The Earthquake Disaster in Turkiye: A Review from Child and Adolescent Psychiatry Perspective

The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences.Copyright © 2023, Duzce University Medical School. All rights reserved.

Stress and loneliness: exploring adolescents' use of social media as a coping strategy during COVID-19.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness. AIM: To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use. METHOD: A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used - the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale. RESULTS: A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants. CONCLUSION: Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic.

Training is not enough: child and adolescent psychiatry clinicians' impressions of telepsychiatry during the first COVID-19 related lockdown.

To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction.

Bacterial Brain Abscess and Life-Threatening Intracranial Hypertension Requiring Emergent Decompressive Craniectomy After SARS-CoV-2 Infection in a Healthy Adolescent.

Acute coronavirus 2 (SARS-CoV-2) infection usually results in mild symptoms, but secondary infections after SARS-CoV-2 infection can occur, particularly with comorbid conditions. We present the clinical course of a healthy adolescent with a brain abscess and life-threatening intracranial hypertension requiring emergent decompressive craniectomy after a SARS-CoV-2 infection. A 13-year-old healthy immunized male presented with invasive frontal, ethmoid, and maxillary sinusitis and symptoms of lethargy, nausea, headache, and photophobia due to a frontal brain abscess diagnosed three weeks after symptoms and 11 days of oral amoxicillin treatment. Coronavirus disease 2019 (COVID-19) reverse transcription-polymerase chain reaction (RT-PCR) was negative twice but then positive on amoxicillin day 11 (symptom day 21), when magnetic resonance imaging revealed a 2.5-cm right frontal brain abscess with a 10-mm midline shift. The patient underwent emergent craniotomy for right frontal epidural abscess washout and functional endoscopic sinus surgery with ethmoidectomy. On a postoperative day one, his neurological condition showed new right-sided pupillary dilation and decreased responsiveness. His vital signs showed bradycardia and systolic hypertension. He underwent an emergent decompressive craniectomy for signs of brain herniation. Bacterial PCR was positive for Streptococcus intermedius, for which he received intravenous vancomycin and metronidazole. He was discharged home on hospital day 14 without neurological sequelae and future bone flap replacement. Our case highlights the importance of timely recognition and treatment of brain abscess and brain herniation in patients with neurological symptoms after SARS-CoV-2 infection, even in otherwise healthy patients.

Evaluating the sector-wide implementation of virtual child and youth mental health services in response to the COVID-19 pandemic: Perspectives from service providers, agency leaders and clients.

Background: The COVID-19 pandemic prompted an abrupt shift in the delivery of community-based child and youth mental health services as virtual care was rapidly adopted. The objective of this study was to evaluate the sector-wide transition to virtual care across Ontario, with a focus on implementation facilitators and barriers. Methods: We used a multi-level mixed-methods design where agency leaders, service providers, and clients shared their experiences planning, implementing, and accessing virtual care. In total, 97 agency leaders, and 192 youth and family members responded to the surveys; 13 agency leaders, and 11 service providers participated in interviews or focus groups. Results: Most agencies undertook a similar journey to implement virtual care. Stakeholders described common facilitators such as staff engagement, leadership support, and training activities. Barriers included internet connection issues, lack of resources, and privacy concerns. Service providers innovated as they implemented by partnering with agencies to meet clients' needs, using multiple platforms to engage clients, and altering session duration to reduce fatigue. Clients found virtual care easy to use, felt confident using it, and intend to continue accessing virtual care. Conclusion: Implementation of virtual care during the pandemic was complex and the evaluation involved obtaining perspectives at multiple levels. This research provides a blueprint for evaluations of the implementation of virtual mental health services, particularly in a child/youth context. Virtual care is a viable way to deliver mental health services, however, equity, accessibility, and appropriateness need to be addressed to ensure services are effective for children, youth, and their families. Plain language abstract: Academic literature suggests that using technology to deliver child and youth mental health services is a promising way to enhance access to care and improve engagement for many children and youth. Despite this, the provision of virtual child and youth mental health services in Ontario prior to the COVID-19 pandemic was limited. Efforts that did exist were largely focused on providing care to those in rural and remote areas. The COVID-19 pandemic prompted a rapid shift to virtual care, as most in-person mental health services were suspended. This paper presents new insight into how virtual mental health services were quickly established and used across Ontario from the perspectives of senior leaders, service providers, and clients. Results from this evaluation showed that agencies followed similar steps to prepare to use virtual services. Staff engagement, support from leadership, and opportunities for staff training supported the implementation of virtual care while internet connections issues, lack of resources (like computers or phones), and privacy and safety concerns hindered the implementation. Most youth and family members found virtual services easy to use and intend to continue using them. Most agencies intend to continue to offer virtual services post-pandemic but noted that it was not appropriate or accessible for all clients. This study provides a foundation for additional research to examine situations and conditions that are most conducive to virtual care delivery to address child and youth mental health concerns. These results may encourage agencies to rely more confidently on virtual services as another means to meet clients' needs and preferences.

Barriers and facilitators to training delivery and subsequent implementation of a localised child and adolescent mental health initiative: a qualitative content analysis.

BACKGROUND: Ensuring that children and young people (CYP) can obtain mental health support from a broad variety of sources is of upmost importance. This is especially true given the increasing prevalence of mental health difficulties in this population, and the associated challenges with receiving support from specialised healthcare services. Equipping professionals, from a wide range of sectors, with the skills needed to provide this support is a vital starting point. This study explored the experiences of professionals who had participated in CYP mental health training modules that related directly to the local implementation of the THRIVE Framework for System Change in Greater Manchester, UK (GM i-THRIVE) to establish the perceived barriers and facilitators behind the implementation of this training programme. METHODS: Directed qualitative content analysis of semi-structured interview data from nine CYP-facing professionals was conducted. Both the interview schedule and initial deductive coding strategy were developed using the findings of a systematic literature review by the authors, that was conducted to explore wider CYP mental health training experiences. This methodology was used to establish the presence or absence of these findings within GM i-THRIVE, before generating tailored recommendations for their training programme. RESULTS: When the interview data were coded and analysed, a strong level of thematic similarity with the authors' review was found. However, we deduced that the emergence of additional themes might reflect the contextual uniqueness of GM i-THRIVE, that is likely to be further compounded by the COVID-19 pandemic. Six recommendations were made for further improvement. These included the facilitation of unstructured peer interaction during training, and ensuring that jargon and key words are fully clarified. CONCLUSIONS: Methodological limitations, guidance for usage, and potential applications of the study's findings are explored. Whilst the findings were largely akin to those of the review, subtle yet important differences were found. These are likely to reflect the nuances of the training programme discussed, however, we tentatively suggest that our findings are transferable to similar training interventions. This study provides a valuable example of how qualitative evidence syntheses can be used to aid study design and analysis: an underused approach.

Consultations due to suspected child and adolescent sexual abuse at the Department of Gynecology of a children's hospital: pre- and intra-COVID-19 pandemic / Consultas por sospecha de abuso sexual infantojuvenil en la sección de Ginecología de un hospital pediátrico: variaciones prepandemia e intrapandemia de COVID-19

Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). Objetivo. Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. Resultados. Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. Conclusiones. Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas

Introduction. It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). Objective. To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. Materials and methods. Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. Results. One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. Conclusions. During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change

Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from "medium" (> 50%) in 2020 to "strong" or "extreme" (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals.

The impact of COVID-19 pandemic on emotional and behavioral problems of children with autism spectrum disorder and developmental delay aged 1-6 years in China.

Introduction: The COVID-19 pandemic outbreak have caused increased levels of emotional and behavioral problems, particularly among people with pre-existing mental health conditions. Young individuals with autism spectrum disorders (ASD) and developmental delay (DD) are particularly at risk due to their vulnerability. The purpose of this study was to look into the different effects of the COVID-19 pandemic on 1-6-year-old children with ASD and DD. Methods: Parents and guardians of children with ASD completed an online survey that included questions about their children's socio-demographics characteristics, the effects of the COVID-19 outbreak on their health, and what they needed in order to deal with the conditions of the pandemic. Results: This study compared 4,138 children with ASD to 711 children with DD. Children with ASD had a higher risk of having more emotional and behavioral problems than children with DD (OR 1.38, 95% CI 1.12-1.70). Compared to parent-oriented rehabilitation at home, discontinuing rehabilitation had a higher likelihood of negative emotional and behavioral change (OR 1.67, 95% CI 1.41-1.98). Having teachers' online support had a higher likelihood of negative emotional and behavioral change for ASD children (OR 1.26, 95% CI 1.03-1.54). Conclusions: This article provided evidence that children with developmental disabilities, particularly ASD, were at risk for a variety of challenges to their emotional functioning during the COVID-19 period, and that online support was not an ideal way for children with ASD to receive effective educational intervention in China.

Contribution of Risk and Resilience Factors to Suicidality among Mental Health-Help-Seeking Adolescent Outpatients: A Cross-Sectional Study.

BACKGROUND: Peer victimization is an established risk factor for youth suicidal thoughts and behavior (suicidality), yet most peer-victimized youth are not suicidal. More data are needed pertaining to factors that confer resilience to youth suicidality. AIM: To identify resilience factors for youth suicidality in a sample of N = 104 (Mean age 13.5 years, 56% female) outpatient mental health help-seeking adolescents. METHODS: Participants completed self-report questionnaires on their first outpatient visit, including the Ask Suicide-Screening Questions, a battery of risk (peer victimization and negative life events) and resilience (self-reliance, emotion regulation, close relationships and neighborhood) measures. RESULTS: 36.5% of participants screened positive for suicidality. Peer victimization was positively associated with suicidality (odds ratio [OR] = 3.84, 95% confidence interval [95% CI] 1.95-8.62, p < 0.001), while an overall multi-dimensional measure of resilience factors was inversely associated with suicidality (OR, 95% CI = 0.28, 0.11-0.59, p = 0.002). Nevertheless, high peer victimization was found to be associated with a greater chance of suicidality across all levels of resilience (marked by non-significant peer victimization by resilience interaction, p = 0.112). CONCLUSIONS: This study provides evidence for the protective association of resilience factors and suicidality in a psychiatric outpatient population. The findings may suggest that interventions that enhance resilience factors may mitigate suicidality risk.

Confirmation of increased and more severe adolescent mental health-related in-patient admissions in the COVID-19 pandemic aftermath: A 2-year follow-up study.

COVID-19 pandemic may have affected youth's mental wellbeing. Youth admissions for mental health emergencies over the 2-year period following the COVID-19 outbreak (March 2020-February 2022) were compared to those occurring in the same period of 2018-2020, with reference to individual and clinical data. The study identified 30 admissions in the pre-pandemic period and 65 (+116.7%) in the post-pandemic period, with the latter being younger, less likely to have a personal psychiatric history, and more likely to receive psychopharmacological treatment. A higher likelihood of earlier, ex novo psychiatric manifestations, requiring medication to reach clinical stability, in the post-COVID era, is suggested.

Epidemic of Depression and Anxiety in child and adolescent population during COVID-19 pandemic: A systematic review and meta analysis of the prevalence of depression and anxiety.

COVID-19 has caused mayhem in the life of people. It has disrupted the social fabric of life. The children and adolescent population has been particularly affected by its direct and indirect effects. This systematic review aims to find the prevalence of depression and anxiety in children and adolescent age groups. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for finding the prevalence of depression and anxiety. We found the total number of participants to be 71,016. A random effect model was used for conducting meta-analysis. The prevalence of depression was mentioned in 17 studies of 23 and the pooled prevalence was 27% [95% confidence interval: 21%-36%] and heterogeneity (I2 statistics; P <.00001) was 100%. The prevalence of anxiety was found in 20 studies of 23 and the pooled anxiety prevalence was 25% (95% confidence interval: 16%-41%) and heterogeneity (I2 statistics; P < .00001) was found to be 100%. The summary of the findings has been provided. Due to high heterogeneity, moderator analysis was performed separately for depression and anxiety subgroups. The study design consisted of cross-sectional studies and some studies conducted through online surveys. The age range varied considerably from 1 year to 19 years; 5 studies had participants aged more than 19 years, but the mean age of the total sample was less than 18 years. We conclude that indeed there is a mental health epidemic among the child and adolescent population. We recommend early intervention and tailored made strategies should for management. As the pandemic is enduring, rigorous monitoring should be done. This age group is under extra pressure owing to a large uncertainty about their studies as well their future.

[Inpatient care capacities in child and adolescent psychiatry-increase in emergency admissions during the COVID-19 pandemic?] / Stationäre Versorgungskapazitäten in der Kinder- und Jugendpsychiatrie ­ Zunahme der Akutaufnahmen während der COVID-19 Pandemie?

The COVID-19 pandemic and the accompanying containment measures have had a fundamental impact on the mental health of children and adolescents. In the present study, the emergency admissions of the first two Corona years (2020/21) at the Department for Child and Adolescent Psychiatry Hall i. T./Innsbruck were retrospectively analysed and compared with the two years before the COVID-19 pandemic (2018/19). There was no change in the total number of emergency admissions in 2020 compared to 2019 before Corona, but in 2021 emergency admissions increased by 40.1%. The pre-Corona (2018/19) gender ratio of 65.4% girls to 34.6% boys did not change in 2020. In 2021, the proportion of girls increased to 74.4%. In the COVID-19 pandemic, acute suicidality increased (+48.3%) while aggression decreased (-51.0%). Acute intoxications increased in the first Corona year and decreased again in 2021. The present study results show that the mental health needs of children and adolescents increased significantly in the course of the COVID-19 pandemic and that this was also reflected in child and adolescent psychiatry. The increased demands must now be met with appropriate care and prevention measures as well as sufficient child and adolescent psychiatric bed capacities in order to mitigate the longer-term psychosocial effects of the COVID-19 pandemic as best as possible.

Reasons and trends in youth's suicide rates during the COVID-19 pandemic.

Background: The COVID-19 pandemic posed many mental health challenges to youth through unprecedented infection control measures such as nationwide school closures. Despite this, few studies have investigated trends in suicide among youth during the pandemic, let alone their reasons. Methods: Population-level data on crude monthly suicide rates (2016-2021) and reasons of suicide (2018-2020) among youth aged 10-19 years were obtained from the Japanese Ministry of Health, Labour and Welfare and the National Police Agency, respectively. Using an event study design (with a Poisson regression model to calculate changes-in-changes (CiC) estimates) and interrupted time series analysis, we investigated changes in monthly suicide rates during the first 12 months of the pandemic (May 2020 to April 2021) compared to pre-pandemic levels (May 2016 to March 2020). Additionally, we investigated the changes in reasons of suicide (family-related, mental illness, social concerns, and academic concerns). Findings: In the event study analysis, suicide rates among youth increased during the pandemic relative to pre-pandemic levels, especially between August-November 2020 (e.g., ratio of the suicide rate in November 2020 relative to previous years, 1.86; 95% confidence interval (CI), 1.30 to 2.66). Though suicide levels returned closer to pre-pandemic levels by December 2020, they remained slightly elevated into 2021. In the interrupted time series analysis, suicide rates increased from May to August 2020 (0.099 cases per 100,000 youth per month; 95% CI, 0.022 to 0.176), followed by a decrease from September to December 2020 (-0.086 cases per 100,000 youth per month; 95% CI, -0.164 to -0.009). We observed elevated suicide rates for all major reasons from summer to autumn 2020, especially suicides attributed to family-related problems and social concerns. Furthermore, rates of suicides attributed to mental illness remained higher than pre-pandemic levels into December 2020. Interpretation: Suicide rates among youth remained slightly elevated compared to pre-pandemic levels into 2021. The reasons of the increase in suicide rates were multifactorial, including mental health issues and disruptions in social relationships. During a pandemic, interventions that provide mental support as well as opportunities for regular social interactions to youth may be beneficial. Funding: Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education.

Nasogastric tube feeding under restraint: practical guidance for children's nurses.

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

Supporting children's nurses to deliver trauma-informed care.

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.

The Behavioral Health Needs of Youth With Preexisting Psychiatric Disorders in the Aftermath of COVID-19.

Children and adolescents with psychiatric disorders are a sizable population of children and youth with special health care needs. While the capabilities of behavioral health resources to meet these youth's needs were already strained, the Coronavirus Disease 2019 (COVID-19) pandemic extended resource limitations just as this subgroup of children and youth with special health care needs faced new stressors and potential exacerbations of their underlying psychiatric illnesses. In this article, we provide a brief narrative review of the factors' manifestations with an emphasis upon their disproportionate impact upon children of color and their families and particularly those from disadvantaged communities. We proceed to provide policy proposals for addressing these disparities. These include raising reimbursement for behavioral health services, increasing telehealth care delivery, reducing inter-state licensing requirements, increasing community-based services, and addressing social determinants of health. Conclusions and directions for strengthening behavioral health service delivery capabilities and addressing systemic injustices are made.

Promoting Mental Health Literacy at Schools in South Korea.

The onset of many lifelong mental illnesses is during childhood and adolescence. There has been an increase in these conditions among children and adolescents especially, during the COVID-19 pandemic. It is essential to promote mental health literacy (MHL) as a preventive and universal intervention for children and adolescents. Positive mental health status in adolescence is related to an increased level of MHL, and various MHL programs at schools have been reported to be effective for adolescent students worldwide. Recently, MHL programs have been developed in South Korea to be used by schoolteachers. There is a need for active dissemination and development of future programs. For continuous and effective education, it is desirable to include MHL education in regular school curricula.

Hopelessness during and after the COVID-19 pandemic lockdown among Chinese college students: A longitudinal network analysis.

INTRODUCTION: In China, recurrent pandemics require frequent city-wide lockdowns and quarantine actions to contain the impact of COVID-19, exposing college students to psychological problems, including hopelessness. Hence, the purpose of helping problematic college students alleviate hopelessness symptoms motivates us to carry out the present study to explore their interrelationship. METHODS: Hopelessness (i.e., a complex phenomenon with important clinical consequences, such as depression and suicidality) was investigated in a large longitudinal sample of college students (N = 2787; 58.59% female; age mean ± SD = 18.34 ± 0.92) who were recruited during and after the COVID-19 lockdown using the Beck Hopelessness Scale (BHS). RESULTS: Applying the novel approach (i.e., symptom network analysis), the results indicated that the edge of #BHS1 (i.e., [NOT] hope-enthusiasm)-#BHS15 (i.e., [NOT] faith-in-the-future) showed the strongest association both in Wave 1 and Wave 2. Similarly, #BHS20 (i.e., not-trying) had the highest node expectedinfluence (centrality) in the hopelessness symptoms network both among Wave 1 and Wave 2. The Network Comparison Test indicated that the global network strength significantly differed between the two time points. As expected, college students' hopelessness will gradually dissipate with the end of segregation control. The stability and accuracy indicated that the network analysis results were trustworthy. CONCLUSIONS: The study findings provide evidence that central nodes and edges connecting symptoms should be addressed. Further interventions and treatments that may target these symptoms are essential to effectively alleviate the overall hopelessness level among college students. Theoretical and clinical potential consequences were discussed in detail.