For young people with eating disorders (EDs), family-based therapy (FBT) is generally recommended as first-line treatment. Although there is an abundance of evidence demonstrating the efficacy of FBT, less than half of young people achieve full remission with this treatment. Enhanced cognitive behaviour therapy (CBT-E) is an established alternative to FBT, demonstrating effectiveness in individuals who have not achieved full remission with FBT. It is also recommended when family therapy is unacceptable, contraindicated, or ineffective. Despite some overlap – particularly in addressing maintaining factors and prioritising weight normalisation – the two treatments diverge significantly in conceptualisation of the eating disorder, proposed mechanisms of action, role of both young people and parents, and strategies and processes of therapy. These differences may contribute to one treatment being effective where the other has not, but can present challenges and difficulties for the young person, family and clinician when transitioning from FBT to CBT-E. In this paper, we provide guidance for clinicians delivering CBT-E with young people who have a history of FBT treatment. We highlight common issues encountered among this cohort, discuss how they can present a barrier to successful implementation of CBT-E, and describe solutions.

Key learning aims

1. (1) To learn the commonly encountered barriers to treatment when implementing CBT-E for young people who have previously engaged in FBT.

2. (2) To learn strategies to overcome these barriers focusing on the young person, parents and multi-disciplinary team.

The dietary inflammatory index (DII) has emerged as a promising tool associated with the development of cardiovascular risk factors. This systematic review and meta-analysis, developed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42022323267), aimed to synthesise observational studies that evaluated the association between the DII and indicators of body adiposity and blood pressure in children and adolescents. PubMed/MEDLINE, Embase, LILACS, CINAHL, Web of Science, Scopus and Google Scholar were searched, without time and language restrictions. The methodological quality of the studies and the certainty of the evidence were assessed using the Newcastle–Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. The meta-analysis revealed that a higher DII (pro-inflammatory diet) was significantly associated with increased odds of body adiposity, as indicated by body mass index (BMI) (odds ratio [OR] = 1·62; 95% confidence interval [CI] 1·38–1·86), waist circumference (OR = 1·45; 95% CI 1·10–1·81) and the waist-to-height ratio (OR = 1·76; 95% CI 1·38–2·14) in adolescents, compared with those with a lower DII (anti-inflammatory diet). In addition, for every unit increase in the DII, there was a small but significant rise in mean BMI (β = 0·06 kg/m2). The children’s dietary inflammatory index (CDII) showed no association with cardiometabolic risk factors. There were no consistent associations between the DII or CDII and blood pressure. In conclusion, while a pro-inflammatory diet (based on the DII) is linked to body adiposity, additional longitudinal studies are needed to explore these associations, particularly regarding the CDII and blood pressure.

The aim of this study was to evaluate the relative validity of food and nutrient intakes estimated by a brief-type diet history questionnaire for Japanese children and adolescents (BDHQ15y) designed to assess habitual dietary intake during the previous month. A total of 432 boys and 412 girls aged 6–17 years from thirty-two prefectures in Japan completed the BDHQ15y and subsequently provided 8-day weighed dietary records (DR) on two non-consecutive days over four seasons for comparison. Among the intakes of forty-four nutrients and thirty-one food groups adjusted for energy intake using the density model, the BDHQ15y showed percentage differences in median intake of less than 10 % compared with the DR for nineteen nutrients in both sexes, as well as for eleven and seven food groups in boys and girls, respectively, indicating good agreement for key nutrients and food groups, including protein, fat, carbohydrate, dietary fibre, grains, vegetables, dairy products and sugar-sweetened beverages (SSB). The median values (25th–75th percentiles) of Spearman’s correlation coefficients in boys and girls were 0·33 (0·28–0·38) and 0·28 (0·23–0·35) for nutrients, respectively, and 0·36 (0·29–0·42) and 0·29 (0·24–0·36) for food groups, respectively. Bland–Altman plots showed wide limits of agreement, with overestimation at higher intakes for most nutrients and food groups, except SSB. In conclusion, the BDHQ15y shows promise for large-scale dietary monitoring, particularly for estimating group-level intakes of key nutrients and food groups. However, its limited ability to rank individual intakes and the variability in individual-level assessments necessitate cautious interpretation and application.

Adolescents may not necessarily have a specific mental health challenge to seek information on mental health. They may be genuinely curious on how to better understand these issues, especially when mental health is being discussed in school, among peers and with parents. The purpose of this study was to examine the frequency and factors associated with online information seeking about mental health among adolescents. A total of 702 high school students from Belgrade, Serbia, participated in the study and filled in an anonymous questionnaire about sociodemographics, digital behaviors and the Electronic Health Literacy Scale (eHEALS). The prevalence of seeking information about mental health in our study sample was 23.5% (165/702). The multivariate model showed that having a lower school performance, lower eHEALS score and browsing health blogs, social media and websites run by physicians and health institutions were independently associated with online information seeking about mental health. Additionally, searching for online information about psychoactive substances, bullying and medications was independently associated with online information seeking about mental health among adolescents. Adolescents are familiar with a variety of sources of online health information, but choose specific online platforms to read about mental health. These platforms could be utilized to promote mental well-being in high schools.

This study investigates the epidemiology of adolescent suicide in India, addressing the limited research on the subject. Data on adolescent suicide (14–17 years) by sex and state were obtained from the National Crimes Records Bureau for 2014–2019, which included acquiring unpublished data from 2016 to 2019. Crude suicide rates for the period 2014–2019 were calculated by sex and state. Rate ratios (RRs) by sex and state were also calculated to assess changes over time, comparing suicide rates from 2017–2019 to 2014–2016. Female adolescent suicide rates, which ranged between 9.04 and 8.10 per 100,000 population, were consistently higher than male adolescent suicide rates, which ranged between 8.47 and 6.24 per 100,000 population. Compared to the first half of the study period (2014–2016), adolescent suicide rates significantly increased between 2017 and 2019 among less developed states (RRs = 1.06, 95% uncertainty interval [UI] = 1.03–1.09) and among females in these states (RRs = 1.09, 95% UI = 1.05–1.14). Male suicide rates aligned with global averages, while female rates were two to six times higher than in high-income and Southeast Asian countries. Findings highlight the urgent need for comprehensive surveillance and targeted suicide prevention strategies to address this critical public health issue.

Ultra-processed foods (UPFs) have negative health consequences. Food insecurity and Supplemental Nutrition Assistance Program (SNAP) are associated with higher UPF intake in U.S. adults, but this has not been examined in U.S. adolescents. This study assesses associations between food security status and SNAP participation with UPF intake in 3,067 adolescents aged 12–19 years with household incomes at or below 300% of the federal poverty line from the 2007–2016 National Health and Nutrition Examination Survey. UPF is defined using the Nova classification and measured as a percentage of daily total energy intake (TEI). High food security, marginal food security, or food insecurity status was determined through the U.S. Department of Agriculture’s eighteen-item Household Food Security Survey. SNAP participation was deemed affirmative if the household reported receiving SNAP benefits in the last year. Multivariable linear regressions that controlled for TEI and sociodemographic covariates and accounted for the complex survey design examined associations between food insecurity and SNAP participation with UPF intake. In the sample, the prevalence of marginal food security was 15.9%, the prevalence of food insecurity was 33.8%, and the prevalence of SNAP participation was 36.5%. After multivariate adjustment, there were no significant differences in UPF intake by food security status. Adolescents participating in SNAP consumed 2.7% higher UPF intake (95% CI: 0.1%, 5.2%, p = 0.04) compared to adolescents not participating in SNAP. Among lower-income U.S. adolescents, SNAP participation but not food security status was associated with higher UPF intake. Programs and policies promoting the intake of more healthful, minimally processed foods should be strengthened.

Modern Western diets, characterised by a substantial proportion of kilocalories derived from ultra-processed foods (UPF), have been associated with systemic inflammation. This study examines the association between UPF consumption and inflammation, assessed through alterations in C-reactive protein (CRP) concentrations, among Brazilian adolescents. This is a cross-sectional study involving a sub-sample of 6316 adolescents aged 12–17 years, participants in the Study of Cardiovascular Risk in Adolescents (ERICA), from seven capitals in Brazil. Dietary intake was assessed using a 24-hour recall, and foods were categorised based on their degree of processing according to the NOVA classification. UPF consumption was then divided into quartiles. For CRP evaluation, blood samples were collected after a 12-hour fasting period and categorised as > 3 mg/l, indicating low-grade inflammation. Poisson regression models with robust variance were employed to assess the association between UPF consumption and high CRP concentrations. High UPF consumption (highest quartile, ≥ 44·9 % kcal/d) was slightly associated with a higher prevalence of CRP after adjusting for potential confounders (prevalence ratio = 1·039; 95 % CI: 1·006, 1·073), compared with those in the lowest quartile of UPF consumption. However, when evaluating different groups of UPF separately (such as sugary beverages, processed meats and sweets), the previous association was no longer observed. These findings suggest a modest association between overall UPF consumption and early indicators of unhealthy low-grade inflammation in adolescents. Further experimental and cohort studies are necessary to clarify the role of UPF in inflammatory processes.

The Senior Wellbeing Practitioner (SWP) postgraduate certificate is a new low-intensity psychological training intended to expand the Children and Young People’s mental health workforce. It builds on the skillset of qualified Child Wellbeing Practitioners (CWPs) and Educational Mental Health Practitioners (EMHPs), by providing training to work with a broader range of presentations including neurodivergence. The SWP Skills and Competency Framework (SWP-SCF) is a new tool developed in response to the need to operationalise and assess the skills necessary to work with the range of presentations SWPs are required to treat, whilst retaining fidelity to the low-intensity intervention approach. As training providers we have used the SWP-SCF with our first cohorts of SWPs as an aid for skill development and reflective practice, as well as for assessment of clinical competency within assignments. Students and tutors have reported good face validity and utility, and further assessment of the validity of this framework appears warranted.

Key learning aims

1. (1) To understand the role of the SWP and how this fits into the wider child and adolescent mental health workforce.

2. (2) To outline the key skills and competencies necessary for SWPs to deliver effective interventions at the low-intensity level.

3. (3) To present how the SWP Skills and Competency Framework was developed and how this can be used as a tool within training and supervision.

Resilience is the dynamic process of adapting to or recovering from stressors, maintaining positive mental health. While most studies have investigated resilience after major life events, less is known about resilience in everyday life. To understand how individuals recover from everyday stressors, and associations with other psychosocial variables, well-being and mental health, we conducted a systematic review of studies to daily resilience, i.e., recovery from daily stressors, using the experience sampling method (ESM). Out of 36 included studies, 11 studies investigated daily resilience in youth (10.9–24.7 years) and 25 in adult samples. Daily resilience was operationalized either with self-report items adapted from trait measures (17 studies) or in terms of affective recovery from daily stressors (20 studies). The self-reported ability to recover from daily stressors reflects subjective experiences of coping with stressors, whereas daily resilience as recovery from daily stressors captures the dynamic process, but is understudied in youth. Daily resilience was associated with psychosocial variables, including better sleep quality and greater optimism. Furthermore, individuals with mental health problems consistently showed longer recovery times after daily stressors. Overall, ESM studies highlight that daily resilience could help to identify individuals at-risk for mental health problems. The findings may facilitate timely interventions.

The COVID-19 pandemic significantly challenged the mental health of children and adolescents, with existing research highlighting the negative effects of restrictive measures to control the virus’s spread. However, in the specific context of this pandemic, there is limited understanding of how these difficulties have persisted over time after the situation was fully restored. This study sought to evaluate the pandemic’s impact on psychological symptoms in children from Italy, Spain, and Portugal across five-time points (2, 5, and 8 weeks, 6 months, and three and a half years after the pandemic’s onset). A total of 1613 parents completed the Psychological Impact of COVID-19 and Confinement on Children and Adolescents Scale, reporting symptoms in their children aged 3–17 years (39.2% female). The findings reveal an initial surge in psychological difficulties—anxiety, mood, sleep, behavioral, eating, and cognitive disturbances—followed by improvements in these domains three and a half years later. By September 2023, Spanish children experienced more significant reductions in symptoms compared to their Italian and Portuguese peers. While the COVID-19 pandemic has been a prolonged crisis, with varying impacts over time and across regions depending on the strictness of restrictions, the trends suggest a gradual improvement in the psychological well-being of children and adolescents.

There has been an increasing number of applications from unaccompanied asylum-seeking children (UASC) in the United Kingdom in recent years. It is well-known that this population is at high-risk of developing mental health disorders, which require early detection and intervention to facilitate successful integration. This paper describes the introduction of mental health screening for unaccompanied asylum-seeking children in a National Health Service (NHS) outpatient clinic in central London. This follows the results of a two-year retrospective analysis of the health needs of the population in our clinic, which identified a high incidence of disturbance to mood and sleep. We describe the selection process for a culturally appropriate and validated screening tool, piloting the Refugee Health Screener (RHS) tool with 20 UASC in clinic, and using preliminary findings to inform a more targeted referral to community Child and Adolescent Mental Health Services (CAMHS). We conclude that implementation of the RHS-13 is feasible for widespread mental health screening for UASC in an NHS setting, and provide suggestions for future research directions within this field.