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Background Understanding the burden and determinants of suicide during adolescence is key to achieving global health goals. We examined the prevalence and determinants of self-reported suicidal ideation and attempts among younger (13–15 years) and older adolescents (16–17 years). Methods Pooled prevalence estimates with 95% confidence interval, were calculated for suicide ideation and attempts for 118 surveys from 90 countries that administered the Global School-based Student Health Survey (GSHS) to adolescents (13–17 years of age) from 2003 to 2017. Indicators (including individual and social factors) associated with suicidal ideation and attempts were determined from multivariable linear regressions on key outcomes. Results The prevalence of suicidal ideation representing 397,299 adolescents (51.3% female) was significantly higher among girls than boys whereas attempts did not differ by age or sex. Being bullied, or having no close friends was associated with suicidal ideation among girls 13–15 years and 16–17 years, respectively. Among all boys, being in a fight and having no close friends was associated with suicidal ideation with the addition of serious injury for boys 13–15 years. Common to all younger adolescents was an association of suicide attempt with being bullied and having had a serious injury. Among young boys, having no close friends was an additional indicator for suicide attempt. Having no close friends was associated with suicide attempt in older adolescents with the addition to being bullied in older girls and serious injury in older boys. Conclusions Building positive social relationships with peers and avoiding serious injury appear key to suicide prevention strategies for vulnerable adolescents. Targeted programs by age group and sex for such indicators could improve mental health during adolescence in low and middle-income countries, given the diverse risk profiles for suicidal ideation and attempts.

Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician-assessment for the 5-stage Tanner scale. We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. PROSPERO # CRD42018100205.

Disturbed sleep represents a potentially modifiable risk factor for depression in children and youths that can be targeted in prevention programs. To evaluate the association between disturbed sleep and depression in children and youths using meta-analytic methods. Embase, MEDLINE, PsycINFO, Scopus, Web of Science, and ProQuest Dissertations & Theses Global were searched for articles published from 1980 to August 2019. Prospective cohort studies reporting estimates, adjusted for baseline depression, of the association between disturbed sleep and depression in 5- to 24-year-old participants from community and clinical-based samples with any comorbid diagnosis. Case series and reports, systematic reviews, meta-analyses, and treatment, theoretical, and position studies were excluded. A total of 8700 studies met the selection criteria. This study adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-analyses and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statements. Study screening and data extraction were conducted by 2 authors at all stages. To pool effect estimates, a fixed-effect model was used if I2 < 50%; otherwise, a random-effects model was used. The I2 statistic was used to assess heterogeneity. The risk of bias was assessed using the Research Triangle Institute Item Bank tool. Metaregression analyses were used to explore the heterogeneity associated with type of ascertainment, type of and assessment tool for disturbed sleep and depression, follow-up duration, disturbed sleep at follow-up, and age at baseline. Disturbed sleep included sleep disturbances or insomnia. Depression included depressive disorders or dimensional constructs of depression. Covariates included age, sex, and sociodemographic variables. A total of 22 studies (including 28 895 patients) were included in the study, of which 16 (including 27 073 patients) were included in the meta-analysis. The pooled β coefficient of the association between disturbed sleep and depression was 0.11 (95% CI, 0.06-0.15; P < .001; n = 14 067; I2 = 50.8%), and the pooled odds ratio of depression in those with vs without disturbed sleep was 1.50 (95% CI, 1.13-2.00; P = .005; n = 13 006; I2 = 87.7%). Metaregression and sensitivity analyses showed no evidence that pooled estimates differed across any covariate. Substantial publication bias was found. This meta-analysis found a small but statistically significant effect size indicating an association between sleep disruption and depressive symptoms in children and youths. The high prevalence of disturbed sleep implies a large cohort of vulnerable children and youths who could develop depression. Disrupted sleep should be included in multifaceted prevention programs starting in childhood.

There is a growing body of research supporting adjunctive dietary interventions to improve depressive symptoms. Quantifying the level of dietary intake reporting accuracy is important when assessing dietary intervention efficacy. The current study assesses dietary intake reporting accuracy among children and adolescents clinically diagnosed with depression. Forty-six participants (87.0% female) with clinically diagnosed depression were included in this analysis with a mean age of 15.04 ± 1.52 years. The reporting accuracy of energy intake was determined using a single dietary recall and the McCrory equations. Thirty (64.8%) participants were categorized as plausible reporters, 16 (35.2%) as under-reporters and none were over-reporters. Mean energy estimates were misreported by −1192.618 ± 817.87 kcal and were proportional to caloric intake. The only covariate significantly associated with misreporting was obesity/overweight. Misreporting was not associated with depressive symptom burden. Depressive symptomology was not associated with under-reporting, indicating that adolescents with clinically diagnosed depression are able to report dietary intake at accuracy levels comparable to adolescents in community samples.

Adolescence is a key developmental window of opportunity for nutrition promotion and cardiometabolic disease (CMD) prevention that can reap long-term significant health, economic and social advantages, however it is currently not a focus in the Developmental Origins of Health and Disease (DOHaD) framework. In this perspective, we argue that adolescence should be included in the DOHaD framework, by examining current evidence on the relationship between adolescent nutrition and risk factors for CMDs, physiological mechanisms, and potential interventions.

Background Unacceptably high levels of childhood malnutrition have been registered in all regions of Uganda over the years. Buhweju district alone contributed 46% prevalence of childhood malnutrition to the 47.8% estimated national prevalence for the whole of western Uganda in 2014. This study assessed health provider and caregiver opinions on factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Methods In this phenomenological qualitative study, we conducted two key informant interviews and six focus group discussions with Village Health Team members and care takers of under five children in Engaju and Nyakishana sub-counties respectively.to explore their opinions on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5. Results Historical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Conclusion Persistent malnutrition in under five children is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services. Thus literacy education for mothers and young adolescent boys and girls through engaging local leaders, local nongovernmental organizations and Companies operating in the district to contribute to social services provision would limit the domestic violence and increase sensitization on male responsibilities in the children care in Buhweju district.

Introduction Poor diet quality is associated with greater depressive symptoms among older youth and adults. Whether dietary patterns in early childhood are also associated with later mental health (MH) outcomes remains unclear, as prospective evidence is limited. This study examined the association between dietary patterns at age 3 and MH symptoms at age 5. Methods Participants were 2,076 children (47.4% female) from the CHILD Birth Cohort Study. MH outcomes were assessed at age 5 using the Child Behaviour Checklist. Dietary patterns were assessed at age 3 and categorized into three groups: Prudent (high in vegetables, fruits, legumes, eggs, and fish), Western-like (high in fast foods, meats, and sugar-sweetened beverages), and Refined grain-Snack (high in refined grains, dairy, and salty snacks). Multivariate linear regression models examined the diet–Total Problems association. Internalizing and Externalizing Problems were examined in sensitivity analyses. Household income, sex, and maternal depression were explored as potential moderators. Results Greater adherence to a Prudent dietary pattern at age 3 was associated with fewer MH symptoms at age 5 ( β = – 1.15 , p < .001). Sensitivity analyses revealed similar associations for the internalizing ( β = – 1.50, p < .001 ) and externalizing (β = – 0.72, p = .033) subscales. No significant moderation effects were observed. Western-like and Refined grain-Snack dietary patterns were not significantly associated with MH problems. Conclusions A prudent dietary pattern may be an important modifiable protective factor for MH outcomes in early childhood. Findings support future research examining the effectiveness of early nutrition interventions in supporting child MH outcomes.

Decreased gut microbial diversity is associated with greater depression symptoms in adults. Findings on the relationship between the gut microbiome and depression or anxiety in children and adolescents are mixed, and evidence syntheses are needed. Seven databases were searched for peer-reviewed studies on the gut microbiome and internalizing symptoms, depression, or anxiety, in children and adolescents (<19 years). Random-effects meta-analyses of alpha diversity indices were performed. Youth advisors validated the research findings’ relevance to their experiences and contributed to dissemination planning. Eight studies were included, representing 2,865 participants (mean age = 11.4 years, SD = 4.3). Study designs were cross-sectional ( n  = 5), longitudinal ( n  = 2), and interventional ( n  = 1). No association was found between alpha or beta diversity and internalizing problems, depression, or anxiety. Increased abundance of genera within phyla Bacillota (e.g., Fusicatenibacter ) and Pseudomonadota (e.g., Escherichia ), along with decreased abundance of other Bacillota genera (e.g., Faecalibacterium ), were associated with depression and anxiety symptoms. This review identified preliminary associations between specific bacterial taxa and depression and anxiety in children and adolescents. Larger studies using comprehensive analytical approaches are needed to explore the role of the gut microbiome in the genesis and treatment of internalizing disorders.

BackgroundThis study investigates the links between dietary diversity, food insecurity and mental health (depression and anxiety) in adolescents from rural Pakistan. Adolescence is a critical time for developing mental health disorders, yet limited research exists on these issues in low- and middle-income countries (LMICs).MethodsThe study included 1,396 adolescents (ages 9–15) and assessed their mental health, nutrition and maternal well-being. Depression and anxiety were measured using standardized questionnaires, while dietary diversity and food insecurity were evaluated through household assessments. Incidence rate ratios assessed the relationship between nutrition and mental health.ResultsResults showed that 8.1% of boys and 10.2% of girls experienced depression, with anxiety rates ranging from 5.8% to 39.1%. Adolescents from households with higher dietary diversity had lower symptoms of depression and anxiety (IRRs:0.91–0.96), while those with higher food insecurity had increased symptoms (IRRs:1.24–1.86). Folate deficiency was associated with depressive symptoms, particularly in boys. Maternal mental health was observed to mediate the relationship between food insecurity and adolescent depression and anxiety.ConclusionsThe study highlights that improving maternal mental health and addressing nutritional deficiencies, particularly folate, may benefit adolescent well-being. Further research in other LMICs is needed to explore these associations and their mechanisms.

BackgroundCurrent first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression.AimsPaediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs.MethodSearches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations.ResultsTen paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature.ConclusionsInterest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.