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Background Emotion regulation (ER) difficulties are common in autistic individuals and may contribute to co-occurring psychopathology during adolescence. However, age-group heterogeneity in existing research limits understanding of ER processes in autistic adolescents. Therefore, this mixed methods systematic review synthesizes current knowledge on ER in autistic adolescents aged 10–24 years. Methods We systematically searched MEDLINE, PsycINFO, Web of Science, and Scopus for empirical studies on ER in autistic adolescents. 32 studies (including two qualitative) met inclusion criteria and were synthesized using a convergent integrated approach. Results Autistic adolescents consistently exhibited more ER difficulties than non-autistic peers, which were associated with internalizing and externalizing symptoms. Greater autism symptom severity, lower theory of mind, and social challenges were frequently linked to lower ER, while no consistent associations with age, gender, or IQ were found. Few studies examined physiological or neurobiological factors, but evidence suggested associations between ER difficulties, lower heart rate variability, and atypical neural responses. Cognitive-behavioral and mindfulness-based interventions generally led to improvements in ER, though results varied and discrepancies between self- and proxy-reports were common. Conclusion ER challenges are pronounced in autistic adolescents and are closely associated with mental health symptoms. While interventions show promise, future research should address measurement heterogeneity, examine neurobiological underpinnings, and include more longitudinal and ecologically valid designs. Trial registration CRD42024529184 (registered April 06, 2024).

Background Gender-affirming hormones do not completely suppress fertility in transgender and gender diverse individuals, highlighting the need for counseling on pregnancy risk and contraceptive options. However, research on current contraceptive care is limited. Studies from the US have identified several barriers to care as well as facilitators, but no studies on this topic have yet been conducted in Europe. This study examined transgender and gender diverse contraceptive care in Germany from the perspective of healthcare providers, assessing its importance and their roles in it, as well as exploring barriers and facilitators. Methods Thirty semistructured qualitative interviews with German healthcare providers were conducted between December 2023 and February 2024. The interview guide included questions on contraceptive care for transgender and gender diverse individuals. Data were analyzed using structuring qualitative content analysis (Kuckartz) with deductive and inductive category development. Results Most interviewees highlighted the need for contraceptive care, depending on various factors such as the type of gender-affirming care applied, sexual practices, and transgender and gender diverse individuals’ desire for pregnancy prevention. Half of the interviewees also offered contraceptive care (depending on their specialization). Numerous barriers to contraceptive care, such as a lack of awareness of contraceptive needs, insufficient research and training programs for medical staff, have been reported, highlighting the importance of facilitators for care such as the implementation of contraceptive counseling as a standard protocol. Conclusion To improve contraceptive care for transgender and gender diverse individuals, the establishment of clear structures and responsibilities, more research, and qualifications among the involved specialties are needed. To gain a comprehensive understanding of the care situation, future research should include the perspectives of transgender and gender diverse individuals. Trial registration We obtained the approval of the Hamburg Medical Council (“Ärztekammer Hamburg”) to conduct our study by means of a “scientific case” (2023-300381-WF, September 11th 2023). Plain english summary Transgender and gender diverse people experience persistent incongruence between their experienced gender identity and their sex assigned at birth - diagnosed as gender incongruence. Many use gender-affirming hormones, such as testosterone or estrogen, to match gender identity and body. These hormones decrease the ability to get pregnant but do not stop it completely. That’s why it is important to give this population information about pregnancy risks and contraceptive options. So far, most research on this topic has come from the US, but little is known about the situation in Europe. This study looked at how healthcare providers in Germany think about contraceptive care for transgender and gender diverse people and how they experience care provision. Thirty healthcare providers (medical doctors and psychologists) in Germany were interviewed between December 2023 and February 2024. Most healthcare providers said they believed contraceptive care was important for transgender and gender diverse people, depending on factors like the type of hormones used and sexual practices, and half of the healthcare providers also offered contraceptive care. Some common challenges included a lack of knowledge about contraception for transgender and gender diverse people, lack of research, and limited training of medical staff. Healthcare providers said that better contraceptive care for transgender and gender-diverse people in Germany needs more research, clear protocols or guidelines, as well as more training for healthcare providers. Future studies should also ask transgender and gender diverse people themselves about their needs and experiences.

Common mental disorders, particularly unipolar depressive disorders, rank among the top 5 with respect to the global burden of disease. As a major public health concern, antepartum depression and anxiety not only affects the individual woman, but also her offspring. Data on the prevalence of common mental disorders in pregnant women in sub-Saharan Africa are scarce. We provide results from Ghana and Côte d'Ivoire. We subsequently recruited and screened n = 1030 women in the third trimester of their pregnancy for depressed mood, general anxiety, and perceived disability using the Patient Health Questionnaire depression module (PHQ-9), the 7-item Anxiety Scale (GAD-7), and the World Health Organisation Disability Assessment Schedule II (WHO-DAS 2.0, 12-item version). In addition to estimates of means and prevalence, a hierarchical linear regression model was calculated to determine the influence of antepartum depression and anxiety on disability. In Ghana, 26.6% of women showed substantially depressed mood. In Côte d'Ivoire, this figure was even higher (32.9%). Clear indications for a generalized anxiety disorder were observed in 11.4% and 17.4% of pregnant women, respectively. Comorbidity of both conditions was common, affecting about 7.7% of Ghanaian and 12.6% of Ivorian participants. Pregnant women in both countries reported a high degree of disability regarding everyday activity limitations and participation restrictions. Controlled for country and age, depression and anxiety accounted for 33% of variance in the disability score. Antepartum depression and anxiety were highly prevalent in our sample and contributed substantially to perceived disability. These serious threats to health must be further investigated and more data are needed to comprehensively quantify the problem in sub-Saharan Africa.

Background: Placental infections caused by Schistosoma spp. and sexually transmitted microorganisms can adversely impact pregnancy outcomes. However, the association between molecular detection of these pathogens in placental tissue and corresponding histopathological inflammation remains unclear, particularly in sub-Saharan African populations. Methods: In this cross-sectional study, placental parenchyma specimens with limited membrane sampling were collected from 103 Ivorian and Ghanaian mothers without known pregnancy or birth complications. Tissue pieces adjacent to PCR-tested samples were analyzed by real-time PCR targeting Chlamydia trachomatis, Mycoplasma hominis, Neisseria gonorrhoeae, Schistosoma spp., Streptococcus agalactiae, Trichomonas vaginalis, Ureaplasma parvum and Ureaplasma urealyticum. Corresponding adjacent tissues were examined by routine histopathology, supplemented with immunohistochemistry when higher pathogen DNA quantities were detected, to assess inflammatory changes. Results: Real-time PCR detected U. urealyticum in 15 out of 103 cases (14.6%, ±0.7%), U. parvum in 13 (12.6%, ±0.6%), S. agalactiae in 11 (10.7%, ±0.5%), the S. haematobium complex in four (3.9%, ±0.2%), M. hominis in four (3.9%, ±0.2%), confirmed N. gonorrhoeae in two (1.9%, ±0.1%) and non-confirmed N. gonorrhoeae in one (1.0%, ±0.1%), T. vaginalis in two (1.9%, ±0.1%), and C. trachomatis (non-lymphogranuloma venereum serovar) in one (1.0%, ±0.1%). Overall, pathogen DNA levels were low, with only four positive PCR results yielding cycle threshold (Ct) values below 30 and none below 25. Histopathological examination revealed no relevant inflammatory changes in any samples. Conclusions: Placental parenchyma tissues with limited membrane sampling testing positive for Schistosoma spp. or sexually transmitted pathogens by molecular methods demonstrated no corresponding histopathological inflammation. These findings warrant confirmatory studies to better characterize potential region-specific placental infection phenotypes and their clinical significance.

Background Postpartum maternal mental health problems affect the development of mother-child interaction and of children’s attachment security. Focus-based brief parent-infant psychotherapy (PIP-f) was developed to support parents ‘mentalize’ their child’s affective states and promote a healthy parent-child relationship and child development. Efficacy of PIP-f was evaluated against care-as-usual (CAU) in a randomized controlled trial within the SKKIPPI project. Method N  = 120 mothers diagnosed with an ICD-10 psychopathological disorder and their infants under one year were randomly assigned to PIP-f ( n  = 57) or CAU ( n  = 63). Primary outcome was maternal sensitivity in mother-child interaction after 6 weeks of intervention. Secondary outcomes include maternal and child psychopathological symptoms, child development, parenting stress, emotional availability, parental reflective functioning and child attachment after 6 weeks and 12 months. Results PIP-f was not superior to CAU in maternal sensitivity ( b  = 0.129, 95%CI [-0.161, 0.418], p  = 0.378) at post-intervention, nor in maternal symptoms ( b =-0.702, [-2.603, 1.198], p  = 0.463) or child symptoms of regulatory disorder ( b  = 1.079, [-2.344, 4.502], p  = 0.531). Attachment security assessed at 12 months did not differ between intervention groups (OR = 2.0, [0.64, 6.33], p  = 0.226). Moderator analyses suggest that emotional availability and parental reflective functioning improve up to 12 months for more severe cases. Conclusion Differences between PIP-f and CAU were smaller than expected, but PIP-f seemed to reduce symptoms of mental health problems. Some evidence exists that mothers with higher symptom burden benefit from PIP-f. High dropout rates and initially high emotional availability prevent generalizability. Trial registration : The trial was registered in the German Register for Clinical Studies (DRKS00016353) on January 16, 2019.

The vast majority of research on mental health has been undertaken in high income countries. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms. In the Child Development Study, a prospective birth cohort study in Côte d'Ivoire and Ghana, the 9-item Patient Health Questionnaire (PHQ-9) was answered by N = 776 women 3 months antepartum, and 3, 12, and 24 months postpartum between April 2010 and March 2014. Growth mixture modeling was used to identify distinct trajectories of depressive symptoms. Several psychosocial, obstetric, and sociodemographic characteristics were assessed and multinomial regression analysis was performed to investigate the influence of these variables on the different depression trajectories. We found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%). The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577). Among other factors, higher levels of anxiety, new pregnancy 2 years after birth, economic stress, and family stress were associated with the risk classes. A substantial proportion of West African women in our sample developed unfavorable patterns of depressive symptoms during the vulnerable phase of pregnancy and early motherhood. Psychosocial factors, especially antepartum anxiety symptoms, played a decisive role in this process. Perceived economic hardship further exaggerated the mental health burden.

(1) Background: Adolescents admitted as acute inpatients belong to a particularly psychosocially vulnerable population. This study aimed to examine the clinical characteristics of an affected population in Germany using a theory-based approach. (2) Methods: We assessed the mental health problems, levels of personality functioning, and the severity of social withdrawal and loneliness in n = 62 adolescents admitted to an acute psychiatric inpatient unit. Cases were investigated cross-sectionally utilizing standardized psychometric questionnaires from the perspective of the patients and clinical experts. (3) Results: Mental health, level of impaired personality functioning, social withdrawal, and loneliness were all positively associated with the need for acute admission. Further analyses revealed that the level of personality functioning fully mediated the positive association between social withdrawal and mental health problems. In contrast, level of personality functioning only partially mediated the positive association between loneliness and mental health problems. (4) Conclusions: Our results suggest that more impairment in personality functioning might lead to poorer mental health when adolescents socially withdraw in the aftermath of the COVID-19 pandemic. Loneliness, social withdrawal, and the level of personality functioning may help identifying essential characteristics of adolescents admitted to acute psychiatric inpatient units and guide the development of specific interventions.

Evidence linking common mental disorders (CMD) in pregnant women to adverse birth outcomes is inconsistent, and studies often failed to control for pregnancy complications. This study aimed to explore the association between antenatal depression and anxiety symptoms and birth outcomes in a low-obstetric risk sample of mother/child dyads in Ghana and Côte d'Ivoire. In 2010-2011, a prospective cohort of 1030 women in their third trimester in Ghana and Côte d'Ivoire was enrolled. Depression and anxiety were assessed in the third trimester using the Patient Health Questionnaire depression module and the 7-item Generalized Anxiety Disorder scale. 719 mother/child dyads were included in the analysis. We constructed multivariate regression models to estimate the association between CMD and low birth weight (LBW), and preterm birth (PTB) to control for potential confounders. The prevalence of depression and anxiety symptoms were 28.9% and 14.2% respectively. The mean birth weight was 3172.1g (SD 440.6) and the prevalence of LBW was 1.7%. The mean gestational age was 39.6 weeks and the proportion of PTB was 4%. Multivariate linear regression revealed no significant association between maternal depression (B=52.2, 95% CI -18.2 122.6, p=0.15) or anxiety (B=17.1, 95% CI -74.6 108.7, p=0.72) and birth weight. Yet, low socio-economic status, female sex of the child, and younger maternal age were associated with lower birth weight. Multivariate logistic regression suggested no significant association between maternal depression (OR: 2.1, 95% CI 0.8 5.6, p=0.15) or anxiety (OR: 1.8, 95% CI 0.6 5.5, p=0.29) with PTB. Our data suggests that depression and/or anxiety in the 3(rd) trimester of pregnancy are not independent predictors of adverse birth outcomes in low obstetric risk women. The role of pregnancy complications as confounders or effect modifiers in studies of maternal CMD and their impact on birth outcomes should be investigated.

Medical complications during pregnancy have been frequently reported from Western Africa with a particular importance of infectious complications. Placental tissue can either become the target of infectious agents itself, such as, e.g., in the case of urogenital schistosomiasis, or be subjected to contamination with colonizing or infection-associated microorganisms of the cervix or the vagina during vaginal delivery. In the retrospective cross-sectional assessment presented here, the quantitative dimension of infection or colonization with selected resistant or pathogenic bacteria and parasites was regionally assessed. To do so, 274 collected placental tissues from Ivory Coastal and Ghanaian women were subjected to selective growth of resistant bacteria, as well as to molecular screening for beta-lactamase genes, Schistosoma spp. and selected bacterial causative agents of sexually transmitted infections (STI). Panton–Valentine-negative methicillin-resistant Staphylococcus aureus (MRSA) was grown from 1.8% of the tissue samples, comprising the spa types t008 and t688, as well as the newly detected ones, t12101 (n = 2) and t12102. While the culture-based recovery of resistant Enterobacterales and nonfermentative rod-shaped Gram-negative bacteria failed, molecular assessments confirmed beta-lactamase genes in 31.0% of the samples with multiple detections of up to four resistance genes per sample and blaCTX-M, blaIMP, blaGES, blaVIM, blaOXA-58-like, blaNDM, blaOXA-23-like, blaOXA-48-like and blaKPC occurring in descending order of frequency. The beta-lactamase genes blaOXA-40/24-like, blaNMC_A/IMI, blaBIC, blaSME, blaGIM and blaDIM were not detected. DNA of the urogenital schistosomiasis-associated Schistosoma haematobium complex was recorded in 18.6% of the samples, but only a single positive signal for S. mansoni with a high cycle-threshold value in real-time PCR was found. Of note, higher rates of schistosomiasis were observed in Ghana (54.9% vs. 10.3% in Ivory Coast) and Cesarean section was much more frequent in schistosomiasis patients (61.9% vs. 14.8% in women without Schistosoma spp. DNA in the placenta). Nucleic acid sequences of nonlymphogranuloma-venereum-associated Chlamydia trachomatis and of Neisseria gonorrhoeae were recorded in 1.1% and 1.9% of the samples, respectively, while molecular attempts to diagnose Treponema pallidum and Mycoplasma genitalium did not lead to positive results. Molecular detection of Schistosoma spp. or STI-associated pathogens was only exceptionally associated with multiple resistance gene detections in the same sample, suggesting epidemiological distinctness. In conclusion, the assessment confirmed considerable prevalence of urogenital schistosomiasis and resistant bacterial colonization, as well as a regionally expected abundance of STI-associated pathogens. Continuous screening offers seem advisable to minimize the risks for the pregnant women and their newborns.

Paedophilic sexual interest is often linked to an emergence during adolescence, but concrete empirical knowledge on its development and early viable treatments remains scarce. The aim of this article is to provide an overview about the current state of research on juveniles with sexual interest in children as well as to introduce the Hamburg Youth Prevention Project (HYPP). The HYPP aims to better comprehend the development of sexual interests in adolescents and seeks to find a basis for improved treatment strategies during this critical developmental period. In this perspective, we outline the framework, goals, and treatment approach for this project. It addresses adolescents who are sexually attracted to younger children or engage in sexual acts with children and who have not yet been in contact with the justice system. The project offers a diagnostic process, anonymous counselling, and treatment. It is grounded in a biopsychosocial perspective on psychosexual development and an integrative family-centred approach. The project is based on the core assumption that in adolescent participants, there is still great flexibility for development, including their sexual interests.