Placebo response in trials with patients with anxiety, obsessive-compulsive and stress disorders across the lifespan: a three-level meta-analysis.

QUESTION: Randomised controlled trials assessing treatments for anxiety, obsessive-compulsive and stress-related disorders often present high placebo response rates in placebo groups. Understanding the placebo response is essential in accurately estimating the benefits of pharmacological agents; nevertheless, no studies have evaluated the placebo response across these disorders using a lifespan approach. STUDY SELECTION AND ANALYSIS: We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies and international registers from inception to 9 September 2022. The primary outcome was the aggregate measure of internalising symptoms of participants in the placebo arms of randomised controlled trials designed to assess the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in individuals diagnosed with anxiety, obsessive-compulsive or stress-related disorders. The secondary outcomes were placebo response and remission rates. Data were analysed through a three-level meta-analysis. FINDINGS: We analysed 366 outcome measures from 135 studies (n=12 583). We found a large overall placebo response (standardised mean difference (SMD)=-1.11, 95% CI -1.22 to -1.00). The average response and remission rates in placebo groups were 37% and 24%, respectively. Larger placebo response was associated with a diagnosis of generalised anxiety disorder and post-traumatic stress disorder, when compared with panic, social anxiety and obsessive-compulsive disorder (SMD range, 0.40-0.49), and with absence of a placebo lead-in period (SMD=0.44, 95% CI 0.10 to 0.78). No significant differences were found in placebo response across age groups. We found substantial heterogeneity and moderate risk of bias. CONCLUSIONS: Placebo response is substantial in SSRI and SNRI trials for anxiety, obsessive-compulsive and stress-related disorders. Clinicians and researchers should accurately interpret the benefits of pharmacological agents in contrast to placebo response. PROSPERO REGISTRATION NUMBER: CRD42017069090.

Critical appraisal and comparison of recommendations of clinical practice guidelines for the treatment of schizophrenia in children and adolescents: a methodological survey.

INTRODUCTION: The production of clinical practice guidelines (CPGs) has grown in the past years. Notwithstanding, the quality of these documents and their recommendations for the treatment of schizophrenia in children and adolescents is still unknown. OBJECTIVE: To assess the quality of the guidelines and recommendations for the treatment of schizophrenia in this population. METHODS: CPGs from 2004 to December 2020 were identified through a systematic search on EMBASE, MEDLINE, PsycINFO, PubMed, Epistemonikos, VHL, Global Index Medicus and specific CPG databases. The CPGs' quality was independently assessed by three reviewers using AGREE II and they were considered of high quality if they scored ≥60% in domains 3 and 6. The evidence classification systems were described, the quality of recommendations was assessed in pairs using AGREE-REX and the recommendations were compared. RESULTS: The database search retrieved 3182 results; 2030 were screened and 29 were selected for full-text reading. Four guidelines were selected for extraction. Two CPGs were considered of high quality in the AGREE II assessment. We described the commonly agreed recommendations for each treatment phase. The pharmacological recommendations were described in all treatment phases. Scores of AGREE-REX were lower for psychosocial recommendations. CONCLUSION: There are still few clinical studies and CPGs regarding schizophrenia in children and adolescents. The quality of the documents was overall low, and the quality of the recommendations report has much to improve. There is also a lack of transparency about the quality of the evidence and the strength of the recommendations. PROTOCOL REGISTRATION NUMBER: CRD42020164899.

Identifying resources used by young people to overcome mental distress in three Latin American cities: a qualitative study.

OBJECTIVE: To explore which resources and activities help young people living in deprived urban environments in Latin America to recover from depression and/or anxiety. DESIGN: A multimethod, qualitative study with 18 online focus groups and 12 online structured group conversations embedded into arts workshops. SETTING: This study was conducted in Bogotá (Colombia), Buenos Aires (Argentina) and Lima (Peru). PARTICIPANTS: Adolescents (15-16 years old) and young adults (20-24 years old) with capacity to provide assent/consent and professionals (older than 18 years of age) that had experience of professionally working with young people were willing to share personal experience within a group, and had capacity to provide consent. RESULTS: A total of 185 participants took part in this study: 111 participants (36 adolescents, 35 young adults and 40 professionals) attended the 18 focus groups and 74 young people (29 adolescents and 45 young adults) took part in the 12 arts workshops. Eight categories captured the resources and activities that were reported by young people as helpful to overcome mental distress: (1) personal resources, (2) personal development, (3) spirituality and religion, (4) social resources, (5) social media, (6) community resources, (7) activities (subcategorised into artistic, leisure, sports and outdoor activities) and (8) mental health professionals. Personal and social resources as well as artistic activities and sports were the most common resources identified that help adolescents and young adults to overcome depression and anxiety. CONCLUSION: Despite the different contexts of the three cities, young people appear to use similar resources to overcome mental distress. Policies to improve the mental health of young people in deprived urban settings should address the need of community spaces, where young people can play sports, meet and engage in groups, and support community organisations that can enable and facilitate a range of social activities.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey.

OBJECTIVES: Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood. DESIGN: Cross-sectional population-based study carried out from November 2011 to March 2012. SETTING: Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample. PARTICIPANTS: A total of 3378 adults (aged 19 years and above) were included. PRIMARY AND SECONDARY OUTCOMES MEASURES: The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models. RESULTS: Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship. CONCLUSIONS: Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Identifying self-report measures of emotion regulation and evaluating their psychometric properties: a protocol for a systematic review.

INTRODUCTION: Successful emotion regulation (ER) is critical for psychological health. Disturbances in this ability are associated with several psychiatric disorders. There are several self-report questionnaires to assess ER. However, there are no studies synthesising the evidence on their psychometric properties. We aim to identify all available instruments addressing ER in adolescents or adults and to critically appraise, compare and summarise the quality of their psychometric properties. For this, we will use COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. METHOD AND ANALYSIS: The search process to identify eligible studies will be conducted in April 2021 including the ProQuest, PubMed, Scopus and Web of Science databases with no restriction in terms of publication date. Eligibility criteria include peer-reviewed research articles written in English or Spanish by means of patient-reported outcome measures focused on ER among participants of 13 years or older. We will assess the quality of measures according to the COSMIN Risk of Bias Checklist. The psychometric properties will be assessed by the COSMIN updated criteria for good measurement. The available evidence will be addressed by the Grading of Recommendations, Assessment, Development and Evaluations approach. Our findings will be synthesised independently for each measure, including information on their sample, theoretical model and psychometric properties when possible. ETHICS AND DISSEMINATION: Ethical approval is not required, as this study does not involve any participants or collection of primary data. Results are expected to be published in a peer-reviewed journal in the field of youth mental health and presented at relevant meetings and conferences. PROSPERO REGISTRATION NUMBER: CRD42021249498.

Interventions to reduce stigma towards mental disorders in young people: protocol for a systematic review and meta-analysis.

INTRODUCTION: The stigma towards mental disorders can limit the use and effectiveness of available mental health interventions for young people. We aim to systematically review effectiveness of interventions to reduce stigma towards mental disorders in young people, as evidence has not been recently and systematically synthesised on this topic. METHODS AND ANALYSIS: We will conduct a systematic review and meta-analysis of randomised or controlled clinical trials of interventions to reduce stigma towards mental disorders in people aged 10-24 years. Studies involving a comparison group, post intervention and/or follow-up assessments of knowledge, attitudes and/or behaviours towards mental disorders (including help-seeking behaviours), will be included. The Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed and PsycINFO databases will be searched, without time limits, for eligible studies in English or Spanish, and with results available. Databases will be searched from July 2020 to April 2021. The study selection process, the data extraction and the critical evaluation-with the Cochrane risk-of-bias tool-of included studies will be performed independently and in duplicate by teams of reviewers, with the assistance of a third party, until reaching a high degree of agreement. In the presence of substantial heterogeneity (I2 >75%), a narrative synthesis of the study results will be used. If feasible, we will also conduct a quality effects model for the statistical synthesis of results. If sufficient data are available, subgroup analyses will be performed to assess potential sources of heterogeneity. Doi plots and the Luis Furuya-Kanamori index will be used to assess publication bias. The Grades of Recommendation, Assessment, Development and Evaluation approach will be used to assess the confidence in the evidence reviewed. ETHICS AND DISSEMINATION: Results are expected to be published in a peer-reviewed journal in the field of adolescent and/or youth mental health. PROSPERO REGISTRATION NUMBER: CRD42020210901.

Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol.

INTRODUCTION: The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents. METHODS AND ANALYSIS: CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations. ETHICS AND DISSEMINATION: Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations. PROTOCOL REGISTRATION NUMBER: CRD42020164899.

Role of optimism in adolescent mental health: a protocol for a systematic review.

INTRODUCTION: Adolescence is a critical period of human development, where adaptive or maladaptive experiences can happen. These experiences are associated with psychological, social, biological and health factors. Previous empirical evidence suggests that mental health is associated with individual assets and positive states, whose presence may become a factor of protection and resistance to mental disorders. Among these, optimism could play a fundamental role in sustaining physical and mental well-being and in dealing with threats potentially harmful to health. Given the rise of research on optimism and its importance in the various health outcomes, it is necessary to initiate processes of compilation and synthesis of this evidence to facilitate the understanding of the importance of this variable on the mental health of adolescents. METHODS AND ANALYSIS: The included studies will be experimental, observational, cross-sectional and longitudinal focussed on the role of optimism on mental health in adolescents, regardless of whether they belong to clinical or non-clinical populations. This systematic review protocol will be carried out following the Cochrane Manual for systematic reviews and will follow the statement on systematic reviews and meta-analysis of PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Searches will run from October 2019 to March 2020, and will be carried out from the following electronic databases: APA PsycNet, BVS (Biblioteca Virtual em Saúde), Web of Science, PubMed Central and Scopus. Two reviewers will obtain the eligible articles, published from January 2009 onward, to assess the quality of each study and extract the data. For the presentation of the results, a narrative and quantitative synthesis will be carried out that groups the data found. ETHICS AND DISSEMINATION: The approval of an ethics committee is not required for a systematic review protocol. The results will be presented at congresses in social sciences and psychology and will be published in a peer-reviewed social or health science journal. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019142616.

Mental health interventions for suicide prevention among indigenous adolescents: a systematic review protocol.

INTRODUCTION: There are more than 370 million indigenous people from 5000 cultures living in 90 countries worldwide. Although they make up 5% of the global population, they account for 15% of the extreme poor. Youth suicide is the second leading cause of mortality among 15-29 years old and disproportionately affects indigenous youth. This research protocol pertains to a systematic review of studies that use a comparator/control group to evaluate the effectiveness of suicide interventions targeting indigenous adolescents (aged 10-19 years). METHODS AND ANALYSIS: We will conduct a systematic search on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO from inception to September 2019 to identify articles that compare mental health interventions for suicide prevention among indigenous adolescents. Two reviewers will independently determine the eligibility of each study. Studies will be assessed for methodological quality using the risk of bias tool to assess non-randomised studies of interventions. We will conduct a meta-analysis if possible and use established statistical methods to identify and control for heterogeneity where appropriate. ETHICS AND DISSEMINATION: This systematic review will use published data and does not require ethics approval. However, this review is in preparation of a feasibility study that will examine how best to support the physical and mental health of indigenous adolescents in Brazil. Ethics approval for the feasibility study was obtained from National Research Ethics Commission. Findings will be disseminated through a peer-reviewed publication and will be made available to key decision-makers with authority for indigenous health and other relevant stakeholders. PROSPERO REGISTRATION NUMBER: CRD42019141754.

Estudio de epidemiología psiquiátrica en niños y adolescentes en Chile: estado actual / Studies on psychiatric epidemiology in children and adolescents in Chile: state of the art

Se destaca el rol de la epidemiología psiquiátrica evolutiva científica para ayudar a la comprensión de las causas y factores de riesgo para trastornos psiquiátricos, evaluar las trayectorias evolutivas y proponer estrategias preventivas y terapéuticas. Se resumen los estudios sobre edades de comienzo, factores de riesgo y protectores, prevalencia de trastornos psiquiátricos y uso de servicios tanto en Latinoamérica como en otros países. Se informa sobre el primer estudio de prevalencia en niños y adolescentes chilenos, su metodología y resultados. Se aplicó en los hogares la versión computarizada de la entrevista DISC-IV. La prevalencia total fue de 22,5%, siendo el grupo de trastornos de comportamiento disruptivo los mas frecuentes, seguidos por los trastornos ansiosos. Se detallan los factores asociados a cada grupo de trastornos y la comorbilidad entre ellos. 41,6% de los niños y adolescentes con Trastorno psiquiátrico asociado a discapacidad social consultó en algún tipo de servicio en el último año. La información derivada de esta investigación prestará utilidad para el desarrollo y perfeccionamiento de programas de salud mental en el país.

The role of scientific developmental psychiatric epidemiology is highlighted in the study of causal and risk factors, evaluation of developmental trajectories and proposal of preventive and therapeutic strategies. Studies on ages of onset, risk and protective factors, prevalence of psychiatric disorders and service use in Latin America and other countries are summarized. Information about methodology and results of the first chilean community epidemiological study are given. Computarized versión of DISC-IV interview was used in the homes. Total prevalence for any disorder was 22,5%, the most frequent being disruptive disorders followed by anxiety disorders. Associated factors and comorbidity for each group of disorders is detailed. 41,6% of children with a disorder associated with psychosocial impairment had sought assistance in some kind of service. Information derived from this study will be useful for the development and improvement of mental health programs in the country.