Faculty Bibliography

BACKGROUND:To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. PURPOSE:To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment. DATA SOURCES:Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered. STUDY SELECTION:Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible. DATA EXTRACTION:An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths. DATA SYNTHESIS:In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations. LIMITATIONS:The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships. CONCLUSION:Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures. PRIMARY FUNDING SOURCE:Swiss National Science Foundation. (PROSPERO: CRD42020180049).

To address the issues with the current nomenclature of psychotropic agents, which may be misleading or confusing, the Neuroscience-based Nomenclature (NbN) started being developed in 2009. It was introduced as one approach to the classification of pharmacological treatments based on a medication's putative psychopharmacological mechanisms of action derived from preclinical and clinical studies. In 2018, the NbN-Child & Adolescent (NbN C&A) was released. Since then, the NbN C&A has been refined, and its website and app (https://nbnca.com/) have been implemented. JAACAP encourages its authors and readers to consider utilizing the NbN C&A and to keep abreast of its developments over time. This is in line with the core missions of the Journal: to contribute to the translation and implementation of the most up-to-date science into real-world clinical practice. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.

OBJECTIVE:This systematic review and meta-analysis aimed to determine the accuracies of a broad range of screening tools for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, and to compare the diagnostic accuracy of tools between population-based and clinical/high-risk samples, and across reporters. METHOD:MEDLINE, PsycINFO, EMBASE, and PubMed were searched up until February 20, 2020, with no language restrictions. Studies reporting diagnostic accuracy of a screening tool against a diagnosis of ADHD in children and adolescents <18 years of age were eligible for inclusion. Meta-analyses were undertaken to provide pooled estimates of the area under the curve (AUC), and sensitivity and specificity of groups of measures. RESULTS:A total of 75 studies published between 1985 and 2021 reporting on 41 screening tools that were grouped into 4 categories (Achenbach System of Empirically Based Assessment [ASEBA], DSM-IV symptom scales, SDQ, and Other Scales) were retained. The pooled AUC for studies using a combined ADHD symptoms score was 0.82 (95% CI = 0.78-0.86), although this varied considerably across reporters (0.67-0.92) and populations (CI = 0.60-0.95). None of the measures met minimal standards for acceptable sensitivity (0.8) and specificity (0.8). CONCLUSION:Most tools have excellent overall diagnostic accuracy as indicated by the AUC. However, a single measure completed by a single reporter is unlikely to have sufficient sensitivity and specificity for clinical use or population screening.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2021 articles that we think deserve your attention or at least a second read.

OBJECTIVES:To summarise evidence on intrawork breaks and their associated effect on doctors' well-being and/or performance at work. DESIGN:Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines DATA SOURCES: Embase, PubMed, Web of Science (Core Collection) and PsychINFO were systematically searched on 6 June 2021. ELIGIBILITY CRITERIA:No restrictions were placed on language, study design or date of publication. DATA EXTRACTION AND ANALYSIS:Methodological quality was appraised using Cochrane's Risk of Bias (ROB-2), Cochrane's Risk of Bias in Non-randomised Studies (ROBINS-I), and the Johanna Briggs Institute (JBI) checklists for cross-sectional, cohort and qualitative studies. Quantitative synthesis was not undertaken due to substantial heterogeneity of design and outcomes. Results are presented narratively. RESULTS:Database searches returned 10 557 results and searches of other sources returned two additional records. Thirty-two papers were included in the systematic review, comprised of 29 unique studies, participants and topics and 3 follow-up studies. A variety of well-being and performance outcome measures were used. Overall, findings indicate that intrawork breaks improved some measures of well-being and/or work performance. However, methodological quality was judged to be low with a high risk of bias in most included studies. DISCUSSION:Using existing evidence, it is not possible to conclude with confidence whether intrawork breaks improve well-being and/or work performance in doctors. There is much inconsistency regarding how breaks are defined, measured and the outcomes used to assess effectiveness. Future research should seek to: (a) define and standardise the measurement of breaks, (b) use valid, reliable outcome measures to evaluate their impact on well-being and performance and (c) minimise the risk of bias in studies where possible. PROSPERO REGISTRATION NUMBER:CRD42020156924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156924.

This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.

OBJECTIVE:Our objective is to explore the change in the severity of ADHD, ODD and anxiety during a two-month lockdown among children in France and the moderating role of behavioural regulation. METHOD:In 235 children with ADHD, the symptom severity of ADHD, ODD and anxiety was investigated one and two months after the beginning of lockdown, and one month after its end. Behavioural regulation skills were estimated with the Behaviour Regulation Index. RESULTS:ADHD, ODD and anxiety scores were increasing or decreasing depending on BRI. CONCLUSION:Baseline behavioural regulation skills may act as a moderating factor for the persistence of ADHD, ODD and anxiety symptoms related to the lockdown.

Inattention to faces in clinical assessments is a robust marker for autism. However, a new study distinguishes diagnostic marker from behavioral mechanism, showing that face looking in everyday activity is equally rare in autistic and neurotypical children and not required for joint attention in either group.