Background Young people's extensive internet and social media use has raised concerns about potential impacts on their mental well‐being. Although many studies have examined general time spent online, fewer have focused on the specific nature of adolescents' online interactions. Methods Using a sample of 15‐year‐olds ( N = 3034) participants from the 2017/2018 and 2021/2022 Swedish Health Behaviour in School‐aged Children (HBSC) surveys, we employed pooled cross‐sectional linear regression models to examine associations between the frequency of online communication with different types of friends and mental well‐being, assessed by the Short Warwick‐Edinburgh Mental Well‐being Scale (SWEMWBS). Results Online communication was associated with adolescents' mental well‐being, but patterns varied by both frequency of communication and the type of friendship. Intense online communication with close friends ( b = 1.63, 95% CI: 0.57–2.70) and larger friend groups ( b = 1.03, 95% CI: 0.44–1.62) was positively associated with mental well‐being. Conversely, communication with virtual friends was associated with poorer well‐being (moderate: b = −1.02, 95% CI: −1.50, −0.43; intense: b = −0.61, 95% CI: −1.14, −0.08). These associations remained robust even after model adjustment. Conclusion The findings show that associations between online communication and adolescents' mental well‐being differ depending on the type of friend with whom they communicate. These contrasting patterns highlight the need to distinguish between different forms of internet and social media use, and efforts to support young people's online activity should consider not only time spent online but also the nature of their online interactions.
This Response addresses a Letter to the Editor by Sahin ( Child and Adolescent Mental Health , 2026) concerning our network analysis of autism characteristics and anxiety symptoms in autistic children and youth ( Child and Adolescent Mental Health , 2025, 30 , 327). In his Letter, Sahin proposes three extensions for future research: examining whether Theory of Mind mediates the association between social communication and anxiety, modeling intolerance of uncertainty and arousal dysregulation as potential bridge mechanisms, and estimating comparable network models using autistic youths' self‐report data. In this Response, I argue that although each extension warrants further examination, it also raises conceptual and methodological issues that require closer consideration. Moreover, I emphasize that examining potentially modifiable mechanisms underlying autism–anxiety co‐occurrence will require future research to move beyond descriptions of cross‐sectional network topology and adopt study designs and network models better suited to examining temporal and mechanistic processes.
Background Transgender adolescents are at high risk for negative health outcomes resulting from marginalization and scarcity of services, intensified by the lack of epidemiological data addressing their needs. Understanding the sociodemographic, clinical, and behavioral characteristics of trans youths may support strategies to improve healthcare for this vulnerable population. Methods In this retrospective cross‐sectional study, we used data extracted from the initial assessment of children and adolescents admitted for care from 2010 to 2023 with a diagnosis of gender incongruence in a specialized Brazilian outpatient clinic, investigating sociodemographic, gender identity and sexual orientation, gender‐affirming attitudes/procedures, romantic and sexual practices, health data, and mental health symptoms and conditions. We explored factors associated with unsupervised hormone use and suicide attempts using multivariable logistic regression models, causal diagrams, and sensitivity analysis with multiple imputation for missing data. Results Two hundred and sixty‐one youths (10–17 years old), 49.8% transgender boys (assigned female at birth who identifies as boys), 42.5% transgender girls (assigned male at birth who identifies as girls), 7.7% transgender nonbinary. Most (51.6%) identified as non‐heterosexual. Compared to trans girls, trans boys had a higher prevalence of anxiety (48.8% vs. 28.6%), self‐injurious behavior (52.7% vs. 30%), problematic tobacco use (21.9% vs. 11.9%), and psychoactive substance abuse (17.2% vs. 6.4%); 26.8% reported prior suicide attempts and 20.3% reported unsupervised use of gender‐affirming hormone therapy. Factors associated with increased odds of unsupervised hormone use included older age and being a trans girl (compared to trans boys and trans nonbinary), whereas factors associated with increased odds of suicide attempts included older age, presence of a psychiatric diagnosis, and alcohol or other psychoactive substance abuse. Conclusion This study provides data for families and health professionals to support risk prevention, ongoing monitoring, and comprehensive care for this vulnerable population.
Background Care experience and chronic physical conditions in children are associated with an increased risk of mental health (MH) problems. These issues can compound, leading to poorer prognosis for both MH and chronic conditions. Examining the relationship between care experience and mental ill-health, and exploring how chronic conditions may influence this, is crucial for informing policy and mitigating the burdens on children, families and healthcare systems.Methods Routine health and social care data were linked for 13,830 care-experienced children (CEC) and 649,771 general-population children (GPC) in Scotland. Hospitalisations were followed from birth (between 1990 and 2004) to 2016. Cox proportional hazards models and negative binomial regression models were used to analyse the associations between care, asthma, diabetes, epilepsy and MH hospitalisations.Results Care experience was associated with a higher risk for MH hospitalisations compared with GPC. For first MH hospitalisations, hazard ratios were 3.22 (95% CI: 2.82-3.68) for CEC females and 2.64 (95% CI: 2.32-2.99) for CEC males. For repeated MH hospitalisations, incident rate ratios were 4.06 (95% CI: 3.58-4.62) for CEC females and 3.66 (95% CI: 3.25-4.12) for CEC males. In both cohorts, chronic conditions were associated with a higher risk for repeated MH hospitalisations.Conclusion CEC are at a higher risk of MH hospitalisations compared with GPC. Irrespective of care status, chronic conditions are associated with a higher risk of repeated MH hospitalisations. Interventions aimed at improving MH would benefit from a focus on children with chronic conditions.
