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In adolescence, the number of depressive symptoms is rising notably. Individuals may have relevant depressive symptoms without meeting the full criteria of a major depressive episode (MDE), a condition referred to as subthreshold depression (sD). This article presents a review on adolescent sD examining the prevalence, the quality of life (QoL), the risk of developing MDE, and preventive programs available for adolescents living with sD. A systematic literature search from the year of the introduction of Diagnostic and Statistic Manual for Mental Disorders Fourth Edition (DSM-IV) until 2012 (18 years) was conducted with a special focus on adolescent sD. Data from 27 studies were included into this review. The results show high prevalence of sD among adolescents, with a negative impact on QoL, and provide evidence that sD is a significant risk indicator of later MDE; therefore, individuals with sD represent good targets for preventive interventions. Our review highlights the fact that sD is a significant health problem among adolescents indeed, and adolescents with sD could be a subgroup of youth, who need further help to reduce their clinically significant depressive symptoms for the successful prevention of a later MDE.

In the past 10 years, there has been a growing interest in self-injurious behavior (SIB) among adolescents. The lifetime prevalence of SIB is between 16 and 22% in community sample with females more likely to engage in SIB. There are conflicting results about the global distribution of the prevalence of SIB and whether the SIB has increased in the 21st century. Our aim in the current study was to conduct a systematic search of and meta-analysis on the prevalence of SIB in adolescents over the past 5 years’ worth of published papers and to examine gender, continental, and year differences. We conducted a systematic search in June 2020 of six databases (PubMed, Scopus, Web of Science, OVID Medline, PsycINFO, EBSCO) with three main search terms: “self-injurious behavior,” “prevalence,” and “adolescence.” Article inclusion criteria were (a) written in English; (b) published between January 1, 2015, and June 18, 2020; and (c) focused on a community sample. Titles and abstracts of the articles were screened first. Then, the relevant full texts were read, and those that met the inclusion criteria were collected. We used Comprehensive Meta-Analysis software was used to conduct the analyses. After the screening process 97, articles were included in the meta-analysis. The age of the samples ranged from 11.00 to 18.53 years. The overall average prevalence of nonsuicidal self-injury in the studies was 16%. There was a significant gender difference: females reported a higher prevalence than males (19.4% and 12.9%, respectively). A significantly higher prevalence was found among Asian articles than those from other continents (19.5% and 14.7%, respectively). The prevalence of SIB did not change significantly between 2013 and 2018. The current research draws attention to the high prevalence of SIB among adolescents, especially among females and those living in Asia. It is important to address this behavior, both in terms of prevention and intervention.

Background During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. Methods A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). Results Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. Conclusions Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.

Risk-behaviors are a major contributor to the leading causes of morbidity among adolescents and young people; however, their association with pathological Internet use (PIU) is relatively unexplored, particularly within the European context. The main objective of this study is to investigate the association between risk-behaviors and PIU in European adolescents. This cross-sectional study was conducted within the framework of the FP7 European Union project: Saving and Empowering Young Lives in Europe (SEYLE). Data on adolescents were collected from randomized schools within study sites across eleven European countries. PIU was measured using Young’s Diagnostic Questionnaire (YDQ). Risk-behaviors were assessed using questions procured from the Global School-Based Student Health Survey (GSHS). A total of 11,931 adolescents were included in the analyses: 43.4% male and 56.6% female (M/F: 5179/6752), with a mean age of 14.89 ± 0.87 years. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviors. The significant association observed between PIU and risk-behaviors, combined with a high rate of co-occurrence, underlines the importance of considering PIU when screening, treating or preventing high-risk behaviors among adolescents.

The emerging literature reports that children with Attention-Deficit/Hyperactivity Disorder (ADHD) show deficits in executive functioning. To date, the combination of drug therapy with certain evidence-based non-medication interventions has been proven to be the most effective treatment for ADHD. There is a gap in the literature regarding comparing the executive functions (EF) of treatment naïve and medicated children with ADHD with both each other and typically developing children. Altogether, 50 treatment naïve and 50 medicated children with ADHD and 50 typically developing children between the ages of six and 12 were enrolled. The Mini International Neuropsychiatric Interview for Children and Adolescents (Mini Kid) and the Test of Attentional Performance for Children (KiTAP) measures were employed. Treatment naïve children with ADHD showed weaker performance on most executive function measures (12 out of 15) than either the medicated ADHD group or the controls. There were no significant differences between the medicated ADHD children and typically developing children in most KiTAP parameters (10 out of 15). Executive function impairments were observable in treatment naïve ADHD children, which draws attention to the importance of treating ADHD. Future studies should focus on the specific effects of stimulant medication on executive functions.

A growing number of studies support the theory that physical activity can effectively foster the cognitive function of children with attention-deficit hyperactivity disorder (ADHD). The present study examines the effect of acute moderate physical activity on the executive functions and attention performance of (1) typically developing children (without psychological, psychiatric or neurological diagnosis and/or associated treatment stated in their medical history); (2) treatment-naïve ADHD children; and (3) medicated children with ADHD. In the current study, a total sample of 150 (50 non-medicated, 50 medicated, and 50 typically developing) children between the ages of 6 and 12 took part in the experiment. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) was used to measure ADHD and the child version of the Test of Attentional Performance (KiTAP) was applied to evaluate the children’s attentional and executive function performance before and after two types of intervention. In order to compare the effects of physical activity and control intervention, half of the children from each group (25 participants) took part in a 20-min long, moderately intense physical activity session on the 60–80% of their maximum heart rate, while watching a cartoon video. In the control condition, the other half of the children (25 participants) from each group watched the same cartoon video for 20 min while seated. Physical activity (compared to the just video watching control condition) had a significantly positive influence on 2 out of 15 measured parameters (median reaction time in the alertness task and error rates in the divided attention task) for the medicated group and on 2 out of the 15 measured variables (number of total errors and errors when distractor was presented, both in the distractibility task) regarding the treatment-naïve group. Future studies should focus on finding the optimal type, intensity, and duration of physical activity that could be a potential complementary intervention in treating deficits regarding ADHD in children.

Background/Aims Attention‐deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders among young people and significantly affects their quality of life. Previous research suggests an increased risk of suicidal behavior among individuals with ADHD; however, this has not yet been investigated in a meta‐analysis of long‐term studies. The primary aim of this study was to conduct an updated systematic review of longitudinal studies on ADHD and suicidality supplemented by meta‐analytic calculations. Methods A systematic search was conducted across the following databases: OVID Medline, OVID PsychInfo, PubMed, Scopus, and Web of Science. Only longitudinal studies were included, in which most participants were under 18 years of age at baseline, had a clinical ADHD diagnosis, and provided sufficient data about suicidal behavior. Results In total, nine studies were included in both the meta‐analysis and narrative review. The average odds ratios were significant and small to moderate in size for the following aspects: overall suicidality (OR = 3.336, 95% CI: 2.201; 5.057, p < 0.001), suicidal ideation (OR = 3.956, 95% CI: 1.996; 7.841, p < 0.001), suicide attempt (OR = 3.344, 95% CI: 1.682; 6.650, p = 0.001), and death (OR = 3.891, 95% CI: 2.103; 7.198, p < 0.001). The number of participants with ADHD ranged from 104 to 86,670, with a mean age between 5.2 and 14.94 years old, and the majority were male. Suicide behavior was more common in the ADHD combined subtype and the hyperactive/impulsive subtype. There are conflicting results regarding sex differences and the role of comorbidities. Conclusions The current systematic review and meta‐analysis confirms previous findings that individuals with ADHD are at an elevated risk for suicidal behavior. However, this relationship is heterogeneous and complex, with significant differences across ADHD subtypes, age groups, sexes, comorbidities, and social issues, all of which play important roles in the development of suicidal behavior. The aim was an updated systematic review of longitudinal studies on ADHD and suicidality supplemented by meta‐analytic calculationsIn total, nine studies were included in both the meta‐analysis and narrative review. The average odds ratios were significant and small to moderate in size for overall and specific suicidal behavior. The current systematic review and meta‐analysis confirms previous findings that individuals with ADHD are at an elevated risk for suicidal behavior.

Suicide is a leading cause of death among adolescents and more knowledge from high risk groups is needed in order to develop effective preventive strategies. The aim of this study was to evaluate the association between sexual minority status and suicidality in a multinational sample of European school pupils. A self-report questionnaire was delivered to 2046 adolescents (mean age 15.34±1.01; 56.3% females) recruited from 27 randomly selected schools in 6 European countries. Suicidal ideation, measured with the Paykel Suicide Scale (PSS), and lifetime suicide attempts were compared between heterosexual and sexual minority (i.e. those with a non-heterosexual orientation) youth. Poisson regression analyses studied the longitudinal association between sexual minority status and the rate of serious suicidal ideation, measured at three time-points during a 4-month period. Several variables, including alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity, were included in multivariable analysis. Sex-stratified analyses evaluated the association respectively among females and males. Of 1958 pupils included in analysis (mean age 15.35±1.00; females 56.8%), 214 (10.9%) were categorized as sexual minority youth (SMY). When compared to heterosexual youth (HSY), SMY were significantly more exposed to substance abuse, bullying, school-related stress, and lower economic status. SMY pupils had significantly higher suicidal ideation scores (p<0.001; r 0.145) as well as higher prevalence of serious suicidal ideation (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.83-3.79) and previous suicide attempts (OR 2.72, 95%CI 1.77-4.18), compared to their HSY peers. The rate of serious suicidal ideation reports during the study was significantly higher among SMY compared to HSY (rate ratio [RR] 2.55, 95%CI 1.90-3.43). A significant difference was found even when controlling for the pupils' country as well as after adjustment for alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity (adjusted RR 1.73, 95%CI 1.23-2.48). Stratified analyses showed significant associations between SMY status and persistent serious suicidal ideation for both sexes, with a notably strong association among male pupils (females aRR 1.51, 95%CI 1.01-2.24; males aRR 3.84, 95%CI 1.94-7.59). European sexual minority youth are a high-risk group for suicidality, independently from objective factors such as victimization or substance abuse. There is a need to develop primary and secondary preventive measures for sexual minority youth, including the management of context vulnerabilities and related distal stressors, before the establishment of proximal stressors. Context-targeting interventions may effectively focus on social and economic factors, as well as on the potentially different risk profile of female and male sexual minority youth.

Background The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology. Methods Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13–18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann–Whitney U test, chi-square test and mediator model were used. Results Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n  = 10 (28.60%), girls: n  = 25 (71.40%) ((χ 2 (1) = 10.643 p  < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls. Conclusions ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.

Subthreshold disorders, conditions with relevant psychiatric symptoms which do not meet the full criteria of a disorder according to the prevailing classification systems, have received increased attention recently. The current paper aims to present a systematic review of subthreshold attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Searching five computerised databases (Ovid MEDLINE, Psychinfo, PubMed, Scopus, Web of Science) with two categories of search terms [(1) subclinical; subsyndromal; subthreshold (2) ADHD] the authors examined the prevalence of subthreshold ADHD among children and adolescents, the comorbidity of subthreshold ADHD and whether there was already any impact of subthreshold ADHD on functioning. Before these questions were answered, the included articles were examined to see what kinds of definitions of child and adolescent subthreshold ADHD are used and what kinds of assessments are used for measuring subthreshold ADHD among children and adolescents. The results of the 18 articles included show that different definitions of subthreshold ADHD in children and adolescents exist, a large variety of instruments are used, the prevalence rate of subthreshold ADHD is wide-ranging (0.8–23.1 %), the comorbidity of subthreshold ADHD is high and there are several areas where subthreshold ADHD has a meaningful impact on functioning. All these suggest that focusing on subthreshold ADHD can be important in preventative interventions. The results of this systematic review support the dimensional approach of ADHD. Further research on uniform criteria of subthreshold ADHD is needed to support the inclusion of this condition in classification systems.