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Depressive disorders are highly prevalent mental problems, which rise sharply after puberty, especially for girls (Salk et al, 2017). While males and females show similar depression prevalence during childhood, from puberty on girls are nearly twice as likely to develop depressive symptoms compared to boys (Stumper & Alloy, 2021). As depression is associated with poor physical and mental health, and it predicts suicide and deliberate self-harm (Naicker et al, 2013), there is a pressing need to identify factors that contribute to the enhanced risk for depressive symptoms during adolescence (LeMoult et al., 2020). Notably, obesity is an eminent risk factor for the development of later depressive symptoms and depression, particularly for females (Sutaria et al, 2018). However, the mechanisms underlying this obesity-depressive symptoms link are mostly unclear. For future prevention and treatment programs, it is of utmost importance to understand which characteristics of children with obesity increase the tendency towards developing depressive symptoms during adolescence. The current study aims to add insights into this question by focusing on the potential (gender-specific) mediating role of body esteem. The confirmation of this mediation would suggest that an increase of body esteem may be an important target for both pediatric obesity and depression interventions. Body esteem is the perceptual component of body image, and it is defined as the subjective assessment of one's own body (Mendelson et al., 2001). During adolescence, body esteem decreases, especially for girls (Bucchianieri et al., Holmqvist, et al., 2007., 2014; Mak et al., 2012). It has been argued that appearance takes an important role in identity formation during this stage, a period of many changes - biological, cognitive, psychosocial, and emotional- that influence how young people perceive the self and their own body (Nelson et al, 2018). Biologically, pubertal development is a gradual process occurring between childhood and adolescence that involves changes in body shape and body fat, especially for girls (Backes & Bonnie, 2019). The answer to the question “how do I see my own body?” will depend on how successful the person is in accepting these changes, which in turn relies on the interaction of the person with the context (Nelson et al, 2018). Primary agents of socialization, such as parents, peers, and the media, send appearance-related messages based on physical stereotypes of beauty, with a common focus on “thinness” for females and “muscularity” for males in most western societies (Llorente et al, 2015). These messages have a high impact on body esteem, especially for girls, who perceive greater sociocultural pressure towards meeting these physical standards (Rodgers et al, 2020). This pressure might also be higher among adolescents whose weight is far from the thinness ideal, who are more likely to experience weight stigma (Pearl & Puhl, 2014). In this line, several studies have shown that children and adolescents with obesity tend to have lower body esteem scores than their peers with normal weight (Moradi et al, 2020., Sagar & Gupta, 2018.; Sanders et al., 2015). Prospective studies point towards an association between obesity and a higher risk of body dissatisfaction among adolescents (Moradi et al, 2020). Moreover, body esteem has been strongly related to depression, independently of other aspects of self-esteem (Jónsdóttir et al, 2008). Moreover, some longitudinal studies suggest that low body esteem predicts later depressive symptoms during adolescence (Bornioli et al., 2021; Sharpe et al., 2018). A mediation approach has been tested by previous studies in adult populations, finding that body image dissatisfaction significantly increased the likelihood of depression among middle-aged women with obesity (Gavin et al, 2010) and among men and women attending a weight-loss facility (Friedman et al, 2002). More specifically, some studies highlight that weight perception, rather than weight status itself, is significantly associated with depression, also during adolescence (Gaskin et al., 2013; Roberts and Duong, 2013; Paulitsch et al, 2021). Given the gender gap regarding body esteem and depressive symptoms from puberty on, the mediation role of body esteem upon the obesity towards depression link might be moderated by gender. However, whether and how these gender differences might interact from childhood to adolescence is still unclear (Mond et al, 2011). Overall, body esteem might be a potential mediator in the relation of obesity with depressive disorders, although, to our knowledge, no studies have tested this hypothesis prospectively. Finally, given that the risk for depression increases during adolescence, it seems essential to explore this underlying path precisely at this stage. Study aim: In the present study, we seek to cover the mentioned gap in the current literature on obesity and depression by investigating whether body esteem is a mediator of the prospective obesity-depression association. In addition, we aim to evaluate whether gender moderates this mediation. Our study is based on a case-control design of children with and without obesity matched on various demographic characteristics (family socio-economic status, child sex and age). The cohorts of children with versus without obesity have been prospectively assessed to explore the development of mental health outcomes during adolescence, while controlling for baseline mental health symptoms during childhood.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first of three scheduled surveys to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent psychiatry (CAP) services in Europe and to assess the abilities of CAP centers to meet the new challenges brought on by the crisis. The survey was a self-report questionnaire, using a multistage process, which was sent to 168 heads of academic CAP services in 24 European countries. Eighty-two responses (56 complete) from 20 countries, representing the subjective judgement of heads of CAP centers, were received between mid-April and mid-May 2020. Most respondents judged the impact of the crisis on the mental health of their patients as medium (52%) or strong (33%). A large majority of CAP services reported no COVID-19 positive cases among their inpatients and most respondents declared no or limited sick leaves in their team due to COVID-19. Outpatient, daycare, and inpatient units experienced closures or reductions in the number of treated patients throughout Europe. In addition, a lower referral rate was observed in most countries. Respondents considered that they were well equipped to handle COVID-19 patients despite a lack of protective equipment. Telemedicine was adopted by almost every team despite its sparse use prior to the crisis. Overall, these first results were surprisingly homogeneous, showing a substantially reduced patient load and a moderate effect of the COVID-19 crisis on psychopathology. The effect on the organization of CAP services appears profound. COVID-19 crisis has accelerated the adoption of new technologies, including telepsychiatry. Supplementary Information The online version contains supplementary material available at 10.1007/s00787-020-01699-x.

The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.