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BACKGROUND: Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. METHODS: Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. RESULTS: We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. CONCLUSIONS: Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. TRIAL REGISTRATION: PROSPERO, CRD42015024759 .

Gratitude therapy is a positive psychotherapy approach given to victims of sexual abuse to generate positive thinking by expressing gratitude to the environment, God and other people. This research aims to test gratitude intervention as a religious activity undertaken to reduce negative emotions in victims of sexual abuse. A total of 104 such victims were identified using the snowball sampling method who were divided into an experimental group (N=52) and a control group (N=52). They were diagnosed as having negative emotions based on the child Trauma Questionnaire Shot-Focus (CTQ-SF) and Gratitude Questioner-6 (GQ-6) with triple ANOVA data analysis. The study’s results demonstrate a significant influence of gratitude on negative emotion, with values of F(39,037) = 4.71, p .01, and ηp2 = 0.113. It can increase feelings of gratitude and reduce negative emotions in victims of sexual abuse. Gratitude therapy helps reduce negative emotions and foster positive emotions amongst such victims. The study could be implemented in people who experience negative emotions related to clinical and non-clinical disorders.

A broad sociocultural perspective defines trauma as the result of an event, a series of events, or a set of circumstances that is experienced as physically or emotionally harmful or life threatening, with lasting impacts on an individual's physical, social, emotional, or spiritual wellbeing. Contexts and practices that aim to be "trauma-informed" strive to attend to the complex impacts of trauma, integrating knowledge into policies and practices, and providing a sanctuary from harm. However, there is a body of critical and decolonial scholarship that challenges the ways in which "trauma-informed" practice prioritizes individualized interventions, reinscribes colonial power relations through its conceptualizations of safety, and obscures the role of systemic injustices. Within music therapy trauma scholarship, research has thus far pointed to the affordances of music in ameliorating symptoms of trauma, bypassing unavailable cognitive processes, and working from a strengths-based orientation. In critiquing the tendency of the dominant trauma paradigm to assign vulnerability and reinforce the individual's responsibility to develop resilience through adversity, this conceptual analysis outlines potential alternatives within music therapy. Drawing on a case example from a research project with young people in school, I elucidate the ways in which music therapy can respond to power relations as they occur within and beyond "trauma-informed" spaces. I highlight two overarching potentials for music therapy within a shifting trauma paradigm: (1) as a site in which to reframe perceived risk by fostering young people's resistance and building their political agency and (2) in challenging the assumption of "safe spaces" and instead moving toward practices of "structuring safety."

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study. METHODS: Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. RESULTS: At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support. CONCLUSION: The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.

Effect sizes of psychotherapies currently stagnate at a low-to-moderate level. Personalizing psychotherapy by algorithm-based modular procedures promises improved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular-based psychotherapy, using a personalized treatment algorithm, is lacking. This proof-of-concept randomized controlled trial was conducted in 70 adult outpatients with a primary DSM-5 diagnosis of major depressive disorder, a score higher than 18 on the 24-item Hamilton Rating Scale for Depression (HRSD-24), at least one comorbid psychiatric diagnosis according to the Structured Clinical Interview for DSM-5 (SCID-5), a history of at least "moderate to severe" childhood maltreatment on at least one domain of the Childhood Trauma Questionnaire (CTQ), and exceeding the cut-off value on at least one of three measures of early trauma-related transdiagnostic mechanisms: the Rejection Sensitivity Questionnaire (RSQ), the Interpersonal Reactivity Index (IRI), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). Patients were randomized to 20 sessions of either standard cognitive-behavioral therapy alone (CBT) or CBT plus transdiagnostic modules according to a mechanism-based treatment algorithm (MoBa), over 16 weeks. We aimed to assess the feasibility of MoBa, and to compare MoBa vs. CBT with respect to participants' and therapists' overall satisfaction and ratings of therapeutic alliance (using the Working Alliance Inventory - Short Revised, WAI-SR), efficacy, impact on early trauma-related transdiagnostic mechanisms, and safety. The primary outcome for efficacy was the HRSD-24 score at post-treatment. Secondary outcomes included, among others, the rate of response (defined as a reduction of the HRSD-24 score by at least 50% from baseline and a score <16 at post-treatment), the rate of remission (defined as a HRSD-24 score ≤8 at post-treatment), and improvements in early trauma-related mechanisms of social threat response, hyperarousal, and social processes/empathy. We found no difficulties in the selection of the transdiagnostic modules in the individual patients, applying the above-mentioned cut-offs, and in the implementation of MoBa. Both participants and therapists reported higher overall satisfaction and had higher WAI-SR ratings with MoBa than CBT. Both approaches led to major reductions of depressive symptoms at post-treatment, with a non-significant superiority of MoBa over CBT. Patients randomized to MoBa were nearly three times as likely to experience remission at the end of therapy (29.4% vs. 11.4%; odds ratio, OR = 3.2, 95% CI: 0.9-11.6). Among mechanism-based outcomes, MoBa patients showed a significantly higher post-treatment effect on social processes/empathy (p<0.05) compared to CBT patients, who presented an exacerbation on this domain at post-treatment. Substantially less adverse events were reported for MoBa compared to CBT. These results suggest the feasibility and acceptability of an algorithm-based modular psychotherapy complementing CBT in depressed patients with psychiatric comorbidities and early trauma. While initial evidence of efficacy was observed, potential clinical advantages and interindividual heterogeneity in treatment outcomes will have to be investigated in fully powered confirmation trials.

Childhood environment can have a profound impact on brain structure and function. Epigenetic mechanisms have been shown to play a critical role in adaptive and maladaptive processes by regulating gene expression without changing the genome. Over the past few years, early life stress (ELS) has been established as a major risk factor for major depression and suicidal behavior along with other psychiatric illnesses in adulthood. In recent years, the emergence of small noncoding RNAs as a mega controller of gene expression has gained attention for their role in various disease processes. Among various noncoding RNAs, microRNAs (miRNAs) are the most studied and well characterized and have emerged as a major regulator of neural plasticity and higher brain functioning. More recently, although limited in number, studies are focusing on how miRNAs can play a role in the maladaptive processes associated with ELS both at adolescent and adult age and whether these processes are critical in developing depression and suicidal behavior. In this review, we critically evaluate how postnatal ELS relates to abnormalities in miRNA expression and functions from both animal and human literature and draw connections from these findings to depression and suicidal behavior later in life.

OBJECTIVE: The current study replicates and extends work with adults that highlights the relationship between trauma exposure and distress in response to subsequent, nontraumatic life stressors. METHODS: The sample included 213 2-4-year-old children in which 64.3% had a history of potential trauma exposure. Children were categorized into 4 groups based on trauma history and current life stress. RESULTS: In a multivariate analysis of variance, trauma-exposed children with current life stressors had elevated internalizing and externalizing problems compared with trauma-exposed children without current stress and nontrauma-exposed children with and without current stressors. The trauma-exposed groups with or without current stressors did not differ on posttraumatic stress disorder symptom severity. Accounting for number of traumatic events did not change these results. CONCLUSIONS: These findings suggest that early life trauma exposure may sensitize young children and place them at risk for internalizing or externalizing problems when exposed to subsequent, nontraumatic life stressors.