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Background:Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists.Methods:This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic.Results:Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment – with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization.Conclusion:Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent–parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.

The association between Attention Deficit Hyperactivity Disorder (ADHD) and suicidal ideation has been the focus of recent research interest among youths and young adults. However, the role perceived stress plays in this association is unclear. We investigated whether perceived stress accounts for the association between ADHD and subsequent suicidal ideation among French students enrolled in the i-Share cohort. The associations between ADHD symptoms, perceived stress at baseline, and suicidal ideation during follow-up were investigated using logistic regression models, and Structural Equation Modeling was used to estimate the indirect effect via perceived stress. In total 4333 participants (median age: 20.3 years; [interquartile range: 18.7-21.8]) were included in the main analyses. ADHD was associated with suicidal ideation (adjusted Odds Ratio = 1.15 [95% Confidence Interval: 1.04-1.26]). Perceived stress partially accounts for the association between ADHD and suicidal ideation (proportion explained 49%). Our study suggests that ADHD and perceived stress represent mental health targets for suicide prevention programs.

BackgroundCross‐sectional associations have been documented between cybervictimization and suicidal risk; however, prospective associations remain unclear.MethodsParticipants were members of the Quebec Longitudinal Study of Child Development (QLSCD), a prospective birth cohort of 2,120 individuals followed from birth (1997/98) to age 17 years (2014/15). Cybervictimization and face‐to‐face victimization experienced since the beginning of the school year, as well as serious suicidal ideation and/or suicide attempt were self‐reported at ages 13, 15 and 17 years.ResultsIn cross‐sectional analyses at 13, 15 and 17 years, adolescents cybervictimized at least once had, respectively, 2.3 (95% CI = 1.64–3.19), 4.2 (95% CI = 3.27–5.41) and 3.5 (95% CI = 2.57–4.66) higher odds of suicidal ideation/attempt after adjusting for confounders including face‐to‐face victimization, prior mental health symptoms and family hardship. Sensitivity analyses suggested that cybervictimization only and both cyber‐ and face‐to‐face victimization were associated with a higher risk of suicidal ideation/attempt compared to face‐to‐face victimization only and no victimization; however, analyses were based on small n. In prospective analyses, cybervictimization was not associated with suicidal ideation/attempt 2 years later after accounting for baseline suicidal ideation/attempt and other confounders. In contrast, face‐to‐face victimization was associated with suicidal ideation/attempt 2 years later in the fully adjusted model, including cybervictimization.ConclusionsThe cross‐sectional association between cybervictimization and suicidal ideation/attempt is independent from face‐to‐face victimization. The absence of a prospective association suggested short‐term effects of cybervictimization on suicidal ideation/attempt.

BackgroundChildhood internalizing symptoms can be associated with adolescent internalizing symptoms, but only a small proportion of symptomatic children are at long-term risk. Our objectives were to (1) distinguish between typical and atypical levels of internalizing symptoms using mother- and teacher-assessments and (2) test the association between childhood internalizing symptoms and adolescent generalized anxiety, depression, and social phobia symptoms in boys and girls.MethodsMulti-trajectory models were used to estimate the evolution of mother- and teacher-reported internalizing symptoms across childhood (1.5 to 12 years) in a large population-based cohort (n = 1431). Multiple linear regression models were implemented to estimate the association between childhood group membership of internalizing symptoms and self-reported specific internalizing symptoms at 15 years by sex.ResultsFive groups of childhood internalizing symptoms were identified: Mother & teacher low (22.6%), Mother moderate/teacher low (37.9%), Mother moderate/teacher high (18.3%), Mother high/teacher low (11.8%) and Mother & teacher high (9.5%). Multiple linear regression models showed that compared to the low group, (1) boys in the high group reported higher social phobia symptoms (p = 0.04), (2) girls in the high group reported higher depression (p = 0.01) and generalized anxiety (p < 0.01) symptoms, and (3) girls in the moderate/high group reported higher generalized anxiety symptoms (p = 0.02) in adolescence.LimitationsThe main limitation is that mothers’ and teachers’ assessments mostly covered different developmental periods.ConclusionsA multi-informant assessment of childhood internalizing symptoms improves adolescent specific internalizing symptoms identification in a general population sample over reliance on a single informant.

Importance: This study used multitrajectory modeling to identify distinct trajectories of physical aggression from ages 1.5 to 13 years for boys and girls. Objectives: To trace the development of boys' and girls' physical aggression problems from infancy to adolescence using mother ratings, teacher ratings, and self-ratings and to identify early family predictors of children on the high physical aggression trajectories. Design, Setting, and Participants: This cohort study used data from the Quebec Longitudinal Study of Child Development (QLSCD), a study of a representative, population-based sample of 2223 infants born in 1997 and 1998 in the Canadian province of Quebec. The dates of analysis were January 2017 to January 2018. Main Outcomes and Measures: Trained research assistants conducted 7 interviews (at child ages 1.5, 2.5, 3.5, 4.5, 5, 6, and 8 years) with the person most knowledgeable about the child (mothers in 99.6% [2214 of 2223] of cases). Teachers assessed the child's behavior at ages 6, 7, 8, 10, 12, and 13 years. Self-reports of behavior problems were obtained from the child at ages 10, 12, and 13 years. Results: The sample included 2223 participants, 51.2% of whom were boys and 91.2% of whom were of white race/ethnicity. The mean response rate for mother ratings of physical aggression during the first 8 years of life was 80.9% (range, 65.1%-91.7%). For teacher ratings of physical aggression from ages 6 to 13 years, the mean response rate was 45.7% (range, 35.4%-56.9%), while the mean response rate of physical aggression assessment from self-ratings between ages 10 and 13 years was 57.9% (range, 55.2%-60.5%). Attrition was higher among families with low socioeconomic status and single-parent families, as well as among young mothers and mothers who were not fluent in French or English. A statistical analysis to examine the consequences of attrition was included. For boys and girls, the frequency of physical aggressions increased from age 1.5 years (2039 [91.7%]) to age 3.5 years (1941 [87.3%]) and then substantially decreased until age 13 years (1228 [55.2%]). Three distinct developmental trajectories of physical aggression were observed for girls and 5 for boys. Most family characteristics measured at 5 months after the child's birth were associated with a high physical aggression trajectory for boys and girls. Conclusions and Relevance: Family characteristics at 5 months after the child's birth could be used to target preschool interventions aimed at preventing the development of boys' and girls' chronic physical aggression problems.

OBJECTIVE: Exposure to maternal depression during early childhood is a well-documented risk factor for offspring's internalizing problems, but the long-term risk and the psychosocial mechanisms underlying the association remain largely unknown. We examined whether maternal depression during early childhood was associated with offspring internalizing problems in adolescence, and the extent to which negative parenting, peer victimization, and poor friendship quality during middle childhood mediated this association. METHOD: We report on a population-based sample of children (n = 1,443) followed-up from 5 months to 15 years. We use yearly assessments of the exposure variable, that is, maternal depression (5 months to 5 years); the putative mediators, that is, peer victimization, friendship quality, and parenting practices (6-12 years); and assessment of the outcome variables at 15 years: self-reported major depressive (MD), generalized anxiety (GA), and social phobia (SP) symptoms. Structural equation modeling was used to test mediation by peer and family relationships. RESULTS: Exposure to maternal depression during early childhood was associated with higher levels of adolescent MD, GA, and SP. Peer victimization was the only significant mediator and explained 35.9% of the association with adolescent MD, 22.1% of that with GA, and 22.1% of that with SP. CONCLUSION: Exposure to maternal depression prior to age 5 years was associated with depression, anxiety, and social phobia extending to adolescence via its impact on peer victimization during middle childhood. Particular attention should be paid to victimization as one potential psychosocial factor via which maternal depression is associated with adolescent internalizing problems.

Importance: Suicidal ideation and suicide attempt (suicidality) are common in adolescence and a public health concern. Childhood depression is a key risk factor for later suicidality and often co-occurs with irritability. No study to date has examined the joint association of depressive mood and irritability during childhood with later suicidality. Objective: To investigate the association of childhood irritability and depressive/anxious mood profiles with adolescent suicidality. Design, Setting, and Participants: This population-based cohort study included 1430 participants in the Quebec Longitudinal Study of Child Development. Participants underwent assessment yearly or bi-yearly (5 months to 17 years). Data were collected from March 16, 1998, through July 17, 2015. Exposures: Profiles defined by the joint developmental trajectories of irritability and depressive/anxious mood at 6 to 12 years of age. Main Outcomes and Measures: Self-reported past-year suicidality (ie, serious suicidal ideation or suicide attempt) at 13, 15, and 17 years of age. Irritability and depressive/anxious mood were assessed using teacher report 5 times from 6 to 12 years of age. Results: The study included 1430 participants (676 boys [47.3%] and 754 girls [52.7%]) followed up to 17 years of age. Group-based multitrajectory modeling identified the following profiles: combined no irritability and low depressive/anxious mood with low irritability and low depressive/anxious mood (831 [58.1%]; reference group), moderate irritability and low depressive/anxious mood (353 [24.7%]), high depressive/anxious mood only (94 [6.6%]), and high irritability and depressive/anxious mood (152 [10.6%]). Children with high irritability and high depressive/anxious mood reported higher rates of suicidality (25 of 152 [16.4%]) compared with the group with the lowest symptom levels (91 of 831 [11.0%]). In logistic regression analyses, the high irritability and depressive/anxious mood profile (odds ratio [OR], 2.22; 95% CI, 1.32-3.74; number needed to be exposed [NNE], 18) was associated with suicidality. To a lesser extent, the moderate irritability and low depressive/anxious mood profile was also associated with suicidality (OR, 1.51; 95% CI, 1.02-2.25; NNE = 48). The high depressive/anxious mood only profile was not associated with later suicidality (OR, 0.96; 95% CI, 0.47-1.95; NNE = -320). The high irritability and depressive/anxious mood profile was associated with a higher suicidal risk compared with the depressive/anxious mood only profile (OR, 2.28; 95% CI, 1.02-5.15). Girls with the high irritability and high depressive/anxious mood profile had higher risk for suicidality (OR, 3.07; 95% CI, 1.54-6.12; NNE = 5). Conclusions and Relevance: Children with high irritability and depressive/anxious mood and, to a lesser extent, with moderate irritability only had a higher suicidal risk during adolescence compared with children with low symptom levels. Early manifestation of chronic irritability during childhood, especially when combined with depressive/anxious mood, may be associated with an elevated risk for adolescent suicidality. The putatively causal role of irritability should be investigated.

Objective: Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. Methods: This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. Results: This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, "self-transformation" and problem solving; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships. Conclusion: Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed.