Consortium Profile: The Methylation, Imaging and NeuroDevelopment (MIND) Consortium.

Epigenetic processes, such as DNA methylation, show potential as biological markers and mechanisms underlying gene-environment interplay in the prediction of mental health and other brain-based phenotypes. However, little is known about how peripheral epigenetic patterns relate to individual differences in the brain itself. An increasingly popular approach to address this is by combining epigenetic and neuroimaging data; yet, research in this area is almost entirely comprised of cross-sectional studies in adults. To bridge this gap, we established the Methylation, Imaging and NeuroDevelopment (MIND) Consortium, which aims to bring a developmental focus to the emerging field of Neuroimaging Epigenetics by (i) promoting collaborative, adequately powered developmental research via multi-cohort analyses; (ii) increasing scientific rigor through the establishment of shared pipelines and open science practices; and (iii) advancing our understanding of DNA methylation-brain dynamics at different developmental periods (from birth to emerging adulthood), by leveraging data from prospective, longitudinal pediatric studies. MIND currently integrates 15 cohorts worldwide, comprising (repeated) measures of DNA methylation in peripheral tissues (blood, buccal cells, and saliva) and neuroimaging by magnetic resonance imaging across up to five time points over a period of up to 21 years (Npooled DNAm = 11,299; Npooled neuroimaging = 10,133; Npooled combined = 4,914). By triangulating associations across multiple developmental time points and study types, we hope to generate new insights into the dynamic relationships between peripheral DNA methylation and the brain, and how these ultimately relate to neurodevelopmental and psychiatric phenotypes.

Experience of Service Questionnaire (ESQ) in children and adolescents: factor structure, reliability, validity, item parameters and interpretability of the parent version for practical use in Greece.

Background: Health systems need tools to assess patient's experience of service, but existing tools lack reliability and validity assessment. Our aim is to investigate the factor structure, reliability, validity, item parameters and interpretability of the parent version of the Experience of Service Questionnaire (ESQ) for practical use in Greece. Methods: A total of 265 caregivers that were using mental health services in Greece participated in this study as part of the Nationwide cross-sectional survey from the Child and Adolescent Mental Health Initiative (CAMHI). Confirmatory Factor Analysis was used to test factor structure. Reliability of all models were measured with omega coefficients. Tobit regression analysis was used to test for convergent and discriminant validity with specifically designed questions. Item parameters were assessed via Item Response Theory. Interpretability was assessed by means of IRT-based scores. Results: We found that ESQ is best represented and scored as a unidimensional construct, given potential subscales would not have enough reliability apart from a general factor. Convergent and discriminant validity was demonstrated, as caregivers who perceived that their child benefited from the received mental health care had 6.50 higher summed scores (SMD=1.14, p<0.001); while those who believed that their child needed additional help had 5.08 lower summed scores on the ESQ (SMD=-0.89, p<0.001). Average z-scores provided five meaningful categories of services, in terms of user satisfaction, compared to the national average. Conclusions: Our study presents evidence for the reliability and validity of the ESQ and provides recommendations for its practical use in Greece. ESQ can be used to measure experience of service and might help drive improvements in service delivery in the Greek mental health sector.

Beyond frequency: Evaluating the validity of assessing the context, duration, ability, and botherment of depression and anxiety symptoms in South Brazil.

Assessment tools for depression and anxiety usually inquire about the frequency of symptoms. However, evidence suggests that different question framings might trigger different responses. Our aim is to test if asking about symptom's context, ability, duration, and botherment adds validity to Patient Health Questionnaire-9, General Anxiety Disorder-7, and Patient-Related Outcome Measurement Information Systems depression and anxiety. Participants came from two cross-sectional convenience-sampled surveys (N = 1,871) of adults (66% females, aged 33.4 ± 13.2), weighted to approximate with the state-level population. We examined measurement invariance across the different question frames, estimated whether framing affected mean scores, and tested their independent validity using covariate-adjusted and sample-weighted structural equation models. Validity was tested using tools assessing general disability, alcohol use, loneliness, well-being, grit, and frequency-based questions from depression and anxiety questionnaires. A bifactor model was applied to test the internal consistency of the question frames under the presence of a general factor (i.e., depression or anxiety). Measurement invariance was supported across the different frames. Framing questions as ability (i.e., "How easily …") produced a higher score, compared with framing by context (i.e., "In which daily situations …"). Construct and criterion validity analysis demonstrate that variance explained using multiple question frames was similar to using only one. We detected a strong overarching factor for each instrument, with little variances left to be explained by the question frame. Therefore, it is unlikely that using different adverbial phrasings can help clinicians and researchers to improve their ability to detect depression or anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Is waiting for rewards good for you? No association between impulsive choice, psychopathology, and functional outcomes in a large cohort sample.

Background: A stronger preference for immediate rewards has been reported in individuals with ADHD and other disorders. However, the consistency of the associations between this preference and psychiatric conditions as well as functional outcomes have been questioned. Research on its association with longitudinal outcomes is scarce. Methods: The current study used data on a choice delay task (CDT) from a school-based cohort of Brazilian children with those at higher risk for psychiatric disorders over-sampled (n = 1917). The sample included typically developing children (n = 1379), those with ADHD (n = 213), and other disorders. The frequency of the trials where children chose a larger later reward versus a smaller sooner reward was compared for those with ADHD and typically developing children. Cross-sectionally and longitudinally, the study also evaluated whether children's preference for larger delayed rewards at baseline predicted the presence of psychiatric disorders and functional life outcomes (academic performance, alcohol use, early pregnancy, criminal conviction, BMI). Results: Children with ADHD and their typically developing peers performed similarly on the CDT. Their baseline task performance was not related to psychiatric conditions or life outcomes. Conclusions: The current results raise questions regarding the use of the CDT with diverse populations and whether a preference for larger delayed rewards is predictive of positive long-term outcomes as widely assumed.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part I.

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part II.

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the utilization of digital health in mental healthcare, the implementation of interventional psychiatry, and the design of innovative mental health systems integrating principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients within general hospitals, where their mental health and physical needs are addressed should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that stand to advance innovation, uphold human rights, and strive for the highest standards in mental health care.

The interplay between ADHD and school shift on educational outcomes in children and adolescents: A cross-sectional and longitudinal analysis.

Many countries implement a double-shift schooling system, offering morning or afternoon shifts, driven by diverse factors. Young people with ADHD may face educational problems attending morning shifts compared to afternoon shifts. To investigate this, we used data from a Brazilian school-based cohort (n = 2.240, 6-14 years old, 45.6% female; 50.2% in the morning shift; 11.2% with ADHD). ADHD was determined by child psychiatrists using semi-structured interview. Educational outcomes were measured cross-sectionally and three years later (80% retention) and included reading and writing ability, performance in school subjects, and any negative school events (repetition, suspension, or dropout). Generalized regression models tested the interaction between ADHD and school shift and were adjusted for age, sex, race/ethnicity, intelligence, parental education, socioeconomic status, and site. Attrition was adjusted with inverse probability weights. We used two dimensional measures of attentional problems as sensitivity analysis. ADHD and morning shift were independently associated with lower reading and writing ability and with higher odds for negative school events cross sectionally. ADHD independently predicted lower performance in school subjects and higher negative school events at follow-up. Interaction was found only at the cross-sectional level in a way that those studying in the afternoon present better educational outcomes compared with those studying in the morning only if they have lower ADHD symptom. Thus, ADHD was not associated with poorer educational outcomes among those studying in the morning. However, participants studying in the afternoon with lower levels of attentional problems presented better educational, despite these associations fade away over time.

Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Functional connectivity development along the sensorimotor-association axis enhances the cortical hierarchy.

Human cortical maturation has been posited to be organized along the sensorimotor-association axis, a hierarchical axis of brain organization that spans from unimodal sensorimotor cortices to transmodal association cortices. Here, we investigate the hypothesis that the development of functional connectivity during childhood through adolescence conforms to the cortical hierarchy defined by the sensorimotor-association axis. We tested this pre-registered hypothesis in four large-scale, independent datasets (total n = 3355; ages 5-23 years): the Philadelphia Neurodevelopmental Cohort (n = 1207), Nathan Kline Institute-Rockland Sample (n = 397), Human Connectome Project: Development (n = 625), and Healthy Brain Network (n = 1126). Across datasets, the development of functional connectivity systematically varied along the sensorimotor-association axis. Connectivity in sensorimotor regions increased, whereas connectivity in association cortices declined, refining and reinforcing the cortical hierarchy. These consistent and generalizable results establish that the sensorimotor-association axis of cortical organization encodes the dominant pattern of functional connectivity development.

Population Neuroscience: Understanding Concepts of Generalizability and Transportability and Their Application to Improving the Public's Health.

In population neuroscience, samples are not often selected with equal or known probability from an underlying population of interest; in other words, samples are not often formally representative of a specified underlying population. This chapter provides an overview of an epidemiological approach to considering the implications of selective participation on the value of our results for population health. We discuss definitions of generalizability and transportability, given the growing recognition that generalizability and transportability are central for interpreting data that are aiming to be population-based. We provide evidence that differences in the prevalence of effect measure modifiers between a study sample and a target population will lead to a lack of generalizability and transportability. We provide an example of an association between a poly-genetic risk score and depression, showing how an internally valid association can differ based on the prevalence of effect measure modifiers. We show that when estimating associations, inferences from a study sample to a population can depend on clearly defining a target population. Given that representative sampling from explicitly defined target populations may not be feasible or realistic in many situations, especially given the sample sizes needed for statistical power for many exposures of interest (and especially when interactions are being tested), researchers should be well versed in tools available to enhance the interpretability of samples regarding target populations.

Trajectories of positive attributes from childhood to young adulthood and its associations with threat and deprivation.

OBJECTIVE: The aims of this study are to investigate the trajectory of positive attributes from childhood to early adulthood and to explore how those trajectories can be modified by two domains of childhood adversity - threat and deprivation. METHODS: A large prospective school-based community cohort of youths (n=2,511, 6-14 years of age, 45% female) was assessed and followed up for 3 years (80% retention) and 6 years (71% retention). Positive attributes were assessed by the Youth Strength Inventory (YSI). Childhood exposure to threat and deprivation were assessed by a composite measure using multiple indicators. RESULTS: Trajectories of YSI scores were non-linear and distinct for boys and girls. While boys presented a more stable trajectory; girls showed higher levels of positive attributes early in life that decrease over time around adolescence. Both exposure to threat and deprivation presented negative linear association with YSI over time. Furthermore, we found interactions between developmental stage and both adversity domains meaning that the effects of exposure to adversity were stronger at earlier developmental stages and almost non-significant closer to early adulthood. CONCLUSION: Our findings provide new evidence on trajectories of positive attributes in youth and reveal and how experiences of adversity in early life impact not only mental disorder but also positive aspects of mental health.

Perinatal and neonatal factors and mental disorders in children and adolescents: looking for the contributions of the early environment to common and dissociable aspects of psychopathology.

High rates of co-occurrence of mental disorders have been hypothesized to represent a result of common susceptibility to overall psychopathology. The purpose of this study is to test the hypothesis that commonalities among psychiatric disorders might be partially driven by sharable perinatal and neonatal environmental factors for mental disorders. Participants were 6-14 years of age children and their parents. Primary caregivers provided data on perinatal and neonatal information assessed retrospectively (n = 2231). Psychiatric disorders diagnoses were assessed using the Development and Well Being Behavior Assessment (DAWBA). We used bifactor models to disentangle common from dissociable aspects of psychopathology. These models allow modeling psychiatric disorders as the result of a common domain of psychopathology (p-factor) and three dissociable domains (fear, distress, and externalizing symptoms). Associations were tested using linear and tobit regression models. The p-factor was associated with male sex, low socioeconomic status, gestational smoking, gestational drinking, low levels of maternal education and presence of mental disorder in the mother. Associations with specific factors also emerged suggesting some risk factors might also have some role for fear, distress and externalizing factors. Our study supports the hypothesis that overall susceptibility to psychopathology might be partially driven by sharable perinatal and neonatal factors.

Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece.

BACKGROUND: In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS: This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS: A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION: A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.

Irritability in Youths: A Critical Integrative Review.

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.

Worldwide Prevalence and Disability From Mental Disorders Across Childhood and Adolescence: Evidence From the Global Burden of Disease Study.

Importance: The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups. Objective: To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study. Design, Setting, and Participants: Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023. Exposure: Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years. Main Outcomes and Measures: Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs. Results: Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years. Conclusions and Relevance: An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives.

An Evaluation of Item Harmonization Strategies Between Assessment Tools of Psychopathology in Children and Adolescents.

Data aggregation in mental health is complicated by using different questionnaires, and little is known about the impact of item harmonization strategies on measurement precision. Therefore, we aimed to assess the impact of various item harmonization strategies for a target and proxy questionnaire using correlated and bifactor models. Data were obtained from the Brazilian High-Risk Study for Mental Conditions (BHRCS) and the Healthy Brain Network (HBN; N = 6,140, ages 5-22 years, 39.6% females). We tested six item-wise harmonization strategies and compared them based on several indices. The one-by-one (1:1) expert-based semantic item harmonization presented the best strategy as it was the only that resulted in scalar-invariant models for both samples and factor models. The between-questionnaires factor correlation, reliability, and factor score difference in using a proxy instead of a target measure improved little when all other harmonization strategies were compared with a completely at-random strategy. However, for bifactor models, between-questionnaire specific factor correlation increased from 0.05-0.19 (random item harmonization) to 0.43-0.60 (expert-based 1:1 semantic harmonization) in BHRCS and HBN samples, respectively. Therefore, item harmonization strategies are relevant for specific factors from bifactor models and had little impact on p-factors and first-order correlated factors when the child behavior checklist (CBCL) and strengths and difficulties questionnaire (SDQ) were harmonized.

Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil.

BACKGROUND: Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. METHODS: For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6-14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010-11, and 1917 were assessed 8 years later (2018-19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. FINDINGS: DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20-2·18; CBCL 1·66, 1·19-2·30), but only CBCL independently predicted poor life chances (1·56, 1·19-2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. INTERPRETATION: Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes. FUNDING: Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de São Paulo; and Medical Research Council, European Research Council. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Parent-Perceived Benefits and Harms Associated With Internet Use by Adolescent Offspring.

Importance: Limited systematic information on familial factors and perception of the benefits and harms of internet use by youths is available. Much of the current research has been hampered by small nondiverse samples and limited information on key familial and offspring characteristics. Objective: To characterize parental perceptions and concerns about internet use associated with adolescent development, well-being, safety, family connectedness, and potential for problematic internet use. Design, Setting, and Participants: A 20-minute, English-language survey was developed with expert stakeholders using previously validated questionnaires and was conducted online between June 17 and July 5, 2022. Participants included 1005 parents of children and adolescents aged 9 to 15 years drawn from an online digital survey platform and calibrated for representation with post hoc weightings. Main Outcomes and Measures: Parent survey responses about family characteristics and internet use were used to compute Internet Addiction Test scores for parents and their offspring, Alabama Parenting Questionnaire scores, and an aggregate family connectedness score. Results: The survey cohort of 1005 parents included 568 women (56.5%) and 437 men (43.5%) with a mean age (SD) of 39.5 (6.4) years. In terms of race and ethnicity, the most common categories included Black or African American (95 [9.5%]), Latinx or Hispanic (100 [10.0%]), White (602 [59.9%]), and 2 or more races or ethnicities (122 [12.1%]). Respondents endorsed parental concerns that included exposure to harmful content (646 [64.3%]) and online bullying (533 [53.0%]). Two hundred twenty-five parents (22.4%) had specific concerns about internet addiction in their adolescent offspring, and twice as many parents reported specific concerns about internet addiction than substance addiction. However, parents also indicated that internet use improved family connectedness among immediate families (468 [46.6%]) and extended families (568 [56.5%]). Internet Addiction Test scores in adolescent offspring were correlated with parent scores (ß = 0.62 [SE = 0.02]; P < .001) and Alabama Parenting Questionnaire-Inconsistent Discipline scores (ß = 0.23 [SE = 0.11]; P = .04). Conclusions and Relevance: In this survey study of parent perceptions of internet use among adolescent offspring, parents believed the internet brought families closer yet also expressed concerns. Problematic internet use among youths was correlated with negative parenting styles and parent internet use. This research adds to the literature by suggesting that families, their communities, and industry may have common ground to collaborate on reducing the negative effects of internet use.

The shared and dissociable aspects of burnout, depression, anxiety, and irritability in health professionals during COVID-19 pandemic: A latent and network analysis.

Burnout syndrome (BS) has been classified as an independent 'work-related phenomenon', however, there is still an important discussion on whether BS is a unique clinical construct due to the overlapping symptoms with other domains of negative affect such as symptoms of depression, anxiety, and irritability. Thus, we investigated the common and dissociable aspects between BS and domains of negative affect such as depression, anxiety, and irritability through a cross-sectional study with 3428 essential service professionals from a national project during the COVID-19 pandemic. Participants were assessed with Burnout Assessment Tool (BAT) and the Patient-Reported Outcomes Measurement Information System (PROMIS) scales to assess the severity of depression, anxiety, and irritability. The discriminability between the constructs was investigated using correlation tests, Bifactor Exploratory Structural Equation Modeling Bifactor (ESEM), and network analyzes. The mean correlation among the four subscales of BAT-12 was stronger with each other than with depression, anxiety, and irritability. Both ESEM and network analysis, despite showing shared characteristics, clearly delineated that Burnout domains were dissociable from other domains of negative affect. Our findings corroborate the ICD-11 strategy to include BS as a separate entity that cannot be fully explained by variance accounted for by other domains.

The association between duration of breastfeeding and the trajectory of brain development from childhood to young adulthood: an 8-year longitudinal study.

Breastfeeding has been associated with several short- and long-term health benefits, including positive cognitive and behavioral outcomes. However, the impact of breastfeeding on structural brain development over time remains unclear. We aimed to assess the association between breastfeeding duration in childhood and the developmental trajectory of overall cortical thickness, cortical area, and total intracranial volume during the transition from childhood to early adulthood. Participants included 670 children and adolescents with 1326 MRI scans acquired over 8 years from the Brazilian High-Risk Cohort for Mental Conditions (BHRCS). Breastfeeding was assessed using a questionnaire answered by the parents. Brain measures were estimated using MRI T1-weighted images at three time points, with 3-year intervals. Data were evaluated using generalized additive models adjusted for multiple confounders. We found that a longer breastfeeding duration was directly associated with higher global cortical thickness in the left (edf = 1.0, F = 6.07, p = 0.01) and right (edf = 1.0, F = 4.70, p = 0.03) hemispheres. For the total intracranial volume, we found an interaction between duration of breastfeeding and developmental stage (edf = 1.0, F = 6.81, p = 0.009). No association was found between breastfeeding duration and brain area. Our study suggests that the duration of breastfeeding impacts overall cortical thickness and the development of total brain volume, but not area. This study adds to the evidence on the potential impact of breastfeeding on brain development and provides relevant insights into the mechanisms by which breastfeeding might confer cognitive and mental health benefits.