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Background Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient’s family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking. Methods We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing. Results We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [− 0.18; 0.30], p  = 0.68, I 2  = 98.0%) and psychopathology (SMD = 0.10 [− 0.17; 0.37], p  = 0.44, I 2  = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered. Conclusions This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment. Trial registration Registered at PROSPERO (CRD42020177558), July 5, 2020.

Alterations of rapid eye movement (REM) sleep have long been observed in patients with psychiatric disorders and proposed as an endophenotype—a link between behavior and genes. Recent experimental work has shown that REM sleep plays an important role in the emotional processing of memories, emotion regulation, and is altered in the presence of stress, suggesting a mechanism by which REM sleep may impact psychiatric illness. REM sleep shows a developmental progression and increases during adolescence—a period of rapid maturation of the emotional centers of the brain. This study uses a behavioral genetics approach to understand the relative contribution of genes, shared environmental and unique environmental factors to REM sleep neurophysiology in adolescents. Eighteen monozygotic (MZ; n  = 36; 18 females) and 12 dizygotic (DZ; n  = 24; 12 females) same-sex twin pairs (mean age = 12.46; SD = 1.36) underwent whole-night high-density sleep EEG recordings. We find a significant genetic contribution to REM sleep EEG power across frequency bands, explaining, on average, between 75 to 88% of the variance in power, dependent on the frequency band. In the lower frequency bands between delta and sigma, however, we find an additional impact of shared environmental factors over prescribed regions. We hypothesize that these regions may reflect the contribution of familial and environmental stress shared amongst the twins. The observed strong genetic contribution to REM sleep EEG power in early adolescence establish REM sleep neurophysiology as a potentially strong endophenotype, even in adolescence—a period marked by significant brain maturation.

Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p  < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p  < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization—compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.

Mental health problems are highly prevalent in children and adolescents, but professional help-seeking behavior in this age group is extremely low. Therefore, the ProHEAD (“Promoting Help-seeking using E-technology for Adolescents”) consortium focuses on three main objectives, i.e.: (1) improving young people’s help-seeking behaviors; (2) improving the selective prevention of common disorders in those who are at risk; and (3) strengthening resources to counteract the development of mental illness. Capitalizing on Internet and mobile technology, ProHEAD delivers low threshold and easily accessible interventions to a large sample of young people. Longitudinal school-based assessments of mental health problems will be conducted at baseline and two annual follow-ups in five regions of Germany in a total sample of 15,000 children and adolescents (aged ≥ 12 years). Based on the results of their baseline assessment, participants are invited to register for one out of five sub-projects. The objectives and procedures of these five randomized controlled trials are published in this issue of Trials .

Background Bullying victimization affects one in ten schoolchildren in Europe and has far-reaching negative consequences for mental health and school achievement. Although school-based bullying prevention programs seem overall capable of reducing the frequency of bullying, the continuous development, improvement, and rigorous evaluation of bullying prevention programs with enhanced feasibility and efficacy is critical. Consequently, we developed the program Bullying&You , which applies a blended-intervention approach to school-based bullying prevention based on latest empirical knowledge regarding effective program components and program-related facilitators. We aim to test its efficacy within a cluster randomized trial (CRT). Methods Bullying&You will be implemented and evaluated in 40 schools (estimated total  n  = 8500 pupils) in Germany. The effectiveness of the program will be investigated in a CRT comparing 20 schools in the intervention group (IG; starting immediately with the program) with 20 schools in the waiting control group (CG; starting with a 1-year delay). The target group of the program are pupils in grades 3–9, as well as the whole school staff. All pupils will be asked to complete questionnaires concerning their bullying experiences (as victims, perpetrators, and bystanders) and mental health at baseline (T0) and two annual follow-ups (T1 and T2). The main endpoint of the trial is the reduction of bullying (prevalence of victims and perpetrators of direct, indirect, and cyberbullying) at 1-year follow-up (T1) in the IG compared to the CG. Secondary endpoints are psychopathology and self-harm behaviour. In addition, further research questions include (a) which specific components of the program prove to be most effective and (b) whether there are certain characteristics that predict program success at the individual level. Discussion School-based bullying prevention programs still lack rigorous evidence for their efficacy. In addition, dissemination of bullying prevention programs has previously been hampered by the high need of resources required from schools for their implementation. The program’s blended-intervention approach allows for a time-efficient and flexible implementation, while the continuous monitoring of the progress ensures program fidelity and strengthens adherence. If proven effective, Bullying&You has the potential to contribute to filling the gap in systematic dissemination of bullying prevention among youth. Trial registration German Clinical Trials Register DRKS00028183. Registered on 02 March 2022.

Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents.

Non-suicidal self-injury (NSSI) is a transdiagnostic psychiatric symptom with high prevalence and relevance in child and adolescent psychiatry. Therefore, it is of great interest to identify a biological phenotype associated with NSSI. The aim of the present study was to cross-sectionally investigate patterns of biological markers underlying NSSI and associated psychopathology in a sample of female patients and healthy controls. Comprehensive clinical data, saliva and blood samples, heart rate variability and pain sensitivity, were collected in n  = 149 patients with NSSI and n = 40 healthy participants. Using machine-based learning, we tested the extent to which oxytocin, dehydroepiandrosterone (DHEA), beta-endorphin, free triiodothyronine (fT3), leukocytes, heart rate variability and pain sensitivity were able to classify participants regarding their clinical outcomes in NSSI, depression and borderline personality disorder symptomatology. We evaluated the predictive performance of several models (linear and logistic regression, elastic net regression, random forests, gradient boosted trees) using repeated cross-validation. With NSSI as an outcome variable, both logistic regression and machine learning models showed moderate predictive performance (Area under the Receiver Operating Characteristic Curve between 0.67 and 0.69). Predictors with the highest predictive power were low oxytocin (OR = 0.55; p  = 0.002), low pain sensitivity (OR = 1.15; p  = 0.021), and high leukocytes (OR = 1.67; p  = 0.015). For the psychopathological outcome variables, i.e., depression and borderline personality disorder symptomatology, models including the biological variables performed not better than the null model. A combination of hormonal and inflammatory markers, as well as pain sensitivity, were able to discriminate between participants with and without NSSI disorder. Based on this dataset, however, complex machine learning models were not able to detect non-linear patterns of associations between the biological markers. These findings need replication and future research will reveal the extent to which the respective biomarkers are useful for longitudinal prediction of clinical outcomes or treatment response.

Background Bullying, problematic internet gaming, and problematic social media use are concerning phenomena, especially among youth. However, studies including all three of them are scarce. Therefore, this study investigated the associations between bullying victimization and the two internet-related outcomes. Furthermore, differences between problematic internet gaming and problematic social media use regarding the individual and moderating effects of gender, age, educational background and mental health problems were examined. Methods Adolescents ( N  = 6,735; 48.85% females) answered a school-based survey on bullying, problematic internet gaming, problematic social media use and mental health problems. The age ranged from grade 5 with M  = 10.77 years ( SD  = 0.68) to grade 9 with M  = 14.75 years ( SD  = 0.87) and overall M  = 12.73 years ( SD  = 1.60). A-level school students represented higher educational background (39.52%) while B-level school students represented lower educational background (60.48%). Multilevel modelling was used to examine the associations of bullying victimization with problematic internet gaming and problematic social media use as well as the influences of gender, school grade as a correlate of age, school type and mental health problems. Results Victims of bullying showed higher odds for problematic internet gaming and problematic social media use. Overall, boys showed higher levels of problematic internet gaming, whereas girls showed higher levels of problematic social media use. Younger adolescents reported higher odds for problematic internet gaming, while no age effect was found for problematic social media use. Students with lower educational background and those with more mental health problems reported more problematic social media use than problematic internet gaming. Mental health problems moderated the association of bullying victimization with problematic internet gaming and problematic social media use, with stronger relations for students with less mental health problems. Furthermore, gender was a significant moderator for problematic social media use but not for problematic internet gaming, with a stronger association for boys. Conclusions Bullying victimization is strongly related to different types of problematic internet use. As differences in the impact on problematic internet gaming and problematic social media use can be identified, prevention should also consider gender, age, educational background and mental health problems. Trial registration DRKS00028183.

Adaptive parent–child interaction plays a major role in healthy child development. Caregiver mental health problems can negatively impact parent–child interaction. In turn, interactional quality is often studied as a predictor of child outcome. However, child characteristics supposedly shape parent–child interactions as well. Given associations between child and caregiver mental health and child temperament, this study aimed at differentiating their effects on dyadic interaction quality in adolescence. Child temperament and character at age 5 were investigated as longitudinal predictors of observed mother–adolescent interactional quality at age 14 in a community sample (N = 76). It was examined whether these effects were independent of maternal and child mental health and earlier dysfunctional interaction. Lower novelty seeking, higher reward dependence, and higher cooperativeness separately predicted higher dyadic interactional quality at age 14. Controlling regressions for dysfunctional interaction at age 5, which was a significant negative predictor of later interactional quality, cancelled out the effects of novelty seeking and cooperativeness. Past or concurrent maternal or child psychopathology did not explain variance in mother–adolescent interaction. Applying backward selection, a model including reward dependence and dysfunctional interaction at age 5 and concurrent maternal stress showed the best fit for explaining dyadic interaction quality. Results suggest that enduring rather than transient child features predict interactional quality in a community sample. Effects of temperament are not better explained by those of psychopathology, but a combination of child, maternal, and dyadic features predicted dyadic behaviour best. Selective prevention should target parenting in the context of challenging child characteristics specifically.