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•Dynamic conditional correlations (DCC) method used to investigate dynamic functional connectivity (FC).•Large sample from ABCD Study showed dynamic FC relationships with age, sex assigned at birth, and pubertal development.•Variability of FC within frontolimbic network increased from ages 9 to 14, especially in those assigned female at birth.•Controlling for age, both those assigned female at birth and those with advanced pubertal development showed decreased variability in all networks studied.•Variability of graph theoretical measures show differential patterns to overall FC variability. Understanding the relative influences of age, pubertal development, and sex assigned at birth on brain development is a key priority of developmental neuroscience given the complex interplay of these factors in the onset of psychopathology. Previous research has investigated how these factors relate to static (time-averaged) functional connectivity (FC), but little is known about their relationship with dynamic (time-varying) FC. The present study aimed to investigate the unique and overlapping roles of these factors on dynamic FC in children aged approximately 9 to 14 in the ABCD Study using a sample of 5122 low-motion resting-state scans (from 4136 unique participants). Time-varying correlations in the frontolimbic, default mode, and dorsal and ventral corticostriatal networks, estimated using the Dynamic Conditional Correlations (DCC) method, were used to calculate variability of within- and between-network connectivity and of graph theoretical measures of segregation and integration. We found decreased variability in global efficiency across the age range, and increased variability within the frontolimbic network driven primarily by those assigned female at birth (AFAB). AFAB youth specifically also showed increased variability in several other networks. Controlling for age, both advanced pubertal development and being AFAB were associated with decreased variability in all within- and between-network correlations and increased variability in measures of network segregation. These results potentially suggest advanced brain maturation in AFAB youth, particularly in key networks related to psychopathology, and lay the foundation for future investigations of dynamic FC.

The BJPsych Open thematic series is devoted to recent advances in the study of non-suicidal self-injury (NSSI) in youth. Together, this body of work reveals new insights that, if replicated, could be translated into clinical practice, enhancing our abilities to understand and treat young people presenting with NSSI.

Background Adolescents undergo important developmental changes, characterized by profound biological and psychosocial changes. This period is also associated with increased vulnerability to mental health challenges and engagement in risky/problematic behaviors. Non-suicidal self-injury (NSSI) and internet addiction (IA) are increasingly recognized as prevalent and interconnected behavioral concerns among adolescents, particularly those with depressive disorders. Impulsivity has also been identified as a key psychological factor in both IA and NSSI. This study aimed to investigate the cross-sectional interrelationships among depression, impulsivity, IA, and NSSI in adolescents. Methods A total of 110 adolescents (55 diagnosed with major depressive disorder [MDD] and 55 healthy controls) were recruited from the Child and Adolescent Psychiatry Outpatient Clinic at Suez Canal University Hospital. The severity of depression was assessed using the Children’s Depression Inventory (CDI). All participants completed the Internet Addiction Test (IAT), Deliberate Self-Harm Inventory (DSHI), and Barratt Impulsiveness Scale (BIS-11). Statistical analyses included group comparisons, correlation analyses, logistic regression. Cross-sectional pathway analyses using structural equation modeling (SEM) was conducted to examine indirect associations between IA and NSSI through depression and impulsivity. Results Adolescents with MDD reported significantly higher levels of NSSI, IA, and impulsivity compared to controls. Significantly positive correlations between IAT, BIS-11, and CDI scores and lifetime NSSI frequency were demonstrated among the depression group. IA and NSSI were significantly associated by indirect pathways through both depression and impulsivity. In serial associational models, the cross-sectional indirect pathway from impulsivity to depression (B = 0.370) was stronger than the reverse direction (B = 0.310). Conclusion Our findings highlighted the interrelated roles of IA, impulsivity, and NSSI among adolescents with MDD. Impulsivity may be a critical factor linking IA to emotional dysregulation and self-injurious behavior. These results highlight the need for integrated screening and prevention strategies targeting impulsivity and these risk behaviors.

Through rich qualitative interviews, Simon and colleagues highlight how parents of suicidal adolescents navigate the process of lethal means restriction (LMR). Parents face challenges throughout the course of LMR that impact not only their ability to implement it effectively, but also the family dynamic at large. Results underscore a need for standardised, comprehensive training in LMR for clinical and medical professionals, as well as for policy solutions that can have more widespread influence and reduce the burden on parents as they support their children through an extraordinarily difficult time.

Fatigue is a pervasive and difficult-to-treat symptom of major depressive disorder (MDD) that contributes to disability. Understanding this problem in its earlier stages will be critical for averting long-term negative outcomes. To investigate the molecular roots of fatigue in early-stage depression, the current work measured bioenergetic mechanisms, with a focus on adenosine triphosphate (ATP), in brain and blood cells in young adults with MDD versus healthy controls (HC). To measure ATP concentration and ATP production rate in the visual cortex, we utilized 31 P magnetic resonance spectroscopy imaging with magnetization transfer ( 31 P MRSI-MT) at 7 Tesla, with and without gamma-ATP resonance saturation. ATP level was also measured in peripheral blood mononuclear cells (PBMCs) at rest and after serial addition of mitochondrial inhibitors. Out of 25 participants (mean age 21.8 years), usable data were available for 18 participants for imaging (9 per group); 24 for PBMCs (13 HC; 11 MDD). The MDD group demonstrated higher ATP production rate in the visual cortex than HC, which correlated positively with Fatigue Severity Scale (FSS) scores. ATP concentrations in PBMCs were higher in MDD than HC, and also correlated with FSS scores. After mitochondrial uncoupling, PBMCs in the MDD group had a lower capacity for ATP production than HC. For the first time, we demonstrate an ATP biosignature of fatigue in young adults with MDD that is visible in both brain and peripheral blood. The findings suggest a compensatory mechanism that occurs early in the disease stage.

Background Mental health challenges are a significant concern among students and trainees in medical fields worldwide, including Japan, where high psychological distress is prevalent. This pilot study examined the feasibility and impact of a 6-day creative arts program designed for Japanese medical and international graduate students. Method A total of 14 students provided informed consent to participate in the study. Employing a convergent mixed-methods design, quantitative and qualitative data were collected and analyzed independently. Students completed the Comprehensive Inventory of Thriving (CIT) before and after the program to assess changes in psychological well-being. Pre-post differences were examined using paired t-tests. Qualitative data collection included post-program surveys, semi-structured interviews, and six-month follow-up interviews. We conducted thematic analysis to identify key patterns in student experiences. We then examined whether changes in CIT scores correlated with the frequency of qualitative codes to identify potential points of convergence between the two datasets. Results Thirteen students completed all major components of the study, with an average attendance of 5.2 out of 6 sessions. CIT scores significantly increased from before ( M  = 198.0, SD  = 29.9) to after completing the program ( M  = 217.3, SD  = 20.2), t (12) = -4.89, p = .0004, indicating a significant increase in thriving. Thematic analysis yielded three core themes: (1) Discovery through the underexplored parts of self and surroundings, (2) Rapid community bonding through inspiration, and (3) Creativity as a disruption to stress. Six-month follow-up interviews revealed additional themes related to enduring impact from the intervention: Applying creative insights into everyday life and mindsets. Through the convergent mixed-methods analysis, one pairing reached statistical significance: the change over time in the CIT subscore ‘Meaning’ was strongly correlated with the qualitative code “Out of the ordinary” (r = + 0.868), suggesting that increases in participants’ sense of meaning were strongly associated with the frequency of experiences that felt “Out of the ordinary” during the creativity program. Conclusion The findings suggest that a creative arts program for medical students is both feasible and effective in promoting well-being, enhancing stress management skills, and deepening self-awareness. The program shows promise for integration into medical education to support students’ holistic development and mental health.

Access to adolescent-friendly, culturally relevant and stigma-free mental health support is essential for reducing the long-term psychological, social and economic challenges of mental illness of youth living with HIV (YLWH). Now more than ever, innovative task-shifting interventions, through which non-mental health professionals provide mental health support to YLWH, need to be explored and supported. While many of these have considered shifting tasks to nurses, tapping into the wisdom and inspiration from artists in the community where YLWH are living could represent a novel and potentially powerful task-shifting strategy.In this opinion piece, we propose that the arts could be explored in future studies as a promising avenue for mental health interventions for YLWH in South Africa. Better Together is a peer-support intervention for youth living with chronic illness, which has been published previously by our team.As part of the discussion, we share feedback about the creative arts component of the Better Together groups provided by Better Together participants themselves.Overall, this feedback yielded several key insights which further underscore the idea that providing youth with opportunities to engage in creative arts in a group setting may represent a promising platform for addressing mental health in YLWH in South Africa.Specifically, we learned that (1) youth enjoyed the opportunity to engage creatively, (2) these experiences helped them connect with others, (3) they gained new insights and perspectives about themselves and their lives, and (4) they experienced a positive impact on their mood and well-being.

Pharmacogenomic (PGx) testing is increasingly utilized to guide psychiatric medication selection and dosing, yet real‐world characterizations of test ordering and clinical implications remain understudied. Additionally, the extent to which psychiatry‐focused PGx results inform prescribing beyond mental health medications is unclear. This study examined patterns of psychiatry‐focused PGx test ordering, the clinical relevance of results among adult and pediatric patients, and implementation challenges within a large health system. Electronic health records (EHRs) of 3383 individuals undergoing psychiatry‐focused PGx testing between 2013 and 2023 were analyzed. Test reports, available as unstructured PDFs, required manual curation before merging with clinical data. Demographic characteristics, test ordering patterns, genotype distributions, and drug‐gene interactions (DGIs) were assessed. Results indicated that 94.5% of individuals had one or more clinically actionable PGx variants. DGIs were identified for current psychiatric medications in 19.3% of adults and 15.0% of youth. Additionally, non‐psychiatric DGIs were identified in 11.8% of adults and 2.1% of youth. Most patients had genotype profiles that could guide future psychiatric and non‐psychiatric prescribing. Despite the clinical relevance, PGx results were inconsistently integrated into EHRs, limiting accessibility and reuse. Indicators of disparities in test ordering related to gender and race suggested systemic inequities and variability in provider adoption practices. Psychiatry‐focused PGx testing holds substantial potential to optimize current and future medication prescribing, extending beyond psychiatry. Key challenges include fragmented EHR integration, inconsistent provider adoption, and disparities in test ordering. Improved standardized reporting, structured EHR integration, and enhanced provider education are necessary to maximize PGx benefits in patient care.

Background A growing body of literature suggests that creative arts interventions can effectively support mental health and well-being in young people. We recently reported that after participating in “Creativity Camp”– a 2-week creative arts group intervention– 69 adolescents with depression showed significantly reduced depression symptoms and improved ratings of well-being. To understand the key processes impacting adolescents during and after this intervention, this study applies a multi-informant qualitative data approach. Method Qualitative data collection methods included participatory observation notes taken during the Creativity Camp sessions and interviewing the adolescents and their parents or guardians at the end of the intervention and six months later. We analyzed data using Constructivist Grounded Theory and triangulated the findings from both sets of data to gain comprehensive and reliable interpretation. Results We found several key processes in the adolescents’ experiences during and after camp: internal negotiation between novelty and discomfort, exploring playfulness and responsibility, discovering the uniqueness of self and others, flexible approach toward life, and an expanded view of creativity. From parent interviews, we found that their children expanded personal boundaries and enthusiasm through deep engagement, empowered perspective, and sustained enthusiasm. Triangulating the data from both sources, we constructed a theory that explains the benefits of Creativity Camp on adolescent well-being: “Personal growth by navigating the world as an artist.” Discussion The qualitative analysis identified key processes from the Creativity Camp intervention, along with changes and long-term impacts that may have fostered personal growth. The framework of navigating the world through an artist’s lens as a pathway to personal growth presents a novel contribution to existing knowledge and practice in art-based interventions for adolescents with depression. This insight can help shape the design of future arts-in-health approaches for supporting adolescent mental health.

Integrative, multilevel approaches investigating neurobiological systems relevant to threat detection promise to advance understanding of the pathophysiology of major depressive disorder (MDD). In this study we considered key neuronal and hormonal systems in adolescents with MDD and healthy controls (HC). The goals of this study were to identify group differences and to examine the association of neuronal and hormonal systems. MDD and HC adolescents (N = 79) aged 12–19 years were enrolled. Key brain measures included amygdala volume and amygdala activation to an emotion face-viewing task. Key hormone measures included cortisol levels during a social stress task and during the brain scan. MDD and HC adolescents showed group differences on amygdala functioning and patterns of cortisol levels. Amygdala activation in response to emotional stimuli was positively associated with cortisol responses. In addition, amygdala volume was correlated with cortisol responses, but the pattern differed in depressed versus healthy adolescents, most notably for unmedicated MDD adolescents. The findings highlight the value of using multilevel assessment strategies to enhance understanding of pathophysiology of adolescent MDD, particularly regarding how closely related biological threat systems function together while undergoing significant developmental shifts.