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Latar belakang. Gangguan pemusatan perhatian/hiperaktivitas (GPPH) merupakan masalah kesehatan mental anak yang serius karena memberikan dampak negatif bagi perkembangan anak. Metilfenidat kerja panjang 20 mg merupakan salah satu obat pilihan utama untuk memperbaiki rentang perhatian anak dalam melaksanakan tugasnya, menurunkan perilaku hiperaktivitas, dan mengurangi perilaku impulsif. Tujuan. Menganalisis dampak pemberian metilfenidat kerja panjang 20 mg selama dua belas minggu dan dampak penghentian obat tersebut selama satu bulan terhadap pola perbaikan gejala klinis GPPH. Metode. Penelitian menggunakan desain time series dengan tujuan untuk melihat pola perbaikan gejala klinis GPPH selama 12 minggu pemberian obat tersebut serta selama obat dihentikan 1 bulan. Duapuluh satu anak dengan GPPH berusia 7–10 tahun yang belum pernah diberikan obat untuk GPPH sebelumnya dan tanpa disertai adanya ko-morbiditas dengan gangguan mental atau gangguan fisik kronik lain diikutsertakan dalam penelitian. Diagnosis GPPH ditegakkan berdasarkan kriteria diagnosis GPPH dari DSM-IV TR dengan bantuan penuntun wawancara MINI for kid. Daftar tilik SPPAHI diisi setiap dua minggu oleh orangtua dan digunakan untuk mengukur pola perbaikan klinis yang terjadi selama 18 minggu penelitian. Uji repeated measures digunakan untuk menganalisis data SPPAHI tersebut. Hasil. Subjek penelitian diberikan metilfenidat kerja panjang 20 mg selama 12 minggu, didapatkan penurunan nilai rerata SPPAHI yang sudah tampak dalam dua minggu pertama pemberian obat dan berlangsung hingga obat dihentikan selama satu bulan (p

Marine productivity, a pivotal factor in marine ecosystems and global carbon cycling, is influenced by various factors including upwelling and terrigenous nutrient influx. We investigated past marine productivity in Banggai Waters, Indonesia, using sediment samples (BUDEE22-29BC and BUDEE22-57BC) and Micro X-Ray Fluorescence (micro-XRF) analyses. Geochemical proxies (K/Ti, Ba/Al, and Zr/Al) help to assess terrigenous influx, upwelling events, and paleoproductivity. Our methodology categorizes productivity into upwelling-driven (UPW), terrigenous influx-driven (TER), and TUP (combined). The incorporation of geochemical proxy data has enabled a comprehensive understanding of historical marine productivity patterns. In BUDEE22-29BC, the K/Ti ratio initially rises and then falls below its threshold, whereas Ba/Al shows spikes and declines before rising again. Zr/Al ratios vary across depths, indicating different paleoproductivity drivers such as terrigenous influence and upwelling. BUDEE22-57BC displayed similar trends in K/Ti, Ba/Al, and Zr/Al ratios, with fluctuations indicating changes in paleoproductivity drivers, including mixing and upwelling effects. The unique positioning of Banggai Waters allows interactions between upwelling, terrigenous influx, and productivity. This study lays the groundwork for further research on past productivity changes and their drivers, thereby enhancing our understanding of marine dynamics.

Purpose: This study aimed to estimate the prevalence of mental health problems and identify potential risk and protective exposures for adolescents in Indonesia., Methods: An innovative sampling approach was applied to simultaneously recruit school- and community-based adolescents aged 16-18 years old from Jakarta (urban megacity) and South Sulawesi (remote province). We used multistage cluster sampling for in-school (N = 1,337) and respondent driven sampling for out-of-school (N = 824) adolescents. Mental health was measured using two validated scales: Kessler-10 and Center for Epidemiologic Studies Depression Scale-Revised. Psychiatric interviews were conducted in a subsample (N = 196) of students from Jakarta to validate the self-report scales., Results: The estimated population prevalence of psychological distress and depression were 24.3% (95% CI = 21.5-27.2) and 12.6% (10.5-14.4) for in-school and 23.7% (20.7-26.7) and 23.5% (20.4-26.5) for out-of-school adolescents, respectively. In participants who completed a psychiatric interview, common psychiatric morbidities were social anxiety, depression, and suicidality. Compared to in-school females, male in-school adolescents reported a lower prevalence of psychological distress (16.9% (13.1-20.7) vs. 30.4% (26.4-34.4)) and depression (10.1% (7.2-13.1) vs. 14.6 (11.4-17.8)). By contrast, for out-of-school adolescents, males reported a higher prevalence of psychological distress (25.2% (21.6-28.9) vs. 20.2% (15.1-25.3)) and depression (26.3% (22.5-30.1) vs. 16.9% (11.8-21.9)). In-school adolescents who did not seek healthcare despite a perceived need were more likely to report psychological distress and depression., Discussion: Adolescent mental health problems are highly prevalent in Indonesia, with substantial variation by gender, geography, and school enrolment. This study and its approach to sampling and measurement may serve as a model to improving mental health surveillance across other settings., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Executive function influences children's learning abilities and organizes their cognitive processes, behaviors, and emotions. This cross-sectional study examined whether an Indonesian Computer-Based Game (ICbG) prototype could be used as a Computer-Based Game Inventory for Executive Function (CGIEF) in children and adolescents. The study was conducted with 200 children, adolescents, and their parents. The parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire, and the children and adolescents completed the CGIEF. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were performed using LISREL Version 8.80. The construct of CGIEF was valid/fit with normal theory-weighted least squares = 15.75 ( p > .05). SEM analysis showed that the theoretical construct of the CGIEF was a valid predictor of executive function. The critical t value of the pathway was 2.45, and normal theory-weighted least squares was 5.74 ( p > .05). The construct reliability (CR) for CGIEF was 0.91. Concurrent validity was assessed using the Bland-Altman plot, and the coefficient of repeatability (bias/mean) was nearly zero between the t scores of total executive functions of the CGIEF and BRIEF. This preliminary study showed that the CGIEF can be useful as a screening tool for executive dysfunction, metacognitive deficits, and behavioral regulation problems among children and adolescents in clinical samples., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries., Method: This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N = 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country., Results: Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales., Conclusion: The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally., (Copyright © 2024. Published by Elsevier Inc.)

This study aimed to assess the diagnostic accuracy of the Patient Health Questionnaire (PHQ) for identifying common mental disorders in an outpatient clinical psychologist office setting in Indonesia. A total of 661 outpatients from a clinical psychology office in Jakarta, Indonesia, participated in the study. The complete PHQ was administered, and its results were compared with diagnoses made by clinical psychologists based on ICD-11 criteria, including somatoform disorder (n = 6), depression (n = 117), Generalized Anxiety Disorder (GAD, n = 50), panic disorder (n = 42), bulimia nervosa (n = 2), binge eating disorder (n = 2), and other diagnoses such as OCD and BPD (n = 442). Receiver operating characteristics were computed to examine cut-off points, and optimal cut-off points based on the Youden Index were identified for somatoform disorder (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD- 7 ≥ 10), and panic disorder (PHQ-PD ≥ 7). Cut-off points for the alcohol abuse and eating disorder modules of the PHQ could not be determined due to a lack of sample, and AUC was suboptimal for PHQ-9, GAD-7, and PHQ-ED. The Indonesian PHQ demonstrated good sensitivity but low specificity in identifying somatoform disorder, depression, GAD, and panic disorders based on ICD-11 criteria among Indonesian clinical psychologist office outpatients. In the Indonesian outpatient psychiatric context, the utility of the Indonesian PHQ appeared to be most effective in ruling out diagnoses., Competing Interests: Declaration of Competing Interest The authors are clinical psychologists who may financially benefit from good accuracy of diagnostic instruments such as the Patient Health Questionnaire., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Epilepsy is a common chronic neurological disorder in pediatrics. Depression is an often underdetected comorbidity in childhood epilepsy. This study aimed to adapt the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y) to the Indonesian language and population, as well as to validate the Indonesian version of NDDI-E-Y (NDDI-E-Y[ID])., Methods: This three-stage study comprised instrument translation, cultural verification, and content validity testing (first stage), pilot testing (second stage), followed by concurrent validity and reliability testing (third stage) of the NDDI-E-Y(ID). Validation was done against the Centre for Epidemiologic Studies Depression Scale - Revised (CESD-R). Content validity, assessed by six experts, was quantified using the content validity index for items (I-CVI) and scale (S-CVI). Participants were adolescents aged 12-17 years diagnosed with any type of epilepsy who completed both instruments. Concurrent validity was evaluated using Spearman's correlation and reliability was measured using Cronbach's alpha., Results: The first stage produced a culturally appropriate NDDI-E-Y(ID). Thirty healthy adolescents and 10 adolescents with epilepsy participated in the second stage. In the third stage, another group of 30 adolescents with epilepsy took part. We obtained I-CVI and S-CVI values averaging 1. The NDDI-E-Y(ID) showed a positive and significant correlation with CESD-R (Spearman's rho = 0.671, p < 0.001). A Cronbach's alpha of 0.928 reflected a high internal consistency., Significance: Based on the results, the NDDI-E-Y(ID) was found to be a valid and reliable screening instrument for detecting depression in youth with epilepsy., Plain Language Summary: Depression is an under-recognized problem in youth with epilepsy. Currently available depression screening tools are in English, making it less suitable for detection purposes in Indonesia. This study developed and validated the Indonesian version of the NDDI-E-Y, a depression screening tool for youth with epilepsy., (© 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Background: Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic., Methods: This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac., Results: According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn's post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001)., Conclusion: Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students' depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing., (© 2024. The Author(s).)

The coronavirus disease 2019 (COVID-19) pandemic has brought drastic changes globally in the past three years, one of which is an increase in the use of digital media or electronic devices. Previous studies have shown that long screen time may stimulate the neurobiological system, resulting in various behavioural and emotional problems; however, there is insufficient population-based evidence. This study aimed to investigate the influence of screen time on behavioural and emotional problems in Indonesian adolescents at three time points: the pre-, peak, and post-peak periods of COVID-19. Data were collected using an online community mental health survey. This survey incorporated the Youth Screen Time Survey to gauge screen time and the adolescent version of the Strengths and Difficulties Questionnaire to assess emotional, conduct, and prosocial behaviour problems. The participants were adolescents in secondary and senior high schools, with 337, 423, and 1,096 participants from the pre-, peak-, and post-pandemic periods, respectively, included in the analysis. Daily average screen time was compared, followed by the calculation of odds ratios for screen time and mental health problems during the different periods. The results demonstrated significant differences in adolescents' total daily average screen time between the different pandemic periods. Decreased screen time was associated with reduced emotional, conduct, and prosocial behaviour problems, especially during the peak period. Thus, psychoeducation on screen time in adolescents should be considered as a point of interest for mental well-being interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Introduction: Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience., Methods: A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group ( n  = 52) and control group ( n  = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week., Results: Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P  = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P  < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P  = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P  < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P  = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P  < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference ( P  < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups., Conclusion: The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kaligis, Ismail, Wiguna, Prasetyo, Gunardi, Indriatmi, Pasaribu, Pandia, Minayati, Magdalena, Nurraga, Pramatirta, Calvin and Sourander.)

Background: Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs., Methods: A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care., Findings: A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay)., Interpretation: Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare., Funding: Australia-Indonesia Centre., Competing Interests: This study was supported by funding from the Health Cluster of the Australia-Indonesia Centre. Peter S. Azzopardi holds a 10.13039/501100000925National Health and Medical Research Council Emerging Leadership Investigator Grant. Jane Fisher is funded by a Professorial Fellowship from the Finkel Family Foundation. Authors declare no other conflict of interests., (© 2023 The Author(s).)

Background: Mother-infant bonding is an important factor that supports an infant's socio-emotional development. Therefore, every family member should acknowledge these processes, especially in an extended family set-up like in Indonesia. The general study objective was to predict several socio-demographic factors associated with mother-infant bonding in Indonesian samples., Method: This is a cross-sectional study. The participants included 168 mothers who had infants aged 0 to 36 months and willingly joined the study by signing the informed consent form. The Indonesian version of mother-infant bonding scale and a socio-demographic questionnaire were administered to all mothers. Logistic regression was applied to identify the socio-demographic factors that had any association with the mother-infant bonding scale. The data were analyzed using the SPSS program version 21 for Mac., Results: The study showed that 13.1% of the participants were categorized as having a moderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showed that vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The model explained 18.6% (Nagelkerke R 2 ) of the variance in impaired mother-infant bonding and accurately classified 86.9% of cases., Conclusion: The findings support prior studies that have been conducted in several countries. Psychoeducation on supporting mother-infant bonding may consist of several topics, such as the advantages of vaginal delivery mode and the importance of family support. It may be delivered in the early adulthood period and, hopefully, basic knowledge during those periods may help strengthen the understanding of mother-infant dyad issues among all family members.

Objective: Inconsistency in the quality of forensic psychiatry report has been criticized for several years. Yet, there are limited guidelines to provide minimally satisfactory forensic psychiatry evaluation conducted by psychiatrists. In addition to the impact towards the forensic psychiatry service, this lack of standardized guidelines may impact the relevant competency development and its various teaching methods of forensic psychiatry among general psychiatrists. Therefore, this study aims to identify components of psychomedicolegal analysis competency as a form of clinical reasoning in forensic psychiatry., Methods: A comprehensive literature review and expert panel discussions were conducted simultaneously to formulate an initial list of psychomedicolegal analysis competency. A total of fourteen experts were chosen based on their expertise in different disciplines that have intersections with forensic psychiatry and the general psychiatry curriculum (e.g. general psychiatrist, forensic psychiatrists and psychologist, law practitioner, and medical education director). The expert panel were instructed to score and provide feedbacks on the items of the initial list. Four-point Likert scale were used in order for the experts to express the relevancy of the core competence to forensic psychiatry practice until it reached the consensus., Results: The final 60 items of psychomedicolegal analysis competency were developed after three rounds of Delphi technique and reached a consensus (>70% and medians score of at least 3,25). These competency then categorized into four steps 1) preparing the case (Item 1-11), 2) conducting the evaluation (Item 12-41), 3) writing the report (42-51), and 4) giving expert opinion in court (Item 52-60)., Conclusion: We developed 60 items of psychomedicolegal analysis competency that can be used as a standardized guide for psychiatrists to conduct forensic psychiatry evaluation, write the report and provide expert opinion in court. Implementation of this guideline can be used to shape further forensic psychiatry education for general psychiatrist and psychiatry residency., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Objective: Emotion is essential in psychiatrists' clinical decision-making in conducting forensic psychiatric evaluations. However, psychiatrists may not be aware of their own emotions and thus prone to the risk of bias in their evaluations. An English version questionnaire was previously developed to assess emotional response and regulation. This study aims to assess the validity and reliability of the translated and adapted Indonesian version of The Multidimensional Emotion Questionnaire (MEQ) among Indonesian general psychiatrists in forensic psychiatry settings., Method: This is a cross-sectional study that translated and adapted The Multidimensional Emotion Questionnaire (MEQ) designed by Klonsky et al. This study was conducted between August 2020 and February 2021, involving 32 general psychiatrists across the country who represented general psychiatrists from different educational backgrounds, clinical experiences, and workplace settings. The translation process was done by a certified independent translator and tested for validity by Item-Level Content Validity Index (I-CVI), Scale-Level Level Content Validity Index (S-CVI), and corrected item-total correlation. Cronbach's alpha values measured reliability aspects., Results: The MEQ was valid and reliable, with an I-CVI score of 0.97-1, an S-CVI score of 0.99, and Cronbach's alpha values of 0.85-0.98 for each emotion. The majority of items had a corrected item-total correlation of higher than 0.30., Conclusion: A proper and available tool to measure general psychiatrists' emotions in evaluating forensic psychiatric cases is essential in enhancing evaluators' awareness of their own emotions to eventually mitigate bias. The Multidimensional Emotion Questionnaire (MEQ) was valid and reliable for Indonesian forensic psychiatry contexts., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Recovery of mental health in people with schizophrenia spectrum disorders is essential, thus it is very important to be assessed. One instrument that measures mental health recovery is the Recovery Assessment Scale - Domains and Stages (RAS-DS), developed within the Australian cultural context to facilitate mental health recovery. An instrument based on conceptions of mental health recovery in Indonesia is still needed. This qualitative study aimed to characterise how persons with schizophrenia spectrum disorders in Indonesia define mental health recovery, to develop the Skala Pemulihan Pasien Skizofrenia (SPPS)/Indonesian Recovery Scale for Patient with Schizophrenia (I-RSPS), and to determine the content validity of the I-RSPS. Qualitative data were collected through focus group discussions (n = 11); data were analysed using conventional content analysis and thematic analysis. An inductive approach was used to develop the I-RSPS items. Content validity was evaluated using an item-level content validity index (I-CVI) and a scale-level content validity index (S-CVI). Validity evaluation trials were conducted with ten participants. Perceptions of mental health recovery in people with schizophrenia spectrum disorders in Indonesia were investigated along social, existential, clinical, functional, and physical dimensions. Some perceptions of family, religion, and spirituality are unique to the Indonesian socio-cultural context, as are some stigmas I-RSPS consists of 40 items with good content validity, with an average I-CVI of 0.99 and an average S-CVI of 0.93, and it was rated as easy to use, with 5.4 min (range: 3-10 min) being the average duration required to complete the scale., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Problematic internet use (PIU) is increasingly recognized as a mental health concern, particularly among adolescents. The resting-state functional connectivity (rsFC) of the triple-network model has been described inconsistently in PIU. Using resting-state fMRI (rsFMRI) and hypothesizing a lower rsFC between default mode (DMN) and central executive networks (CEN) but a higher rsFC within the salience network (SN), this study scrutinized the neural substrates of PIU adolescents. A total of 30 adolescents with PIU and 30 control subjects underwent rsFMRI. The severity of PIU was evaluated by the Internet Addiction Test. Additionally, personality traits as well as emotional and behavioral problems were evaluated by the Temperament and Character Inventory (TCI) and the Strength and Difficulties Questionnaire (SDQ), respectively. Focusing on the DMN, SN, and CEN, we compared rsFC values between PIU and the control. Subsequently, within the combined group of subjects, TCI and SDQ correlation and mediation effects were investigated. Higher rsFC values of the left lateral prefrontal cortex (LPFC(L)) with the left anterior insula (aIns(L)) were observed for PIU than for the control, while rsFCs of the LPFC(L) with the medial PFC (MPFC), LPFC(L), as well as with the right lateral parietal cortex (LP(R)) were lower for PIU. Among these significant group differences, the rsFC between the LPFC(L) and MPFC was mediated by emotional symptoms (standardized β = -0.12, 95% CI -0.29, -0.0052). The dysfunctional attention switching and incentive salience regulated by the SN were implicated as being a neural correlate of PIU, and this relationship would in part be explained by the emotional dysregulation associated with PIU in adolescents.

The traditional diagnosis of Attention Deficits/Hyperactivity Disorder (ADHD) is through parent-child interviews and observations; therefore, innovative ADHD diagnostic tools that represent this digital era are needed. Virtual reality (VR) is a significant technology that can present a virtual immersive environment; it can provide an illusion of participation in an artificial milieu for children with ADHD. This study aimed to develop an ADHD-VR diagnostic tool construct (Research Domain Construct/RDC) based on the DSM5 ADHD diagnostic criteria, and using the RDC to develop a diagnostic tool with a machine learning (ML) application that can produce an intelligent model to receive some complex and multifaceted clinical data (ADHD clinical symptoms). We aimed to expand a model algorithm from the data, and finally make predictions by providing new data (output data) that have more accurate diagnostic value. This was an exploratory qualitative study and consisted of two stages. The first stage of the study applied the Delphi technique, and the goal was to translate ADHD symptoms based on DSM 5 diagnostic criteria into concrete behavior that can be observed among children in a classroom setting. This stage aimed to gather information, perceptions, consensus, and confirmation from experts. In this study, three rounds of Delphi were conducted. The second stage was to finalize the RDC of the ADHD-VR diagnostic tool with ML, based on the first-stage results. The results were transformed into concrete activities that could be applied in the programming of the ADHD-VR diagnostic tool, followed by starting to input data that were required to build the diagnostic tool. The second stage consisted of more than ten focus-group discussions (FGDs) before it could be transformed into the ADHD-VR diagnostic tool with the ML prototype. First-stage data analysis was performed using Microsoft Excel for Mac. Qualitative data were analyzed using conceptual content analysis with a manifest/latent analysis approach. From the first stage of the study, there were 13 examples of student behaviors that received more than 75% totally agreed or agreed from the experts. The RDC of the ADHD-VR diagnostic tool with machine learning application consisted of three domains and was divided into six sub-domains: reward-related processing, emotional lability, inhibitory, sustained attention, specific timing of playing in order, and arousal. In conclusion, the results of this study can be used as a reference for future studies in a similar context and content, that is, the ADHD-VR diagnostic tool with machine learning based on the constructed RDC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wiguna, Bahana, Dirgantoro, Minayati, Teh, Ismail, Kaligis and Wigantara.)

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place., (© 2021. The Author(s).)

Objective: Clinical reasoning as an essential skill for psychiatrists, especially in forensic psychiatry, relies on their thinking and decision-making skills. However, not all psychiatrists are aware of their decision-making styles. This study examines the validity and reliability of the Indonesian translation of the Decision Style Scale (DSS) instrument among general psychiatrists in the Indonesian forensic psychiatry setting., Method: This is a cross-sectional study involving 32 general psychiatrists from all nine psychiatric residency training centers in Indonesia. The study was conducted between August 2020 and February 2021. The translation process involved certified independent translators. The validity was tested using Item-Level Content Validity Index (I-CVI), Scale-Level Level Content Validity Index (S-CVI), and item-total correlation. Internal consistency reliability was measured using Cronbach's alpha., Results: After translation, the instrument was sent back and received feedback from the original authors of DSS. The final version of DSS was valid with an I-CVI score of 0.84-1 and an S-CVI score of 0.99. All but one item had a corrected item-total correlation of more than 0.30. The reliability test of DSS also showed acceptable results with Cronbach's alpha values of 0.43-0.83, and an overall internal consistency score of 0.83 and 0.62 for intuitive and rational scales, respectively., Conclusion: DSS serves as a valid, reliable, and readily-available tool to measure psychiatrists' decision-making styles in forensic psychiatry settings. Enhancing psychiatrists' awareness of their decision-making styles may help in mitigating the risk of bias in forensic psychiatry evaluations., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic., Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals., Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries., Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mori, Tiiri, Lempinen, Klomek, Kolaitis, Slobodskaya, Kaneko, Srabstein, Li, Huong, Praharaj, Ong, Lesinskiene, Kyrrestad, Wiguna, Zamani, Sillanmäki and Sourander.)

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia. Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability). Results: The content validity test produced positive results with an I-CVI scores of 0.7-1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521. Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kaligis, Ismail, Wiguna, Prasetyo, Indriatmi, Gunardi, Pandia, Minayati, Magdalena, Nurraga, Anggia, Pamungkas, Tran, Kurki, Gilbert and Sourander.)

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t -value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t -value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI ( R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wiguna, Minayati, Kaligis, Ismail, Wijaya, Murtani and Pradana.)

Objective: Several general psychiatrists experience lack of confidence when they perform forensic psychiatric evaluations that may be due to limited or insufficient training. This study aimed to determine whether structured forensic psychiatry educational modules are associated with general psychiatrists' self-confidence in conducting forensic psychiatric evaluations in Indonesia., Method: A cross-sectional study was conducted with 246 general psychiatrists. A questionnaire was developed exclusively for this study by a group of experts based on relevant references and it was distributed online. Sample questions included: "How often do you perform forensic psychiatric evaluations?", "As a general psychiatrist, are you confident in conducting forensic psychiatric evaluations?", and "Do you experience any difficulties when conducting forensic psychiatric evaluations?" Data were analyzed through SPSS 20 for Windows; a p-value <0.05 indicated statistical significance., Results: Compared to general psychiatrists who did not study structured forensic psychiatry educational modules during their residency training, those exposed to such modules reported confidence in conducting forensic psychiatric evaluations in the following cases: insanity defense in cases of violence, insanity defense, fitness to stand trial, malingering, capacity to consent to treatment, risk of recidivism, guardianship, and parenting capacity. Furthermore, those with higher self-confidence were less likely to experience difficulties in conducting forensic psychiatric evaluations., Conclusion: Structured forensic psychiatry educational modules during general psychiatry residency training played an important role in the development of psychiatrists' self-confidence., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

This study compares the Empathy Quotient (EQ) and Systemizing Quotient (SQ) scores of elementary school children with and without ADHD. The study also examined their brain types and, because sex plays a big role in empathy and systemizing ability, compared the results of the boys and girls. This cross-sectional study involved 122 participants, including 61 parents of children with ADHD and 61 parents of children without ADHD. The EQ, SQ and brain types were obtained using the Empathy and Systemizing Quotient in children (EQ-/SQ-C), validated in the Indonesian language. Data was analyzed using the SPSS program version 20 for Windows, with a p -value < 0.05 for statistical significance. There was a significant difference in EQ between children with and without ADHD, the score being lower in children with ADHD. There was also a significant difference in SQ among girls with and without ADHD, but not in boys. The brain types in both groups were not significantly different. The results indicate that children with ADHD have a lower ability to empathize compared to children without ADHD. Systemizing abilities were significantly lower in girls with ADHD than in girls without. Therefore, an intervention program focusing on improving empathy and systemizing ability needs to be developed in the community., Competing Interests: The authors declare no conflict of interest during the preparation, data collection, interpretation of the results, or article writing.

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Raharjanti, Wiguna, Purwadianto, Soemantri, Bardosono, Poerwandari, Mahajudin, Ramadianto, Alfonso, Findyartini, Nugrahadi, Lazuardi, Subroto, Saroso and Levania.)

The aim of this study was to develop an Indonesian computer-based game prototype, including feasibility testing, targeted on attention deficit/hypersensitivity disorder (ADHD) clinical symptoms and executive function. The study comprised five steps. The first to third steps used an exploratory qualitative research design. The Delphi technique with FGD was applied to collect qualitative data. During the study, seven experts participated in ten FGDs. Feasibility testing was conducted as a one group pre- and post-test design that included ten children with drug-naïve ADHD without other mental or physical disorders. Feasibility data were collected before and after 20 training sessions with the Indonesian computer-based game prototype. The framework analysis was performed for qualitative data. Quantitative data were analyzed using the paired t-test, Pearson's correlation and Spearman's rank-order correlation. Outputs of the exploratory qualitative study were the Indonesian computer-based game prototype constructs and general agreements of the prototype,. The Indonesian computer-based game prototype construct comprised six components: reward-related processing, control inhibition, improved sustained attention, specific timing, increased arousal, and improved emotional regulation. After 20 sessions of training, several indicators decreased significantly, such as CATPRS-teacher rating (18.5 [5.31] vs. 12.9 [5.51], p = 0.047), BRIEF-GEC (64.80 [10.21] vs. 57.50 [7.51], p = 0.02), BRIEF-MI (66.1 [7.61] vs. 58.4 [7.56], p = 0.014), BRIEF-Initiate (66.6 [10.15] vs. 54.1 [6.49], p = 0.008), BRIEF-Working Memory (68.0 [6.89] vs. 60.9 [10.05], p = 0.02), and BRIEF-Organization of Material (60.7 [12.88] vs. 49.3 [11.79], p = 0.04). There was a low to moderate correlation between CATPRS-teacher and -parent rating and several BRIEF domains. Feasibility testing output also included the training procedure guideline. The present study indicated that the Indonesian computer-based game prototype could be used as a framework to develop a fixed computer-based game intervention for children with ADHD. However, further randomized controlled studies need to be conducted to show its effectiveness., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

"Transitional-age youth" describes those whose ages range from 16-24 years old. In this phase, the youth face new challenges and new experiences which may increase the risk for having mental health problems, yet not very many seek help from mental health professionals. In Indonesia, no data are available about mental health problems and the needs of transitional-age youth. This study explores common mental health problems experienced during this stage and assesses how they cope with problems and their expectations from health services. This was a cross-sectional study involving 393 Indonesians aged 16-24 years in May 2020. More than 90% of students had financial and academic difficulties and felt lonely. The most prevalent mental health problem among students was anxiety (95.4%). Most of the students, ranging from 90% to 96.4%, had positive coping strategies. However, around 50% of respondents reported self-harming and having suicidal thoughts. The results of subcategories analysis between ages and faculties were similar. Their most important expectations from mental health services included confidentiality (99.2%) and being welcoming and friendly (99.2%). In conclusion, this study highlighted the most common problems transitional-age youth experience in Indonesia. While some of them already knew how to deal with their problems, not all the participants had good coping mechanisms. Their healthcare expectations were also explored, thereby providing a useful background to revise and amend the current conditions.

Internet addiction (IA) is an emerging behavioral problem that constitutes a major health threat to vulnerable populations, including adolescents. However, there is a paucity of IA screening tools specifically designed for adolescents, especially in Indonesia. Therefore, the current study developed and validated the IA Diagnostic Questionnaire (KDAI) in adolescents while acknowledging local cultural influences. The KDAI was conceived through extensive literature reviews, expert discussions based on Delphi methods, a face validity study, focus group discussion (N = 31) for initial reliability testing, and a recruited pilot study (N = 385) and main study (N = 643) for exploratory and confirmatory factor analyses, respectively. The multi-sample analyses demonstrated that the KDAI model with the best fit and reliability comprised a seven-factor structure, including withdrawal, loss of control, increase of priority, negative consequences, mood modification, salience, and impairment. These factors were scrutinized against domains of IA Test, and concurrent validity was ascertained. Subsequently, a receiver operating characteristic curve and area under the curve determined a cutoff score of 108 to discern adolescents with IA. Taken together, the KDAI displayed excellent psychometric indices and sensitivity as a screening tool for IA in adolescents., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ 2 ) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% ( n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Anindyajati, Wiguna, Murtani, Christian, Wigantara, Putra, Hanafi, Minayati, Ismail, Kaligis, Savitri, Uiterwaal and Diatri.)

Background: Internet addiction is a serious problem that can negatively impact both the physical and mental health of individuals. The Internet Addiction Test (IAT) is the most common used instrument to screen internet addiction worldwide. This study sought to investigate the psychometric properties of an Indonesian version of the IAT., Methods: The IAT questionnaire was made the focus of forward translation, expert panel discussions, back translation, an item analysis (30 subjects), a pilot study (385 subjects), and field testing (643 subjects). Factor structure was analysed by exploratory (EFA) and confirmatory factor (CFA) analyses, whereas reliability was measured with Cronbach's alpha coefficient., Results: Factor analysis revealed that the Indonesian version of IAT, consisted of 3 domains, and had good validity (χ2 p < 0.001; RMSEA = 0.076; CFI = 0.95; SRMR = 0.057, and AIC = 784.63). The Cronbach's alpha score is 0.855. A significant association was also observed between the level of internet addiction with gender (p = 0.027) and the duration of internet use per day (p = 0.001)., Conclusion: The Indonesian version of IAT provides good validity and reliability in a three-dimensional model. Therefore, it can be utilised as a tool for screening internet addiction in the Indonesian population., Competing Interests: The authors have declared that no competing interests exist.

The COVID-19 pandemic does not affected only physical but also mental health and socioeconomic part. The social distancing, social quarantine, school from home, and work from becomes a new normal these days. Being adolescence, the above conditions may be challenging due to their developmental milestones. Therefore, this brief report aimed to preliminary identify proportion of adolescents' emotional and behavior problems and several factors related to it during COVID-19 pandemic in Indonesia. The findings might raise some understanding of youth mental well-being and programs that can be applied in schools and community in general to overcome the issues. The study was designed as cross sectional and used online survey that started on April 2020. During April 15-May 10, 2020, there were 113 adolescents participated on this survey. Strength and Difficulties Questionnaire (SDQ) 11-17 years old was used to assess adolescent emotional and behavior problems; and specific life experience questionnaire was designed to collect other independents variables (Cronbach's α = 0.75). All participants fulfilled the online informed consent before they started to complete the questionnaire. All data was analyzed by using SPSS version 20 for Mac. The average age of research subjects were 14.07 (2.18) years old; 98.2% was school from home. There was 14.2% of the total research subject at risk on total difficulties problems; 38.1% of adolescent was at risk on peer-relationship problems, 28.3% at risk on pro-social behavior problems, 15% at risk on conduct behavior and 10.6% at risk on emotional problems. The number of adolescent that perceived worse to significantly worse self-mental well-being prior COVID-19 increased during COVID-19 pandemic in Indonesia ( p < 0.05). There was significantly association between having mental health information and conduct behavior (OR = 10.34, 95%CI = 1.27-78.86); Subjective anxiety due to COVID-19 pandemic and pro-social behavior problems (OR = 2.37, 95% CI = 1.00-5.63), parental support and total difficulties (OR = 0.09, 95% CI = 0.14-0.60) and pro-social behavior problems (OR = 0.09, 95% CI = 0.01-0.82); friends support during COVID-19 pandemic and conduct behavior (OR = 0.20, 95% CI = 0.04-1.00) and pro-social behavior problems (OR = 0.14, 95% CI = 0.02-0.75). To be concluded, during phase 1 and 2 COVID-19 pandemic and school closures in Indonesia, adolescents were at risk for having emotional and behavior problems. Therefore, maintain clear mental health information, keep them on connection with school by designing an optimal tele-education, tele-consultation, and virtual activity programs to accommodate adolescents' biopsychosocial needs in the near future., (Copyright © 2020 Wiguna, Anindyajati, Kaligis, Ismail, Minayati, Hanafi, Murtani, Wigantara, Putra and Pradana.)

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children resulting in disturbances in their daily functioning. Virtual reality (VR) and machine learning technologies, such as deep learning (DL) application, are promising diagnostic tools for ADHD in the near future because VR provides stimuli to replace real stimuli and recreate experiences with high realism. It also creates a playful virtual environment and reduces stress in children. The DL model is a subset of machine learning that can transform input and output data into diagnostic values using convolutional neural network systems. By using a sensitive and specific ADHD-VR diagnostic tool prototype for children with DL model, ADHD can be diagnosed more easily and accurately, especially in places with few mental health resources or where tele-consultation is possible. To date, several virtual reality-continuous performance test (VR-CPT) diagnostic tools have been developed for ADHD; however, they do not include a machine learning or deep learning application. A diagnostic tool development study needs a trustworthy and applicable study design and conduct to ensure the completeness and transparency of the report of the accuracy of the diagnostic tool. The proposed four-step method is a mixed-method research design that combines qualitative and quantitative approaches to reduce bias and collect essential information to ensure the trustworthiness and relevance of the study findings. Therefore, this study aimed to present a brief review of a ADHD-VR digital game diagnostic tool prototype with a DL model for children and the proposed four-step method for its development., (Copyright © 2020 Wiguna, Wigantara, Ismail, Kaligis, Minayati, Bahana and Dirgantoro.)