Silvestre J, Dubé B, Gray KM
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41581552 · Publisher ↗
Increasing the number of child and adolescent psychiatristsis a topic of increasing attention in the United States. Shortages in the child and adolescent psychiatry (CAP) workforce are expected, given the rising burden o...
Increasing the number of child and adolescent psychiatristsis a topic of increasing attention in the United States. Shortages in the child and adolescent psychiatry (CAP) workforce are expected, given the rising burden of mental health disorders and retirement of psychiatrists. Inadequate access to CAP expertise can lead to negative mental health outcomes for vulnerable patient populations..
Second-Generation Antipsychotics and Real-World Outcomes in Youth With On- and Off-Label Indications.
Zhang L, Quinn PD, Bjureberg J … +7 more , Hellner C, Sepe-Forrest L, Brikell I, Kuja-Halkola R, Froehlich TE, D'Onofrio BM, Chang Z
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41581551 · Publisher ↗
OBJECTIVE: Second-generation antipsychotic (SGA) treatment has increased in youth globally. However, the effects of these agents on real-world outcomes are largely unknown, especially for non-approved indications. METHOD...
OBJECTIVE: Second-generation antipsychotic (SGA) treatment has increased in youth globally. However, the effects of these agents on real-world outcomes are largely unknown, especially for non-approved indications. METHOD: This study included a national cohort of incident SGA recipients 7 to 17 years of age in Sweden from 2007 to 2020. Youth were followed from 1 year before SGA initiation through up to 1 year afterward, and in recurrent treatment analyses, up to 13 years after initiation. Within-individual comparisons were used to examine the risk of psychiatric hospitalization, self-harm, accidental injury, and violent crime before and after treatment. RESULTS: The study included 21,306 SGA initiators (53.1% male; median age 14.8 years at baseline). Indications included psychosis-related disorders (1,966 [9.2%]), autism spectrum disorders (5,140 [24.1%]), depression/other mood disorders (3,669 [17.2%]), intellectual disability (987 [4.6%]), and attention-deficit/hyperactivity disorder (2,992 [14.0%]). Within a year of initiation, 5,604 (26.3%) experienced psychiatric hospitalization, 1,749 (8.2%) self-harm, 954 (13.6% of those ≥16 years of age) violent crime, and 3,134 (14.7%) accidental injury. Risks were generally elevated immediately before SGA initiation and decreased across subsequent treatment without fully returning to baseline, although there was variation across indications. For example, psychiatric hospitalization and self-harm displayed larger pre-initiation elevations and subsequent decreases for youth with psychosis-related disorders (eg, psychiatric hospitalization: pre-initiation odds ratio [OR] = 11.30 [95% CI, 9.84-12.97]; OR = 2.59 [95% CI = 2.21-3.02]). Conversely, youth with neurodevelopmental disorders demonstrated greater decreases in violent crime (eg, attention-deficit/hyperactivity disorder: OR = 1.66 [95% CI, 1.23-2.26]; OR = 1.26 [95% CI, 0.94-1.70]). Accidental injury risk did not statistically significantly differ (eg, ASD: OR = 0.90 [95% CI, 0.77-1.07]). CONCLUSION: After having escalated before initiation, risk of psychiatric hospitalization, self-harm, and violent crime decreased during SGA treatment without fully returning to baseline. There was little evidence of associations with accidental injury.
Longitudinal Association Between Psychotic-Like Experiences and New-Onset Mental Disorders in Late Adolescents.
Sun M, Wang D, Ricard J … +4 more , Wang J, Zhong S, Yang X, Zhou L
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41580121 · Publisher ↗
OBJECTIVE: The study aimed to examine the temporal association between psychotic-like experiences (PLEs) and new-onset mental disorders in late adolescents. METHOD: This longitudinal study used data from the Guangzhou Ea...
OBJECTIVE: The study aimed to examine the temporal association between psychotic-like experiences (PLEs) and new-onset mental disorders in late adolescents. METHOD: This longitudinal study used data from the Guangzhou Early Mental Health Screening for University Students (GEMSS), conducted in China from 2020 to 2024. PLEs conditions were defined based on the participants' baseline assessment. Person-year incidence rates of any new-onset mental disorder (MD), psychotic disorder (PD), and non-psychotic disorder (non-PD) were calculated in different PLEs groups. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of different PLEs conditions, and their population attributable fractions (PAFs) for mental disorders were computed. RESULTS: Of the 6,737 included participants (56.2% female; mean [SD] age, 18.84 [0.72] years), 876 (13.0%) were currently experiencing PLEs at baseline (cur-PLEs), 2,815 (41.8%) had previously experienced PLEs (pre-PLEs), and 3,046 (45.2%) had never experienced PLEs before (non-PLEs). Compared to the non-PLEs group, the cur-PLEs group exhibited a significantly higher risk for developing any new-onset MD (HR = 4.83, 95% CI = 3.22, 7.24), PD (HR = 10.59, 95% CI = 1.23, 91.0), and non-PD (HR = 6.22. 95% CI = 3.96, 9.80), whereas the pre-PLEs group exhibited a significantly higher risk for incident MD (HR = 2.11, 95% CI = 1.44, 3.07) and non-PD (HR = 2.25, 95% CI = 1.48, 3.40). The PLEs conditions accounted for 49.1% (95% CI = 0.483, 0.499), 74.4% (95% CI = 0.738, 0.749), and 52.4% (95% CI = 0.515, 0532) of new-onset MD, PD, and non-PD. CONCLUSION: PLEs in late adolescence are closely associated with the onset of psychotic and non-psychotic disorders. These findings underscore the critical importance of PLEs in screening high-risk populations as a transdiagnostic predictor of mental disorders. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available.ne or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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