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The epidemiology of psychiatric disorders among young people is a topic often discussed within the media. However, the reported prevalence of child and adolescent psychiatric disorders depends upon the sample studied, temporal context and methodology used. Within the UK, the use of large, methodologically rigorous surveys has improved understanding of disorders at a population level. The findings paint a solemn picture with 1 in 8 young people found to have a diagnosable mental disorder in 2017 and follow ups in 2020 and 2021 suggesting this may have increased to 1 in 6. The main drivers in these increases appear to be a rise in emotional disorders, particularly in older adolescents and most strikingly among females. Other disorders, when compared across timepoints, appear to have remained relatively stable in prevalence. The classification of disorders within child and adolescent psychiatry is also an ever-evolving field with changes made in each new diagnostic manual which reflect current thinking and the incorporation of new knowledge. This chapter discusses recent changes to the classifications of disorders in child and adolescent mental health and recent epidemiological findings.
This chapter reviews a broad spectrum in Child and Adolescent Mental Health; that of the anxiety disorders. The chapter briefly introduces the concept of attachment and touches on how attachment disorders, and attachment styles evolve. It focuses in on PTSD and C-PTSD, with a particular spotlight on C-PTSD as a new diagnostic concept, and considers its importance in understanding presentations of trauma and emotional dysregulation in children and young people. The chapter also investigates the epidemiology and course of anxiety disorders; and considers the differentiating features of the different presentations. We finish with an overview of interventions, including the rise of computerised approaches in treating the anxiety disorders in young people.
A survey found that 1 in 6 (16%) of children aged between 5 and 16 years has a probable mental illness. Furthermore, research has shown that most of these disorders have their origins in childhood, even if they are typically diagnosed in adulthood. Childhood represents a critical period of physical, cognitive, psychological, behavioural and social transformation. Identifying risk and protective factors that alter the typical developmental trajectory could have long-term educational, social, societal and economic implications. This chapter will address what is meant by the term risk factor and how these can be identified, provide examples of risk factors thought to be important in child and adolescent psychiatry. It concludes with some case vignettes to highlight the importance of taking a developmental biopsychosocial approach to identifying risk, considering predisposing, precipitating, perpetuating and protective factors.
Gender diversity is relatively common in youth, with rates increasing in the general population. This increase may be related to decreased stigma in gender expression, adolescent experimentation, environmental factors or due to the recent interest in quantitatively measuring this trait. Gender diversity in and of itself is a not a psychiatric disorder. But mental health providers might see gender diverse youth if there is the desire for gender-affirming treatment, for assessing and treating of co-occurring psychiatric disorders or to promote resilience in situations where bullying and stigmatisation are taking place. As such, clinicians should be prepared to provide a confidential and competent environment that recognises the vast range of gender diversity currently seen in youth. In addition, while research on mental health in gender diverse youth has substantially expanded in the past decade, limitations of these data influence interpretation and generalisability. Well-designed studies should address gaps, such as long-term follow-up periods for gender diverse youth and those who have received gender affirmative care. They should also examine developmental trajectories and the stability of gender identity. Gender diversity in racial and ethnic minorities who may have different psychiatric presentations should also be addressed in future research.
Various key events characterise experiences in later life, such as retirement, bereavement, caregiving, developing long-term conditions and hospital admission. Given their potential to disrupt lives, such events may affect older people’s mental health, but research on the associations between such events and depression has produced inconsistent findings.
Aims
To investigate the impact of key events in later life on depression trajectories in a representative cohort of people aged 50–69 in England.
Method
Our sample draws on 6890 respondents aged 50–69 in Wave 1 (2002/2003) of the English Longitudinal Study of Ageing, following them through to Wave 9 (2018/2019). We measured depression using the eight-item Center for Epidemiological Studies Depression scale. Later life events included retirement, spouse/partner death, becoming an unpaid caregiver, developing a limiting long-term illness and hospital admissions because of a fall or non-fall causes. Piecewise mixed-effects logistic regression models tested for changes in the trajectories of depression before and after each event.
Results
Statistically significant improvements in the trajectory of depression were observed following spousal bereavement, one’s own retirement and hospital admission because of causes other than falls, with reductions in the odds of depression of 48% (odds ratio: 0.52 (95% CI: 0.44–0.61)), 15% (0.85 (0.78–0.92)) and 4% (0.96 (0.94–0.99)), respectively. No changes were associated with developing a limiting long-term illness, becoming an unpaid caregiver or following spousal retirement or a hospital admission because of a fall.
Conclusions
The findings highlight the relative resilience among older adults in England in terms of depression following key later life events. There is still a role to play in delivering mental health support for older people following such events, particularly by improving the identification of those at risk of certain events as part of a broader strategy of prevention. Findings also underscore the importance of partner/spousal circumstances on individual mental health.
To examine whether unconscious and systemic biases regarding ethnicity have an impact on equity of access to a national tic service for children and young people (CYP) at Great Ormond Street Hospital for Children, London, UK. We retrospectively reviewed triaged referrals over an 18-month period and examined differences in triage decision, re-referrals required before acceptance and symptom severity at initial assessment by clinician-perceived and self-assigned ethnicity.
Results
There was no evidence of an unconscious bias within the triage process. CYP from racially minoritised ethnic backgrounds were underrepresented and presented with greater overall need at initial assessment.
Clinical implications
Better recording of ethnicity is a requisite starting point for research. We encourage local services to audit ethnicity of the CYP they refer to national and specialist services. Findings call for greater awareness of challenges faced by patients from racially minoritised ethnic backgrounds.
Schizophrenia is associated with premature mortality, but most evidence comes from high-income regions.
Aims
This study aimed to estimate the excess mortality associated with schizophrenia in southern China.
Method
We linked register data from a nationwide information system for psychosis to death registers. Individuals diagnosed with schizophrenia and residing in Guangzhou between 2014 and 2021 were included. Standardised mortality ratios (SMRs) were calculated to compare the mortality of people with schizophrenia with that of the general population. Life expectancy, potential years of life lost (PYLL) and years of life lost (YLL) were estimated for all-cause mortality and specific causes of death. Gender difference in these metrics was examined.
Results
There were 3684 deaths (11.3%) during the study period. The leading causes of death were circulatory, neoplastic and respiratory diseases. The mortality rate among people with schizophrenia was twofold greater than in the general population, with a greater risk associated with unnatural causes than natural causes. The risk of mortality due to suicide was 15-fold higher than that of the general population. The life expectancy in schizophrenia was around 60 years, which is 21 years shorter than that for the general population. Schizophrenia was associated with substantial premature mortality burden, showing greater impact in men than women.
Conclusions
Schizophrenia is associated with increased premature mortality, reduced life expectancy and substantial PYLL. The enduring disparity in mortality underscores an imminent call for targeted interventions aimed at suicide prevention and enhancement of the physical well-being of people with schizophrenia.
Although the United States incarcerates nearly two million people, the epidemiology of psychiatric disorders in correctional populations is not well understood, and no study has examined temporal trends in psychiatric disorder prevalences within a single correctional system. This study assessed how psychiatric disorder prevalences have changed in the Texas Department of Criminal Justice (TDCJ), the largest American state prison system housing post-conviction, sentenced individuals.
Methods
This retrospective cohort study of TDCJ electronic medical record data from 1 January 2016 through 31 December 2023 included all persons incarcerated for any duration during that period. Diagnoses were based on International Classification of Disease (ICD-10) diagnostic codes. Outcomes were annual prevalences of depressive, bipolar and schizophrenia spectrum disorders stratified by age, race and sex. Cochran-Armitage Tests were used to assess temporal trends within each stratum. Two-way interactions were assessed by fitting Generalized Estimating Equations models using autoregressive correlation with repeated subjects.
Results
The overall population ranged from 170,269 to 222,798 individuals. Approximately, one-third were White (34.5–35.4%), one-third Black (31.0–32.3%), and one-third Hispanic (32.7–33.5%). Most were aged 30–49 (52.8–57.3%), and men (88.9–90.7%) outnumbered women (9.3–11.1%). The prevalences (per 100 [95% CI]) of psychiatric disorders generally increased when comparing 2016 to 2023. Depressive disorders increased the most among those aged 30–49 (5.23 [5.10–5.35] to 6.71 [6.56–6.86]), Hispanic individuals (3.86 [3.72–4.00] to 5.72 [5.53–5.90]), and men (4.72 [4.63–4.82] to 6.53 [6.42–6.65]). Bipolar disorders increased the most among those aged ≥50 (2.57 [2.42–2.72] to 3.46 [3.29–3.63]), Hispanic individuals (1.31 [1.23–1.40] to 2.23 [2.11–2.35]), and men (2.26 [2.20–2.33] to 3.12 [3.04–3.20]). Schizophrenia spectrum disorders increased the most among those aged ≤29 (1.33 [1.24–1.42] to 2.52 [2.35–2.68]), Hispanic individuals (1.53 [1.44–1.62] to 3.21 [3.35–4.40]), and women (1.27 [1.56–1.89] to 4.24 [3.95–4.53]). When stratified by demographic variables, trend tests were significant for nearly all comparisons (P < 0.0001), and all two-way interactions were significant (P < 0.0001).
Conclusions
The prevalences of major psychiatric disorders in the Texas prison system increased when comparing 2016 to 2023, with certain disorders rising more rapidly than others within specific subgroups. These findings emphasize the need for expanded mental health treatment options and resources within correctional settings.
In England, Shiga toxin-producing Escherichia coli (STEC) serogroup O26 has recently emerged as a public health concern, despite fewer than half of diagnostic laboratories in England having the capability to detect non-O157 STEC. STEC O26 cases frequently report exposure to farms or nurseries. We describe the epidemiology of STEC O26 and examine evidence for a relationship between O26 and exposure to these settings. We analysed national surveillance data describing laboratory-confirmed STEC cases and public health incidents over the past 10 years to explore the incidence, clinical outcomes, and association with farms and nurseries for STEC O26 cases compared to STEC O157 and other serogroups. Between 2014 and 2023, the proportion of STEC notifications which were STEC O26 increased from 2% (19/956) to 12% (234/1946). After adjusting for age, we found no difference in the likelihood of farm or nursery attendance between O26 and O157 cases but a significantly higher risk of HUS in O26 (adjusted risk ratio 3.13 (2.18–4.51)). We demonstrate that STEC O26 is associated with the same risk of farm or nursery attendance as other STEC serogroups but a higher risk of severe morbidity. Our findings reinforce the need for improved surveillance of non-O157 STEC.
Evidence on the effects of parental Adverse Childhood Experiences (ACEs) on adolescent mental health remains limited. This study investigates the associations between parental ACEs, children’s exposure to threat- and deprivation-related ACEs, and adolescent depression and anxiety using data from the Longitudinal Study of Australian Children.
Methods
We conducted a secondary analysis of the Longitudinal Study of Australian Children (LSAC), a population-based longitudinal cohort study. Parental ACEs were retrospectively reported by caregivers. Children’s exposure to ACEs was assessed from ages 4–17 years and categorised as threat-related ACEs (e.g., bullying, hostile parenting, unsafe neighbourhoods, family violence) or deprivation-related ACEs (e.g., financial hardship, parental substance abuse, parental psychological distress, death of a family member, parental separation, parental legal problems). Depressive and anxiety symptoms were self-reported by adolescents at ages between 12 and 17 years. Modified Poisson regression models were used to examine the independent and combined associations of parental ACEs and children’s threat- and deprivation-related ACEs (assessed before ages 12, 14, and 16 years) with depression and anxiety outcomes, including tests for interaction effects.
Results
The analysis included 3,956 children aged 12–13 years, 3,357 children aged 14–15 years, and 3,089 children aged 16–17 years. Males comprised 50.8–59.8% and females 40.2–49.2% across all ages. By the age of 17, 30.4% and 9.4% of the adolescents had depression and anxiety, respectively. Parental ACEs (≥2) were associated with increased depression risk at ages 12 to 13 years (RR = 1.42; 95% CI: 1.10–1.84) and at 16–17 years (RR = 1.19; 95% CI: 1.02–1.39). Exposure to ≥ 2 deprivation-related ACEs significantly increased the risk of depression across all ages, with relative risks ranging from 1.31 to 2.18. High threat-related ACEs (≥2) were associated with increased depression risk only at 12 to 13 years (RR = 2.01; 95% CI: 1.28–3.17). No significant interactions were observed.
Conclusions
The findings reinforce the ACEs model by showing that, at the population level, early identification of children exposed to early life deprivations rooted in financial crisis or familial adversities, combined with targeted interventions for both children and parents and supportive social policies, can reduce long-term mental health risks.
The dinoflagellates Hematodinium spp. are important endoparasites of a wide range of decapod crustaceans from across the globe. High prevalences of infection have been reported particularly in decapods of commercial importance including crabs and some lobster species. While such infections usually result in their death, the dynamics of these differ widely depending on location, the genotype of Hematodinium and host. This review aims to explore the interaction between these parasites and their hosts with particular emphasis on the diversity of host range, methods of detection, impact on fisheries and how this parasite multiplies within hosts without causing any apparent cellular immune response. Emphasis is placed on evaluating the future directions required to solve key unanswered questions of this increasingly important parasite.
We investigated the potential yield of conducting active case finding for tuberculosis (TB) within a defined geographic radius (50 or 100 m) around the households of individuals diagnosed with TB at health facilities. In a well-defined geographic area within Kampala, Uganda, residential locations were determined for 85 people diagnosed with TB at local health facilities over an 18-month period and for 60 individuals diagnosed with TB during a subsequent community-wide door-to-door screening campaign. Ten of the individuals diagnosed through community screening lived within 50 m of an individual previously diagnosed with TB in a local health facility (TB prevalence: 0.98%), and 15 lived at a distance of 50–100 m (prevalence: 0.87%). The prevalence ratio was 1.4 (95% confidence interval (CI): 0.7–2.9) for those <50 m and 1.2 (95% CI 0.6–2.2) for those 50–100 m, compared to >100 m. Using TB notifications to identify areas for geographically targeted case finding is at most moderately more efficient than screening the general population in the context of urban Uganda.
Legal epidemiology is an emerging field that examines how laws and policies influence human rights and health outcomes, particularly in areas such as in-patient psychiatric treatment, community treatment orders and child maltreatment, This editorial highlights contributions from BJPsych Open that apply legal epidemiological methods to assess issues relevant to child maltreatment and coercion in psychiatric care. Findings emphasise the need for early intervention, standardised evaluation measures and reforms that prioritise human rights and well-being. Legal epidemiology can offer a scientific basis for improving legal frameworks, as well as promoting equitable and effective mental healthcare.
Cannabis use increases the risk of psychosis, but cannabis-based medicinal products may provide additional therapeutic opportunities. Decriminalisation of cannabis has led to wider availability in certain jurisdictions, while in the UK regulated medicinal preparations are not readily accessible. A more balanced approach could reduce harms while maximising potential therapeutic benefits.
How did women come to be seen as 'at-risk' for HIV? In the early years of the AIDS crisis, scientific and public health experts questioned whether women were likely to contract HIV in significant numbers and rolled out a response that effectively excluded women. Against a linear narrative of scientific discovery and progress, Risk and Resistance shows that it was the work of feminist lawyers and activists who altered the legal and public health response to the AIDS epidemic. Feminist AIDS activists and their allies took to the streets, legislatures, administrative agencies, and courts to demand the recognition of women in the HIV response. Risk and Resistance recovers a key story in feminist legal history – one of strategy, struggle, and competing feminist visions for a just and healthy society. It offers a clear and compelling vision of how social movements have the capacity to transform science in the service of legal change.
Strongyloidiasis, caused by Strongyloides stercoralis, is a neglected parasitic disease and a major global public health issue. This infection exhibits diverse clinical manifestations that, along with the high rates of asymptomatic cases and low-sensitivity diagnostic methods, contribute to the underreporting of the disease. With an estimated 600 million people infected worldwide, this disease is particularly prevalent in tropical and subtropical regions with poor sanitary conditions, which includes Brazil. Understanding the epidemiology of the disease is essential for the development of control strategies, but the lack of comprehensive data makes it difficult to identify the real impact of the infection, thus leading to underreporting and a lack of awareness of its severity on public health. Given this scenario, this literature review aimed to summarize the reported prevalence and associated factors of strongyloidiasis in Brazil. A total of 33 articles published between 2005 and 2025 were retrieved from PubMed, Science Direct, Scielo, and LiLacs databases using keywords related to strongyloidiasis in Brazil. The data collected in this review indicate that the majority of the published studies are concentrated in the Southeast region of Brazil, with the state of Minas Gerais accounting for the highest number of publications. It was also observed that the prevalence of strongyloidiasis is underestimated due to diagnostic challenges and high rates of false negatives, especially among asymptomatic patients. In addition, the scarcity of specific studies on the disease in Brazil limits the understanding of its true incidence, underscoring the need for further research.
Human babesiosis is a disease transmitted by the bite of an infected tick or via blood transfusions involving contaminated blood products; in humans, it can lead to severe complications and even death, depending on the clinical history, age and health status of the affected patient. Babesiosis is caused by members of the Babesia spp., protozoan parasites whose life cycle includes sexual reproduction in the arthropod vector and asexual reproduction in the mainly mammalian host. Cases of human babesiosis have been rare, but there are increasing reports of human babesiosis associated with climatic changes affecting the geographical distribution of the parasite and tick vector, enhanced vector–human interactions and improved awareness of the disease in humans. Diagnostics and treatment options for humans are based around discoveries in veterinary research, such as point-of-care testing in cases of bovine babesiosis, and include direct diagnosis by blood smears, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) technologies, and indirect diagnosis by ELISA, immunofluorescence tests (IFAT) and fluorescent in situ hybridisation. Treatment involves a combination of drugs such as azithromycin and atovaquone, or clindamycin and quinine, but more effective options are being investigated, including, but not limited to, trans-chalcones and tafenoquine. Improved surveillance, awareness and diagnosis, as well as advanced technologies to interrupt vector–host interactions, are crucial in managing the increased threat posed by this once-neglected disease in humans.