[Mobile Applications to Promote Youth Mental Health: Opportunities and Challenges]. / Applications mobiles pour soutenir la santé mentale des jeunes : opportunités et défis.

Introduction Adolescence is a sensitive period during which many changes occur and may have the potential to affect an individual's cognitive and psychosocial development. It is also during this period that the most abrupt increase in mental health problems is noted. Several initiatives seek to prevent the onset or deterioration of these disorders among young people, and especially those in situations of vulnerability because the emotional or behavioral difficulties they are already displaying or because of the adversities they face. In these efforts, the use of technology is generally perceived as natural, even desirable, among these "digital natives." Objective This critical review examines the strengths and limitations of mobile applications (apps), as documented in the literature, and based in our own experience, to evaluate their potential to support youths' mental health and resilience in times of adversity, and the obstacles most likely to lessen their impacts. Findings Mobile apps, by their format and through the types of usage they provide, allow young people to have access to evidence-based information anchored to their realities. Apps also represent an opportunity to engage certain young people in a process of change or to support them in their request for help. All the more, these new tools are available at all times and are aligned to their needs for autonomy and confidentiality. Many challenges must, however, be overcome to best support young people's mental health through apps, including reliance on scientific validation, the protection of personal data and the capacity to attract and promote engagement in young people. Conclusion The critical analysis of the available literature is intended as a strategic thinking process to further support the development of future apps that will meet the best standards as viewed by a multitude of actors likely to create and use them.

A Prospective Study of Childhood Predictors of Traumatic Brain Injuries Sustained in Adolescence and Adulthood.

OBJECTIVE: Traumatic brain injuries (TBIs) are sustained by approximately 17% of males in the general population, many of whom subsequently present mental disorders, cognitive, and physical problems. Little is known about predictors of TBIs and how to prevent them. The present study aimed to determine whether inattention-hyperactivity and/or all externalizing problems presented by boys at age 10 predict subsequent TBIs to age 34 after taking account of previous TBIs and family social status (FSS). METHOD: 742 Canadian males were followed, prospectively, from age 6 to 34. Diagnoses of TBIs were extracted from health files, parents-reported sociodemographic and family characteristics at participants' age 6, and teachers-rated participants' behaviors at age 10. Separate logistic regression models predicted TBIs sustained from age 11 to 17 and from age 18 to 34. For each age period, two models were computed, one included previous TBIs, inattention-hyperactivity, FSS, and interaction terms, the second included previous TBIs, externalizing problems, FSS, and interaction terms. RESULTS: In models that included inattention-hyperactivity, TBIs sustained from age 11 to 17 were predicted by age 10 inattention-hyperactivity (odds ratio [OR] = 1.46, 1.05 to 2.05) and by TBIs prior to age 11 (OR = 3.50, 1.48 to 8.24); TBIs sustained from age 18 to 34 were predicted by age 10 inattention-hyperactivity (OR = 1.31, 1.01 to 170). In models that included all externalizing problems, TBIs from age 11 to 17 were predicted by prior TBIs (OR = 3.66, 1.51 to 8.39); TBIs sustained from age 18 to 34 were predicted by age 10 externalizing problems (OR = 1.45, 1.12 to 1.86). Neither FSS nor interaction terms predicted TBIs in any of the models. CONCLUSIONS: Among males, using evidence-based treatments to reduce inattention-hyperactivity and externalizing problems among boys could, potentially, decrease the risk of TBIs to age 34. Further, boys who sustain TBIs in childhood require monitoring to prevent recurrence in adolescence.

Enduring effect of childhood maltreatment on cortisol and heart rate responses to stress: The moderating role of severity of experiences.

There is a relative consensus about the detrimental impact of childhood maltreatment on later mental health problems and behavioral difficulties. Prior research suggests that neurophysiological stress mechanisms may partly mediate this association. However, inconsistent findings regarding hypothalamic-pituitary-adrenal axis and sympathetic responses to stress complicate this investigation. Furthermore, the concordance in these two stress systems is not well understood. We tested whether the severity of maltreatment affected the association between maltreatment and cortisol and heart rate (HR) stress responses and the symmetry of these responses. Participants were 155 males (56 maltreated and 99 controls) aged 18 to 35 years. Cortisol and HR were measured in response to the Trier Social Stress Test. Childhood maltreatment, sociodemographic factors, and health-related factors were measured using self-reported questionnaires. Maltreated participants had higher cortisol responses to stress in comparison to controls. However, a shift from moderate to lower to higher cortisol responses was noted as the severity of the experiences increased. Participants exposed to more experiences of maltreatment also showed a greater symmetry between cortisol and HR stress responses. Our findings provide further support for persistent dysregulation of the HPA axis following childhood maltreatment, of which the expression and symmetry with the sympathetic system may change according to the severity of experiences.

Are Traumatic Brain Injuries Associated With Criminality After Taking Account of Childhood Family Social Status and Disruptive Behaviors?

OBJECTIVE: The authors aimed to elucidate the links between traumatic brain injuries (TBIs) and criminal convictions in a sample of 724 Canadian males with and without criminal records followed up to age 24. METHODS: Prospectively collected data were analyzed to determine whether prior TBIs predicted subsequent criminal convictions after taking account of family social status (FSS) and childhood disruptive behaviors. At age 24, diagnoses of TBIs were extracted from health records and convictions from official criminal records. In childhood, teachers rated disruptive behaviors and parents reported FSS. RESULTS: Proportionately more individuals with offender status than nonoffender status sustained a TBI from age 18 to age 24 but not before age 18. Individuals with offender status who had sustained a TBI before and after their first conviction were similar in numbers, were raised in families of low social status, and presented high levels of disruptive behaviors from age 6 to age 12. When FSS and childhood disruptive behaviors were included in multivariable regression models, sustaining a prior TBI was not associated with an increased risk of juvenile convictions for any type of crime, for violent crimes, for convictions for any crime or violent crime from age 18 to age 24, or for a first crime or a first violent crime from age 18 to age 24. CONCLUSIONS: Among males, there was no evidence that prior TBIs were associated with an increased risk of subsequent criminal convictions from age 12 to age 24 when taking account of FSS and childhood disruptive behaviors, although these latter factors may be associated with an increased prevalence of TBIs among adult offenders.

A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder.

BACKGROUND: Some evidence suggests that the prevalence of Borderline Personality Disorder (BPD) is elevated among male criminal offenders. It is not presently known whether offending, and violent offending, are limited to those presenting comorbid Antisocial Personality Disorder (ASPD) who have a childhood history of conduct problems and whether offending is linked to psychopathic traits. METHODS: A community sample of 311 males followed from age 6 to 33 years, one third of whom had a criminal charge between ages 18 and 24, completed diagnostic interviews and the Psychopathy Checklist-Revised interview. Information on childhood included parent-reported family characteristics and teacher-rated of hurtful and uncaring behaviours, conduct problems, hyperactivity and inattention, and anxiety at age 6, 10, and 12 years. Health files were obtained as were records of criminal convictions from age 12 to 33. RESULTS: At age 33, 4% of the men presented BPD and not ASPD, 16% ASPD and not BPD, 8% BPD + ASPD, and 72% neither disorder (ND). Comorbid disorders were common: BPD were distinguished by high levels of anxiety disorders, BPD and BPD + ASPD by depression disorders, and BPD, BPD + ASPD, and ASPD by substance dependence. Official files indicated use of health services by all participants. One-third of participants with BPD and BPD + ASPD acquired a diagnosis of a personality disorder. More than one-third of participants with BPD + ASPD obtained scores indicative of the syndrome of psychopathy. Convictions for violent crimes varied across groups: In adolescence, BPD none, BPD + ASPD 16%, ASPD 16%, and ND 3.6%; from age 18 to 33, BPD 18%, ASPD 19%, BPD + ASPD 52%, and ND 4.4%. Offenders with BPD + ASPD were convicted, on average, for four times more violent crimes than offenders with ASPD and seven times more than ND offenders. In childhood, men with BPD + ASPD and with ASPD had obtained similarly elevated ratings for disruptive behaviours as compared to ND. CONCLUSION: BPD comorbid with ASPD was associated with violent criminal offending in adolescence and most strongly in adulthood, elevated levels of psychopathic traits, and childhood disruptive behaviour. BPD showed similar characteristics but to a much less degree.

Validation of an adapted procedure to collect hair for cortisol determination in adolescents.

INTRODUCTION: In the last decades, cortisol has been extensively studied in association to early exposure to adversity as well as in the etiology of a number of physical and mental problems. While saliva and blood samples allow the measurement of acute changes in cortisol secretion, hair samples are thought to provide a valid retrospective measure of chronic cortisol secretion over an extended period of time. Nevertheless, the existing protocol for hair collection involves considerable financial and logistical challenges when performed in large epidemiological studies. OBJECTIVE: This study aimed to validate an adapted collection protocol asking participants to sample their hair at home and to send it back to our laboratory by regular mail. METHODS: Participants were 34 teenagers between 17 and 18 years of age. They participated in two hair collections: (a) at home, with the help of someone they know, and (b) in our laboratory, with a trained research assistant. RESULTS: We noted a strong correlation between cortisol ascertained from hair collected at home and at the laboratory. No mean difference in cortisol levels could be detected between the two protocols. Moreover, we showed that a wide range of hair-related, sociodemographic, lifestyle factors that may be associated with hair cortisol levels did not affect the association between cortisol measures derived from each protocol. CONCLUSION: Our study provides initial support that reliable measures of chronic cortisol secretion could be obtained by asking adolescents to collect a sample of their hair at home and send them to the laboratory by regular mail. This adapted protocol has considerable financial and logistical advantages in large epidemiological studies.