To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions.
METHODS: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed.
RESULTS: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression.
CONCLUSIONS: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards.

OBJECTIVE: The objective of this study was to identify longitudinal predictors of depressive symptoms in autistic children and youth.
METHODS: Participants were youth with a diagnosis of autism who were part of the Province of Ontario Neurodevelopmental Disorders Network longitudinal substudy. Depressive symptoms were assessed using the child behaviour checklist (CBCL) affective problems subscale. Univariate and multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between clinical and demographic characteristics at baseline (T1) and clinically elevated depressive symptoms (CEDS) approximately 4 years later (T2).
RESULTS: The mean age of participants (n = 75) at T1 was 9.8 years (SD = 2.7) and at T2 was 14.1 years (SD = 2.8). A total of 37% and 35% of participants had CEDS at T1 and T2, respectively. Additionally, 24% of participants had CEDS at both T1 and T2. T1 characteristics associated with T2 CEDS were: loneliness (OR = 3.0, 95% CI, 1.1 to 8.8), self-harm (OR = 4.0, 95% CI, 1.1 to 16.9), suicidal ideation (OR = 3.9, 95% CI, 1.0 to 16.5), more social and adaptive skills (OR = 0.3, 95% CI, 0.1 to 0.9), elevated restricted and repetitive behaviours (OR = 3.8, 95% CI, 1.3 to 11.6), psychotropic medication use (OR = 3.0, 95% CI, 1.1 to 8.4), attention-deficient/hyperactivity disorder (OR = 2.8, 95% CI, 1.1 to 7.8), and T1 CEDS (OR = 8.8, 95% CI, 3.1 to 27.0) (uncorrected for multiple comparisons). Associations persisted after adjusting for age and intelligence quotient (IQ) differences. Age, sex, IQ, teasing/bullying on the CBCL, family psychiatric history and family income were not associated with T2 CEDS.
CONCLUSIONS: Our results highlight both high prevalence and high potential for the persistence of depressive symptoms in autism and emphasize the importance of early support to address loneliness and social participation.
Study assessing risk factors for depression in autistic youthPlain Language SummaryObjectiveThe goal of this study was to find risk factors for depression in autistic youth.MethodsThe study included autistic youth who were part of the Province of Ontario Neurodevelopmental Disorders Network. Symptoms of depression were identified using mental health surveys and screening tools completed by parents. We studied 75 youth over two time points, to understand what factors might predict greater depression risk.ResultsThe average age of our study population at the first visit was 10 years old, and 14 years old at the second visit. Our study found that 37% of participants had elevated symptoms of depression at the first visit, and 35% at the second visit. Factors associated with future depressive symptoms included: loneliness, self-harm, suicidal ideation, high levels of restrictive/repetitive behaviours, depressive symptoms at the first visit, and ADHD. Factors that protected against depressive symptoms included high levels of social skills.ConclusionOur results show high levels of depressive symptoms among autistic youth, and the potential for this to persist over time in this population. Our findings emphasize the importance of early supports to address loneliness and social participation.

BACKGROUND: Children and adolescents living with mental health problems often experience stress and poor mood states, which may influence their quality of life and well-being. Arts interventions may improve mood and well-being and reduce physiological stress in this vulnerable population.
METHODS: A cohort of patients in child and adolescent psychiatry (N = 42; age range: 12-18 years) participated in one of four arts activities including choir singing (n = 11), textile design (n = 9), drama (n = 16), and clownery (n = 6). They were led by professional artists and delivered through five consecutive 90-min daily afternoon sessions over the course of 1 week. Questionnaires of mood and saliva samples before and after each session served to assess short-term psychobiological changes. In addition, patients reported their quality of life and well-being at the beginning and at the end of the 1‑week program.
RESULTS: Results showed that alertness was significantly enhanced after textile design (∆post-pre = 4.08, 95% CI [0.77, 7.39]) and after singing (∆post-pre = 2.20, 95% CI [-0.55, 4.94]). Moreover, mood tended to be positively affected by textile design (∆post-pre = 2.89, 95% CI [-0.39, 6.18]). Quality of life increased significantly after singing (∆post-pre = 5.49, 95% CI [1.05, 9.92]). Arts participation except singing was associated with significant reductions in salivary cortisol (sCort) (textile design ∆post-pre = -0.81 ng/mL, 95% CI [-1.48, -0.14]; drama ∆post-pre = -0.76 ng/mL, 95% CI [-1.28, -0.24]; clownery ∆post-pre = -0.74 ng/mL, 95% CI [-1.47, -0.01]). No significant changes were observed for well-being over the whole program and salivary immunoglobulin A (sIgA) after any of the arts activities.
CONCLUSIONS: These results suggest that arts participation can improve mood state and reduce stress in young people with mental disorders, but there is a need for further studies.
UNASSIGNED: HINTERGRUND: Kinder und Jugendliche mit psychischen Problemen leiden häufig unter Stress und negativer Stimmung, was ihre Lebensqualität und ihr Wohlbefinden beeinträchtigen kann. Künstlerische Interventionen können die Stimmung und das Wohlbefinden verbessern und den physiologischen Stress in dieser gefährdeten Bevölkerungsgruppe reduzieren.
METHODS: Eine Kohorte von Patienten der Kinder- und Jugendpsychiatrie (N = 42; Altersspanne: 12–18 Jahre) nahm an einer von 4 künstlerischen Aktivitäten teil, darunter Chorgesang (n = 11), Textildesign (n = 9), Schauspiel (n = 16) und Clownerie (n = 6). Diese wurden von professionellen Künstler*innen geleitet und über einen Zeitraum von einer Woche in fünf 90-minütigen, täglichen Nachmittagssitzungen durchgeführt. Fragebögen von Stimmungs- und Speichelproben vor und nach jeder Sitzung dienten dazu, kurzfristige psychobiologische Veränderungen zu erfassen. Darüber hinaus berichteten die Patienten zu Beginn und am Ende des einwöchigen Programms über ihre Lebensqualität und ihr Wohlbefinden.
UNASSIGNED: Die Ergebnisse zeigten, dass die Wachsamkeit nach Textildesign (∆post-prä = 4,08, 95%-KI [0,77, 7,39] und Singen (∆post-prä = 2,20, 95%-KI [−0,55, 4,94] signifikant erhöht war. Darüber hinaus wurde die Stimmung tendenziell durch Textildesign positiv beeinflusst (∆post-prä = 2,89, 95%-KI [−0,39, 6,18]). Die Lebensqualität stieg nach dem Singen signifikant an (∆post-prä = 5,49, 95%-KI [1,05, 9,92]). Die Teilnahme an den künstlerischen Aktivitäten mit Ausnahme des Singens war mit einer signifikanten Reduktion des Kortisolspiegels verbunden (Textildesign ∆post-prä = −0,81 ng/ml, 95%-KI [−1,48, −0,14]; Schauspiel ∆post-prä = −0,76 ng/ml, 95%-KI [−1,28, −0,24]; Clownerie ∆post-prä = −0,74 ng/ml, 95%-KI [−1,47, −0,01]). Es wurden keine signifikanten Veränderungen des Wohlbefindens während des gesamten Programms und des Immunglobulins A nach einer der künstlerischen Aktivitäten beobachtet.
UNASSIGNED: Diese Ergebnisse weisen deutlich daraufhin, dass die Teilnahme der psychisch kranken Kinder und Jugendlichen an künstlerischen Aktivitäten deren Stimmung verbessern und den Stress senken kann. Gleichzeitig zeigt sich auch die Notwendigkeit weiterer Studien.

Objectives: This study aimed to examine switch from first-line methylphenidate (MPH) to lisdexamfetamine (LDX) in school-aged children with attention-deficit/hyperactivity disorder (ADHD). Methods: This is a retrospective observational study based on systematic review of patient records of all children (7-13 years) diagnosed with ADHD and referred to a Danish specialized outpatient clinic. The study included 394 children switching from MPH to LDX as either second-line or third-line treatment (atomoxetine [ATX] as second-line treatment) during the study period from April 1, 2013, to November 5, 2019. Results: One in five children switched from MPH to LDX at some point during the study period. The most frequent reasons for switching to LDX were adverse effects (AEs; 70.0% for MPH, 68.3% for ATX) and lack of efficiency (52.0% for MPH, 72.7% for ATX). Top five AEs of LDX were decreased appetite (62.4%), insomnia (28.7%), irritability/aggression (26.1%), weight decrease (21.1%), and mood swings (13.9%). MPH and LDX had similar AE profiles, yet most AEs were less frequent after switching to LDX. At the end of the study period, the majority were prescribed LDX as second-line rather than third-line treatment (86.1% in 2019). However, the likelihood of LDX as second-line treatment decreased with the number of psychiatric comorbidities, ADHD symptom severity as assessed by parents, and if AEs were a reason for MPH discontinuation. Among children observed for at least 1 year after initiation of LDX, 41.3% continued LDX treatment for a year or longer. LDX continuation was less likely if AEs were a reason for MPH discontinuation. Similarly to MPH and ATX, the most frequent reasons for LDX discontinuation were AEs (74.4%) and lack of efficiency (34.7%). Implications: The findings support LDX as an important option in the personalized treatment of children with ADHD and may support prescribers in the clinical decision-making on switching medication.

UNASSIGNED: Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject.
UNASSIGNED: Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD.
UNASSIGNED: Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001).
UNASSIGNED: This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.

OBJECTIVE: First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba.
METHODS: The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve.
RESULTS: Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children.
CONCLUSIONS: Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.

BACKGROUND: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care.
METHODS: During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context.
RESULTS: The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators\' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy.
CONCLUSIONS: The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.

BACKGROUND: Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence.
METHODS: Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis.
RESULTS: Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants\' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later.
CONCLUSIONS: Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.

A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth\'s mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth\'s daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth\'s characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society.

UNASSIGNED: Psychiatry is a challenging setting that requires extraordinary effort from the staff. Healthcare workers in the field of psychiatry face substantial levels of violence, making the identification of abuse risk factors a social concern. Both the conduct of the children and their relatives can pose potential harm. Our study delved into the criminological and psychiatric factors underlying violence against healthcare workers.
UNASSIGNED: We used qualitative, semi-structured, self-developed, online questionnaire involving 21 respondents. The participants were representing the staff composition of our department. The data set was coded in two phases using a multi-stage content analysis method. The results were compared with Hungarian and international literature.
UNASSIGNED: Among the participants, 52% reported no instances of physical abuse. The most prevalent form of perceived non-contact abuse was threats, accounting for 38% of reported cases. The identified risk factors for abuse included the child\'s psychiatric disorder, communication issues, parental behavior, and low socio-economic status. Psychological trauma was identified as the most severe consequence. The respondents\' opinion indicated that the most common cause of violence (52%) was attributed to the child\'s mental disorder. Workers primarily deal with abuse through negative emotions, with 76% of them reporting feelings of victimization. Additionally, 43% believed that abuse cannot be avoided, while 19% emphasized the significance of worker competence.
UNASSIGNED: Our research can help to identify risk factors in child psychiatry wards and provide guidance for developing effective responses to violence against healthcare workers in Hungary, especially at our ward.