Search

The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children's mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement. [ABSTRACT FROM AUTHOR]

Background: Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods: Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results: The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions: Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α =.92) as well as across all countries included (α ranged from.90 to.94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below.70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding. [ABSTRACT FROM AUTHOR]

Background The Me and My School Questionnaire (M&MS) is a self-report measure for children aged eight years and above that measures emotional difficulties and behavioural difficulties, and has been previously validated in a community sample. The present study aimed to assess its clinical sensitivity to justify its utility as a screening tool in schools. Methods Data were collected from service-users (n = 91, 8-15 years) and accompanying parent/carer in outpatient mental health services in England. A matched community sample (N = 91) were used to assess the measure's ability to discriminate between low- and high-risk samples. Results Receiver operating curves (area under the curve, emotional difficulties = .79; behavioural difficulties = .78), mean comparisons (effect size, emotional difficulties d = 1.17, behavioural difficulties = 1.12) and proportions above clinical thresholds indicate that the measure satisfactorily discriminates between the samples. The scales have good internal reliability (emotional difficulties α = .84; behavioural difficulties α = .82) and cross-informant agreement with parent-reported symptoms is comparable to existing measures (r = .30). Conclusion The findings of this study indicate that the M&MS sufficiently discriminates between highrisk (clinic) and low-risk (community) samples, has good internal reliability, compares favourably with existing self-report measures of mental health and has comparable levels of agreement between parent-report and self-report to other measures. Alongside existing validation of the M&MS, these findings justify the measures use as a self-report screening tool for mental health problems in community settings for children aged as young as 8 years. [ABSTRACT FROM AUTHOR]

Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy. [ABSTRACT FROM AUTHOR]