ObjectiveThe self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries. Method This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N = 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country. Results Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales. Conclusion The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally.

Background/Objectives: Parental internalizing issues, particularly maternal mental health, can significantly influence adolescents’ mental health by altering parenting behaviors and roles. This study explores the role of parental rejection in moderating the relationship between parental depressive, anxiety, and stress symptoms and adolescents’ mental health and quality of life. Methods: One hundred thirty eight mothers (mean age: 47.96, SD = 5.06 years) and 68 fathers (mean age: 51.07, SD = 5.53 years) of adolescents aged 12–18 completed measures on mental health, parental rejection, and adolescent well-being. Results: Maternal rejection was found to moderate the relationship between maternal anxiety symptoms and adolescents’ quality of life, as well as between maternal anxiety symptoms and adolescents’ mental health problems. Paternal rejection moderated the relationship between paternal stress symptoms and adolescents’ mental health. However, parental rejection did not moderate the relationship between parental depression and adolescents’ quality of life or mental health. Conclusions: These findings highlight the distinct roles of maternal and paternal rejection in adolescent development and suggest that parental mental health, particularly anxiety and stress, has a significant impact on adolescent well-being. Future studies should consider the influence of both parents and focus on longitudinal effects. These results emphasize the need for interventions addressing parental rejection to improve adolescent outcomes.

The Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) is one of the most popular semi-structured psychiatric interviews for children and adolescents. Its latest DSM-5 version (K-SADS-PL DSM-5) has only recently been adapted and validated in various languages. In the present study, we aimed to investigate the reliability and validity of the Greek version of the K-SADS-PL DSM-5.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13–15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22–1.29; boys, OR 1.29, 95% CI 1.25–1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

BackgroundThe transgenerational transmission of affective disorders calls for integrating promotion of child development in the services offered to families with parental depression. The main objective of the present research was to examine the effectiveness and differences in the impact of two relevant interventions in Greece. Methods Thirty families of depressed patients were randomly assigned to the six-to-eight session Family Talk Intervention group and 32 families were included in the lower intensity parent-only two-to-three session Let's Talk about the Children group. Depressed parents and the eldest of their children were assessed prior to the interventions and 4, 10, and 18 months following baseline assessment. Results In both groups there were significant improvements in parent's depression, anxiety, perceived social support, parenting and family functioning, as well as improvements in child's depression, anxiety, and child emotional/behavioral problems. Child's prosocial behavior, perceived social support, and health-related quality of life were significantly improved in both groups. All positive effects were evident four months following baseline assessment and could be still documented at 1.5-year follow-up. Mixed linear models showed that family functioning and parenting to a lesser extent were associated with the greatest changes in children's psychosocial outcomes in both interventions.. Limitations The lack of data regarding parents that refused to receive the interventions may limit generalizability of results. A further limitation is the lack of a no-intervention control group. Conclusions The study offers a preliminary evidence base for integrating preventive interventions for child mental health in routine clinical practice with adult depressed patients.

The new coronavirus pandemic (COVID-19) has been accompanied by severe psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness.

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

BackgroundMaking a diagnosis of a particular mental disorder in children and adolescents can be a challenging or overwhelming task for clinicians and researchers, with each step of a DSM-5 based diagnostic procedure necessitating a practical use of time to gather appropriate information. Objective To assess concurrent validity of the Computer-Assisted Structured Diagnostic Interview (CASDI), a newly devised, fully structured interview which encompasses categorical and dimensional approaches and automatically navigates the interviewer, through computerized decision trees (algorithms), in a specified probing system. Method A total of 258 children and adolescents (46.51% boys) aged 8-18 years (Mean±SD: 12.66±2.73) and their parents were recruited from a community sample. For each pair of child-parent, the child and one parent were interviewed separately by an interviewer using the CASDI and by a second blind interviewer using the DSM-5 Pediatric Diagnostic Interview one week after the CASDI administration. Validity indicators (sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values for 12-month diagnoses were calculated. Results The CASDI had sensitivity above 70% for Neurodevelopmental Disorders, Schizophrenia Spectrum and Other Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, Somatic Symptom and Related Disorders, Feeding and Eating Disorders, Elimination Disorders, Sleep-Wake Disorders, Gender Dysphoria, Disruptive, Impulse-Control, and Conduct Disorders, Substance-Related and Addictive Disorders and below 50% for Bipolar and Related Disorders and Dissociative Disorders. Conclusion The observed validity indicators suggest that the CASDI can be potentially used to accurately diagnose child and adolescent mental health disorders for research and clinical purposes. Its use in special populations, such as hospitalized or institutionalized children and adolescents, deserves further study.

Background:The current global financial crisis that started in 2008 resulted in a significant decline in global trade, slowing/reversing economic growth worldwide, and a dramatic increase in public sector debt. At the same time, the global migrant/refugee crisis has reached extreme rates, with millions of people being forced to abandon their homes and communities because of war, political violence or related threats. There is a broad consensus about the deleterious consequences of these crises on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse and suicidal behavior. Although the separate consequences of economic recession and immigration are extensively discussed in previous research, we know very little about the processes through which the intersection of economic crisis and migrant crisis contributes to the vulnerabilities of natives and migrants during these crises. Of particular concern is the status of children, adolescents and their families, who constitute one of the most vulnerable groups in society.Aim:To discuss the contexts that economic and migrant crises shape and suggest possible effects of this intersection on mental health risks, especially among children, adolescents and their families, through reflecting on the recent experience in Greece.Method:Review of the literature and critical analysis of the effects of the confluent crises.Conclusion:The interactive effects of these two crises need further exploration. Novel and diverse models of psychological understanding need to be developed in order to manage the effects of the confluent crises. The role of mental health professionals is crucial in this respect, offering culturally flexible, accommodating and empathetic approaches, allowing healing and acceptance in the face of adversity.

Leros became infamous worldwide in the 1980s because of a scandal in its mental institution, the Leros asylum. The scandal provoked universal outrage and the international pressure triggered the Greek mental health reform. Under the reform projects Leros I and Leros II (1990–1994), numerous interventions took place in the Leros asylum as part of deinstitutionalisation. Following that, the Psychargos programme advanced developments for community-based services. Deinstitutionalisation and development of community mental health services have advanced significantly since the 1980s. However, this reform is still incomplete, given that sectorisation, adequate primary care policies, inter-sectoral coordination and specialised services are under-developed. This problematic situation is further complicated by the severe impact of the current financial crisis.

The recession has increased job insecurity in the European Union (EU) which may result in higher levels of psychological distress, burnout and anxiety.To investigate the association of job insecurity and financial difficulties with mental health in 27 member states of the EU and to explore the moderating effect of having financial difficulties on the relationship between job insecurity and mental health.The sample consisted of employed people from 27 European countries where the Eurobarometer survey (73.2 wave, 2010) was administered by the European Commission. Mental well-being and psychological distress were measured using the Vitality and Mental Health Index (MHI-5) subscales from the Short-Form 36-item health survey (SF-36v2). Linear regression including an interaction term was used to test the underlying factors in this study.Among the 12594 respondents, experiencing job insecurity was associated with lower Vitality [β = −3.82, 95% confidence interval (CI) −5.29 to −2.36] and MHI-5 (β = −3.48, 95% CI −4.91 to −2.04). Similarly, having financial difficulties was significantly correlated with lower Vitality (β = −8.65, 95% CI −12.07 to −5.24) and MHI-5 (β = −11.51, 95% CI −15.08 to −7.94). However, having financial difficulties did not moderate the relationship between job insecurity and both mental health scales.This study highlights the negative effect of job insecurity and financial difficulties on mental health in the EU. Support to employees facing job security issues should be a priority regardless of the financial circumstances.

To the Editor In a cohort study, Dr Huybrechts and colleagues found that maternal use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy was associated with a potential increased risk of persistent pulmonary hypertension of the newborn (PPHN). The source cohort was restricted to women with a depression diagnosis, and a logistic regression analysis was used to estimate the odds ratios for PPHN associated with antidepressant exposure. However, the authors decided not to adjust for cesarean delivery because it has been shown that conditioning on such an intermediate perinatal factor is susceptible to overadjustment bias.

Adolescence has been documented as the peak age of onset for mental health perturbations, clinical disorders and unsubstantiated health complaints. The present study attempted to investigate associations between multiple, recurrent subjective health complaints (SHC) with emotional/behavioural difficulties, as measured by the Strengths and Difficulties Questionnaire scale (SDQ), among Greek adolescents.

Early childhood education services create potentially optimal opportunities to identify and respond effectively to preschoolers' mental health problems. However, little is known about the knowledge, skills and competencies of early childhood educators in the area of mental health. The present study aimed to contribute to this field through conducting focus group interviews with professionals from public early childhood education centres in Greece.

To assess psychosocial functioning and distress of children and adolescents with cystic fibrosis compared to healthy controls.

To investigate possible differences in emotional/behavioral problems and cognitive function in children with nephrotic syndrome compared to healthy controls and to examine the effect of disease-specific and steroid treatment-specific characteristics on the abovementioned variables.

Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression.

High school students are a common target group in initiatives addressing discriminatory attitudes towards people with mental illness. However, these initiatives are rarely evaluated and documented. The aim of our paper is to evaluate the effectiveness of a school-based educational intervention for improving adolescents' attitudes and reducing the desire for social distance from people with mental illness living in their community. A total of 161 students aged 16-18 years old were questioned at baseline assessment and 86 of them received a three-workshop educational intervention while 75 students comprised the control group. A follow-up assessment 1 month post intervention evaluated its impact. Attitudes and the social distance were assessed through the Community Attitudes towards the Mentally Ill scale and a 10-statement questionnaire based on the Self-report Inventory of Fear and Behavioural Intentions, respectively. Data from 140 subjects were analyzed. All attitude dimensions and half of the measured social distance statements were significantly improved in the intervention group at follow up assessment compared to controls. However, the statements measuring more intimate types of social relationships did not change significantly post intervention. In conclusion, short educational interventions can be effective to some extent in reducing discriminatory attitudes towards people with mental illness. However, effective interventions to address deeply held negative stereotypes will require further research.

Experience of common health symptoms without a clear physical or psychological cause, such as headache or dizziness, is often reported in adolescence. The present study attempted to investigate associations of self-reported subjective health complaints (SHC) with a number of sociodemographic factors of Greek adolescents.

IntroductionAripiprazole has been shown to be effective in children and adolescents with Schizophrenia spectrum disorders and few adverse effects have been reported. However, little is known about the effectiveness of aripiprazole in the treatment of pediatric patients with Intellectual Disabilities (ID) and Schizophrenia.Aims and objectivesTo expand our knowledge on the use of aripiprazole in treating adolescents with ID for Schizophrenia.MethodsUsing a retrospective review, one female and one male adolescent inpatient (11.5 and 14 years old; Wechsler Scale of Intelligence full intelligence quotient equal to 61 and 38, respectively) with a diagnosis of Schizophrenia received aripiprazole 15 mg/day and were monitored for six weeks. The primary outcome was the Positive and Negative Symptom Scale (PANSS) from baseline to endpoint.ResultsThere was a significant reduction in the overall PANSS score in both adolescents with a marked decrease in negative symptoms (blunted affect, emotional withdrawal, poor rapport, passive/ apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation, and stereotyped thinking). Among symptoms of general psychopathology, guilt feelings, motor retardation and poor attention were mostly improved. In both cases, positive and negative subscales showed significant reductions after week four. Female inpatient's weight increased from 49.5 Kg to 50 kg, while male inpatient's weight remained stable (75 kg) during monitoring. No other side effect (e.g. Q-T-corrected interval alterations, hyperprolactinemia, extrapyramidal symptoms) was developed.ConclusionsAripiprazole could be considered as a potential therapeutic agent for adolescents with ID and Schizophrenia, especially when negative symptoms are of major concern.

Abstract This study examined prospectively the role of parental psychopathology among other predictors in the development and persistence of posttraumatic stress disorder (PTSD) in 57 hospitalized youths aged 7?18 years immediately after a road traffic accident and 1 and 6 months later. Self report questionnaires and semistructured diagnostic interviews were used in all 3 assessments. Neuroendocrine evaluation was performed at the initial assessment. Maternal PTSD symptomatology predicted the development of children's PTSD 1 month after the event, OR = 6.99, 95% CI [1.049, 45.725]; the persistence of PTSD 6 months later was predicted by the child's increased evening salivary cortisol concentrations within 24 hours of the accident, OR = 1.006, 95% CI [1.001, 1.011]. Evaluation of both biological and psychosocial predictors that increase the risk for later development and maintenance of PTSD is important for appropriate early prevention and treatment.

The frequency of health care use is crucial for adolescent well-being and health systems. The present study was the first to test a set of variables in a representative sample of Greek adolescents in order to identify factors that predict health care use and contribute to improving health service planning. Questionnaires were administered to a random sample of adolescents (N=1 194) aged 11–18 years and their parents (N=973) in 2003. Data from 894 participants with full data were analyzed. Parents' education, adolescents' chronic health needs, physical well-being and emotional/behavioural problems as well as parent-child relationship were independent predictors of health care use, although some factors, such as gender, age, type of residence, family affluence, social support and parental health status that previous research identified as predictors were not confirmed. Beyond the need of health care, other factors also play an important role in the utilization of health services by adolescents and their families.

Although several studies have reported findings concerning the association between smoking and emotional/behavioural problems, little research has investigated this association after controlling for confounding factors which have been found to be significantly correlated with both cigarette smoking and emotional/behavioural problems and may have a strong effect on the relationship between adolescents' mental health and smoking. The present study attempted to assess the association between adolescents' smoking status and their emotional/behavioural problems after controlling for a number of possible confounders (i.e. age, gender, parental smoking status, exposure to family smoking, family socioeconomic status, adolescents' leisure time) in a Greek nation-wide school-based sample.

Abstract Background? Although several studies have reported findings concerning the interrelationship between smoking and specific health behaviours, little research has investigated how smoking behaviour may be associated with a cluster of health-related behaviours. The present study was an effort to extend previous research through assessing smoking status, patterns of physical and sedentary activity, as well as eating behaviours and diet quality, in order to gain some insight regarding the relationship between cigarette smoking and a cluster of health behaviours in a Greek sample of adolescents. Methods? A sample of 2008 students (1021 male and 987 female, 12?17 years of age, 7th?12th grade) was selected from all schools of a representative Athens suburb in Greece. All children completed a questionnaire that was developed for the purposes of the study which retrieved information about age, sex, school class, individual and family smoking status, dietary habits and physical activity. Various statistical tests were performed. Results? Age, playtime, consumption of soft drinks and foods from school canteens were positively associated with smoking status while the consumption of fruit juice, dairy products for breakfast and the frequency of breakfasts were inversely associated the aforementioned dependent variable. Conclusions? This study supports the interrelationships between multiple lifestyle behaviours and tobacco use in adolescents. Future research is needed in order to elaborate on the nature of these relations, especially for those at higher risk.

This study aimed at examining the relationship between parental subjective health status and adolescents' health-related quality of life (HRQoL) as well as the role of gender, socioeconomic status, presence of chronic health care needs and social support on the above interaction.

The Strengths and Difficulties Questionnaire (SDQ) is a practical, economic and user-friendly screening instrument of emotional and behavioural problems in children and adolescents. This study was aimed primarily at evaluating the factor structure of the Greek version of the SDQ.

Abstract Aim:? To investigate the associations of some family characteristics with adolescents? self-reported emotional/behavioural problems. Methods:? Questionnaires were administered to a Greek nation-wide random sample of adolescents (N = 1194) aged 11?18 years and their parents (N = 973) in 2003. The present analysis included the questionnaires completed by mothers and their offspring (639 families). Adolescents? emotional/behavioural problems, as measured by the Strengths and Difficulties Questionnaire, were assessed in relation to family socioeconomic status and residence type, parental marital status, educational attainment and subjective mental health, family cohesion and parent?child relations. Results:? The analysis showed that parental marital status other than being married, poor parent?child relations and low levels of maternal subjective mental health were independently correlated with significantly more adolescents? emotional/behavioural problems. Conclusion:? Family factors are potential determinants of adolescent emotional/behavioural problems and therefore are potential targets for prevention and/or intervention.

The objective of this study is to determine the level of depressive symptoms among a sample of Greek children aged 8–12 years, as measured by the Greek Children’s Depression Inventory (CDI), as well as to examine CDI’s psychometric properties. A nationwide school-based sample of 650 children was initially recruited and depressive symptoms were assessed with the CDI among 538 children who provided all relevant information. Statistical evaluation included assessment of CDI internal reliability, test–retest reliability, determination of age, gender and socioeconomic status (SES) effects. Based on the distributions of CDI scores observed in this normative sample, a recommended cutoff score, identifying a high probability of serious levels of depressive symptoms that need to be further evaluated, was defined. Internal reliability and test–retest reliability were satisfactory and the expected associations with age and gender were observed. High SES was correlated with significantly less depression symptoms. The prevalence of depressive risk, when the cutoff point of 19 or 13 was taken as threshold, was much lower than those obtained from studies in other countries. The cutoff point of 15, corresponding to 90th percentile of the present sample, may be used as a screening threshold for further assessment. The present results are encouraging providing evidence about the psychometric properties of the CDI and implications for child mental health promotion planning in Greece. Further validation of the CDI against other measures and psychiatric diagnoses is needed.