It is estimated that, globally, the mean point prevalence of diagnosable mental disorders in children and adolescents is higher than 11%, and around half of cases of major mental disorders have their onset before the age of 18. Mental disorders with onset in childhood or adolescence have an enormous impact on the developing brain, body and personal identity, as well as on the short- and long-term social, educational and functional capacity of individuals. Child and adolescent psychiatry - as a discipline, profession, academic field, and network of clinical services - is still relatively young, with its formal evolution beginning in the 20th century. Therefore, it is not surprising that there are currently many challenges, but also opportunities and expected future developments, in this area. In this paper, we identify and address the core challenges, possible solutions, opportunities, and future directions of child and adolescent psychiatry. In the first part of the paper, challenges and possible solutions are discussed regarding diagnostic issues, stigma, access to care, shortage of mental health professionals, evidence-based treatments, treatment adherence, parental participation/engagement, integration with schools, digital influences and cyberbullying, and war/forced displacement. In the second part, opportunities and developments are addressed that relate to early identification and intervention, resilience, interdisciplinary collaborations, integration with primary care, community-based approaches, use of digital technologies, precision child and adolescent psychiatry, artificial intelligence and related ethical issues, and cultural diversity and competences. Despite the significance and impact of mental disorders in children and adolescents, clinical delivery and research on these conditions remain underfunded and underprioritized, even in high-income countries, with clinical services and prevention/early intervention research receiving minimal investment. Addressing mental health in children and young people requires multi-level strategies beyond individual treatment, including tackling structural and socioeconomic barriers and creating opportunities for strengthening resilience and well-being. A well-trained workforce, adequate policies, and increased public awareness are crucial. Overall, the current gaps demand urgent action and global funding rebalancing to more adequately meet the critical needs of children and young people challenged by mental illness.
This study provides insights into the impact of prolonged war on suicidality, focusing specifically on suicide-related calls to Israel's national mental health helpline during the year following the October 7, 2023, Hamas terror attack and ongoing war.Utilizing data from 615,046 helpline calls between October 7, 2022, and November 2, 2024, the findings showed an immediate, significant increase in overall distress calls after the attack. Conversely, there was a notable and persistent decrease in both the proportion and total number of suicide-related calls throughout the year-long period of war. These findings align with previous research suggesting that heightened war-related distress does not necessarily lead to increased suicide risk, possibly due to factors such as increased social cohesion. Building upon our previous research, the current study contributes to the limited body of knowledge regarding suicidality patterns during prolonged wars. The study underscores the complexity of suicidality patterns during a prolonged war and emphasizes the need for ongoing monitoring and targeted mental health interventions during sustained national crises.
Abstract Background Accurate identification of Parkinson’s disease (PD) in large electronic health record (EHR) population-based databases is challenging due to diagnostic heterogeneity in routine care, with a substantial proportion of individuals diagnosed with PD had not been diagnosed by a specialist. Our aim was to develop and validate a simplified rule-based medication algorithm to identify PD in a nationwide healthcare registry and apply it to estimate long-term incidence, prevalence, and pre-diagnostic diagnoses. Methods Using Clalit Health Services EHR data covering over five million individuals (2005–2025), we constructed a medication-based algorithm incorporating predefined inclusion and exclusion criteria and two levels of diagnostic certainty (probable/possible PD). Validation was performed against two independent specialist-confirmed PD cohorts and FDOPA PET/CT and a non-PD neurological cohort. Incidence rates per 100,000 were calculated annually with 95% confidence intervals (CIs) assuming a Poisson distribution. Age-adjusted incidence rates were computed using the WHO standard population. motor and non-motor diagnoses preceding PD were examined up to 18 years before the index date using matched controls. Results The algorithm identified 34,368 PD patients (56.5% male; mean age at index 75.2 ± 10.5 years). Sensitivity was 94.8% (95% CI 90.4–97.2) in the FDOPA PET/CT cohort, 94.8% (95% CI 92.1–96.6) in the private clinic cohort, and 94.7% (95% CI 90.9–96.9) in the movement disorder clinic cohort. Specificity was 85.2% (95% CI 77.8–90.6). Incidence increased markedly with age but declined significantly over time (overall annual percent change [APC] - 4.47%, 95% CI -4.90 – -4.03). Age-adjusted incidence rates (≥20 years) declined 2.4-fold between 2005 and 2024 (55 [95% CI 53–58] to 23 [95% CI 21–24] per 100,000). Overall prevalence declined modestly (APC -0.78%, 95% CI -0.84 – -0.72), with increases in younger age groups and declines in older groups. Constipation, depression, and tremor diagnoses were more frequent years before diagnosis, whereas smoking-related codes were less frequent among future PD patients. Conclusions This validated medication-based algorithm provides a reproducible framework for PD identification in large registries. Applied over two decades in a nationwide cohort, it demonstrated high diagnostic performance and revealed age-dependent declines in PD incidence alongside heterogeneous prevalence trends.
BACKGROUND:Fibromyalgia (FM) frequently co-occurs with mental disorders, but population-scale estimates for personality disorders (PDs) and cluster-specific patterns over extended horizons are limited. We quantified cross-sectional prevalence and 20-year cumulative incidence of recorded PD diagnoses in FM versus matched controls, and assessed the impact of diagnostic opportunity. METHODS:We performed a retrospective matched-cohort study within a nationwide Israeli health system. Adults with FM (N = 15,869) were matched 1:5 to controls (N = 79,345) on sex, age, and enrollment year. Outcomes were ICD-10 PD codes (F60-F61; ancillary F63-F69). Cross-sectional prevalence at baseline and end-of-follow-up was compared using conditional logistic regression (odds ratios [ORs], 95% CIs) with false-discovery-rate. Among participants PD-free at baseline, 20-year cumulative incidence ("risk") was estimated with risk differences (RD, percentage points) and risk ratios (RR) using Wilson and log-Wald intervals. A surveillance-calibrated sensitivity analysis scaled RRs by the FM:control psychiatry-visit ratio to approximate adjusted RRs (aRRs). RESULTS:At baseline, any PD was more prevalent in FM than controls (1.84% vs 0.49%; OR 3.79, 95% CI 3.26-4.42; q < 0.001), with pronounced elevations in Cluster B-especially borderline PD (F60.31)-and smaller signals in Cluster C (avoidant, F60.6). At the end of follow-up, contrasts persisted or strengthened (any PD 2.85% vs 0.57%; OR 5.11, 4.48-5.82; q < 0.001). Among those PD-free at baseline, 20-year risk remained higher in FM (any PD 1.03% vs 0.08%; RD 0.95 pp., 0.78-1.14; RR 12.87, 9.62-17.22), driven by Cluster B (borderline 0.20% vs 0.02%; RD 0.19 pp.; RR 12.34, 6.48-23.51). Surveillance calibration attenuated but did not eliminate Cluster-B excess (e.g., borderline aRR ≈ 3.07). CONCLUSIONS:FM is associated with a selective, durable enrichment of Cluster-B PDs-most notably borderline-observable cross-sectionally and as long-term cumulative risk, only partly explained by diagnostic opportunity. Findings support routine PD screening within FM care and motivate mechanistic work on immuno-neuroendocrine and frontolimbic pathways.
Objective: Current data on the association between attention-deficit/hyperactivity disorder (ADHD) and essential hypertension (EH) in pediatric populations are very limited, as most research has focused on adults. This study investigated the long-term prevalence of EH in Israeli youth aged 5–18 years with ADHD, examining also trends in antihypertensive medication use. Methods: A retrospective cohort study was conducted using data from Leumit Health Services. The ADHD cohort (N = 18,558) was compared in a 1:2 ratio to controls (N = 37,116), who were strictly matched for age, gender, birth year and quarter, socioeconomic status (SES), sectors, region, and cumulative years of LHS membership up to the index date. Diagnoses of ADHD and EH were identified using ICD-9/10 codes, depending on the year of diagnosis. Logistic regression analyses were used to assess the associations between ADHD, EH and the use of antihypertensive medications over a 20-year follow-up. Results: ADHD-diagnosed children had a higher prevalence of EH, with odds ratios (ORs) of 3.17 (95% CI: 1.46–7.16, p = 0.0017) at 5 years, 2.94 (95% CI: 1.45–6.09, p = 0.0013) at 10 years, and 1.92 (95% CI: 1.26–2.93, p = 0.0015) at 20 years. ADHD patients showed a greater use of antihypertensive medications, including calcium channel blockers (OR 1.85, 95% CI: 1.02–3.35, p = 0.035), renin angiotensin system blockers (OR 2.20, 95% CI: 1.15–4.25, p = 0.013), and diuretics (OR 1.77, 95% CI: 1.21–2.60, p = 0.0028). Conclusions: These findings highlight an association between ADHD diagnosis and EH, suggesting regular cardiovascular monitoring of children with ADHD. Further studies are needed to uncover the role of stimulant medications and shared biological and behavioral factors involved in the pathogenesis.
