Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies.

BACKGROUND: Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents.MethodWe conducted a systematic review of all published literature on psychotic symptom prevalence in two age groups, children aged 9-12 years and adolescents aged 13-18 years, searching through electronic databases PubMed, Ovid Medline, PsycINFO and EMBASE up to June 2011, and extracted prevalence rates. RESULTS: We identified 19 population studies that reported on psychotic symptom prevalence among children and adolescents. The median prevalence of psychotic symptoms was 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years. CONCLUSIONS: Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9-12 years) compared to older (13-18 years) children

Risk factors for self-harm and suicidal ideation and behaviour in adolescents and young adults: a protocol for an umbrella review of systematic reviews [version 1; peer review: 2 approved with reservations]

Background:There are many primary studies on the risk and protective factors for self-harm and suicidal ideation and/or behaviour in the adolescent and young adult (AYA) age group.  Moreover, there have been many systematic reviews on these primary studies. Some of these focus on a specific population, a geographic area, a specific risk factor or a socioeconomic group, whereas others are more general in their approach.  An umbrella review of these systematic reviews is an appropriate design to synthesise the available research regarding the main risks and protective factors for self-harm and suicidal ideation and/or behaviour in AYAs and to establish the relative strength of the associations of these risk and protective factors.    Methods and analysis: The PRISMA-P checklist was used for this protocol. The databases to be used for this umbrella review will be Ovid Medline, Embase, APA PsycInfo, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus.  Systematic reviews included will date as far back as the year 2010 and up to the present so as to ensure that the evidence is contemporary and up-to-date.  Two authors, including the first author, will independently screen the results for inclusion.  The AMSTAR 2 checklist will be used for the quality assessment process and the overall strength of the body of evidence will be assessed using the GRADE tool.  </p

Birth weight and childhood psychopathology in the ABCD cohort: association is strongest for attention problems and is moderated by sex

Many studies have shown low birth weight is associated with psychopathology later in life, particularly attention-deficit/hyperactivity disorder (ADHD). The association is well-replicated, independent from a variety of potential familial confounds, and follows a dose–response curve (decreasing birth weight linked with increasing odds of disorder). However, the specificity of the association to attention problems is called into question by the extent of comorbidity in ADHD, and recent findings that the association is stronger for autism than ADHD. We test the relative dose–response strength of birth weight on multiple aspects of behavior to explore specificity of the effect to attention problems. We also test recent suggestions that the association between birth weight and attention problems is driven by males. Our sample consisted of 9,076 children aged 9–10 from the United States (Adolescent Brain Cognitive Development study). Outcomes included 9 problem-scales and the total problems scale from the Child Behavior Checklist (CBCL). Attention problems were the most strongly associated with birth weight after controlling for gestational age, potential familial confounds, and multiple testing, supporting the outcome-specificity of this association. Contrary to recent registry-based findings, an association between birth weight and an autism scale was not observed. Sex moderated the effect of birth weight on total problems, attention problems and aggressive behavior such that these inverse associations were strongly driven by males. Our findings have strong implications for sex-specific prediction and etiological models of childhood psychopathology.</p

Prenatal and perinatal complications in the development of psychosis: canaries in the coalmine

Although first suggested as early as the 1930s, the study of obstetric complications as risk factors for later psychotic disorders came to the fore in the late 1980s, when proponents of the neurodevelopmental aetiological model of schizophrenia cited the association between obstetric adversity and later schizophrenia as an essential building block for this theoretical approach. A meta-analytic review of this literature in 2002 concluded that no specific obstetric complications were associated with schizophrenia– rather a host of prenatal and perinatal risk factors of small effect size (typically with odds ratios [ORs] of less than 2).<br

Childhood adversity and adolescent psychopathology: evidence for mediation in a national longitudinal cohort study

BACKGROUND: Childhood adversity is a well-established risk factor for psychopathology; however, many who experience adversity do not go on to develop psychopathology. Poor self-concept and poor parental support are known risk factors for adolescent psychopathology, which may account for some of this mechanism.AIMS: To investigate candidate mediators in the relationship between childhood adversity and psychopathology.METHOD: We used data from the age 9 and 13 waves of the child-cohort of the Growing Up in Ireland study. We undertook mediation analysis by path decomposition of the relationship between childhood adversity and psychopathology (internalising and externalising problems) at age 13 and persistent psychopathology. Candidate mediators were self-concept, parent-child relationship and hobby participation at age 9.RESULTS: Childhood adversity was reported by 28.2% of participants, and was significantly associated with internalising and externalising problems. Parent-child conflict mediated the relationship between childhood adversity and both age 13 and persistent psychopathology, accounting for 52.4% of the relationship between childhood adversity and persistent externalising problems (indirect odds ratio, 1.30; 95% CI 1.19-1.43) and 19.2% for persistent internalising problems (indirect odds ratio, 1.24; 95% CI 1.15-1.34). There was a small mediating effect of self-concept. Hobby participation and positive parent-child relationship did not mediate these relationships.CONCLUSIONS: Parent-child conflict explains almost half the relationship between childhood adversity and persisting externalising problems in adolescence, and a fifth of the relationship with persisting internalising problems. This suggests parent-child conflict is a good target for interventions in childhood to prevent adolescent psychopathology.DECLARATION OF INTEREST: None.</div

‘Enlightened change agents with leadership skills’: a scoping review of competency-based curricula in public health PhD education

There is growing momentum for PhD curricula to move away from traditional apprenticeship models and to adopt competency-based education models. The objectives of this study were to identify key drivers for adopting competency-based curricula during PhD training and to articulate key competencies to be developed as part of the curriculum for PhD public health training. Relevant peer-reviewed and grey literature published between 2002–2022 was included. Data were extracted using Microsoft Excel and the findings were grouped descriptively. 22 records were included, with the USA showing the most progress regarding competency integration. Key drivers for adopting competency-based curricula include meeting emerging challenges in the public health field and preparing graduates for a labour market beyond the academic route. Communication and leadership skills have emerged as key competencies that require further development. PhD education must be underpinned by clearly defined competencies relevant to the public health context and supporting graduates move to the next phase of their careers.</p

‘Enlightened change agents with leadership skills’: a scoping review of competency-based curricula in public health PhD education

There is growing momentum for PhD curricula to move away from traditional apprenticeship models and to adopt competency-based education models. The objectives of this study were to identify key drivers for adopting competency-based curricula during PhD training and to articulate key competencies to be developed as part of the curriculum for PhD public health training. Relevant peer-reviewed and grey literature published between 2002–2022 was included. Data were extracted using Microsoft Excel and the findings were grouped descriptively. 22 records were included, with the USA showing the most progress regarding competency integration. Key drivers for adopting competency-based curricula include meeting emerging challenges in the public health field and preparing graduates for a labour market beyond the academic route. Communication and leadership skills have emerged as key competencies that require further development. PhD education must be underpinned by clearly defined competencies relevant to the public health context and supporting graduates move to the next phase of their careers.</p

Pharmacy student attitudes to mental illness and the provision of mental health care: a repeated cross-sectional survey

Background: Attitudes to mental illness are an important factor in the willingness of professionals to engage in mental health care. Aim: The aim of this study was to understand attitudes of undergraduate pharmacy students in Ireland to severe mental illness and the provision of medicines optimisation services as well as the variation in these attitudes throughout the undergraduate course. Method: A survey instrument was compiled using existing published research and validated questionnaires. The survey was distributed to students in their first, third and Master of Pharmacy years annually between 2014 and 2019. Although designed as a longitudinal study, following the matching process there were a limited number of students who completed more than one survey and therefore data were treated as independent samples. Results: The overall average response rate was 25% per survey (n = 191 participants) Notwithstanding generally positive attitudes, a sizeable proportion of students felt people with severe depression and schizophrenia were hard to talk to (n = 48, 25.3%; n = 54, 29.2%) Less than half of MPharm students expressed confidence and competence in caring for people with more severe mental illnesses such as bipolar disorder and schizophrenia and 29% (n = 60) of students would feel awkward asking someone about their antipsychotic medication. Almost two thirds (n = 120, 63.8%) expressed an interest in a career in mental health. Conclusion: Irish pharmacy students have generally positive attitudes towards people with severe mental illness and provision of medicines optimisation services. There is an opportunity to improve pharmacy graduates perceived competence and confidence to provide mental health services.</p

Psychotic-like experiences? Trajectories and typologies of hallucinations and delusions from early adolescence to early adulthood in a population-based sample of Irish youth

Objectives: Hallucinations and delusions that occur in the absence of a psychotic disorder are common in children and adolescents. Longitudinal phenomenological studies exploring these experiences are notably lacking. The objective of the current paper was to explore the phenomenology and characteristics of hallucinations and delusions from early adolescence to early adulthood.Methods: Participants were 17 young people aged 18-21 years from the general population, all of whom had a history of childhood hallucinations and/or delusions. Longitudinal data on the phenomenological characteristics and attributions of reported hallucinatory and delusional phenomena spanning nine years were explored using content analysis.Results: Hallucinatory and delusional phenomena were transient for two-thirds of the sample. The remaining one-third reported reoccurring hallucinatory and delusional phenomena into early adulthood. In those, two typologies were identified: (1) Paranormal typology and (2) Pathological typology. The former was characterised by hallucinatory and delusional phenomena that were exclusively grounded in subcultural paranormal or spiritual belief systems and not a source of distress. The latter was characterised by delusion-like beliefs that were enmeshed with individuals' mood states and a source of distress. The perceived source, the subcultural context and how young people appraised and integrated their experiences differentiated the Paranormal and Pathological typologies.Conclusions: Not all hallucinatory and delusion-like experiences are psychotic-like in nature. To reliably differentiate between pathological and non-pathological hallucinations and delusions, assessments need to explore factors including the phenomenology of individuals' experiences, how people make sense and appraise them, and the subcultural contexts within which they are experienced.</p

Predicting childhood ADHD-linked symptoms from prenatal and perinatal data in the ABCD cohort

This study investigates the capacity of pre/perinatal factors to predict attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. It also explores whether predictive accuracy of a pre/perinatal model varies for different groups in the population. We used the ABCD (Adolescent Brain Cognitive Development) cohort from the United States (N = 9975). Pre/perinatal information and the Child Behavior Checklist were reported by the parent when the child was aged 9-10. Forty variables which are generally known by birth were input as potential predictors including maternal substance-use, obstetric complications and child demographics. Elastic net regression with 5-fold validation was performed, and subsequently stratified by sex, race/ethnicity, household income and parental psychopathology. Seventeen pre/perinatal variables were identified as robust predictors of ADHD symptoms in this cohort. The model explained just 8.13% of the variance in ADHD symptoms on average (95% CI = 5.6%-11.5%). Predictive accuracy of the model varied significantly by subgroup, particularly across income groups, and several pre/perinatal factors appeared to be sex-specific. Results suggest we may be able to predict childhood ADHD symptoms with modest accuracy from birth. This study needs to be replicated using prospectively measured pre/perinatal data. </p